Exploratory study on the effects of Chiari malformation-I on cognitive, emotional/behavioral, and physical functioning in a pediatric population

Abstract

__Objective: To explore perceived cognitive, emotional/behavioral, and physical functioning in children with CM-I via well-established parent-proxy metrics. Additionally, exploring possible similarities and differences between pediatric participants who qualify for surgical intervention vs. participants who do not.

__Methods: In this study, 22 participants (ages 5-17 years) with CM-I were recruited from an urban medical center. The participants’ parent/guardian completed a parent proxy measure (PROMIS) evaluating perceived cognitive, emotional/behavioral, and physical functioning of their child (i.e., cognition, mobility, anxiety, depression, fatigue, pain, and sleep). Univariate descriptive statistics, bivariate analyses, and inferential statistics were conducted. Clinical characteristics (i.e., herniation) were also reported and their significance on cognitive, emotional/behavioral and physical functioning, explored.

__Results: Results revealed that participants with CM-I exhibited higher levels of physical impairments (fatigue, pain, and sleep difficulties) compared to the normative sample of the PROMIS. Anxiety scores were also higher in the CM-I group, while depression scores were close to the Mild Impairment cut-off point. While significant correlations were found among the various PROMIS measures, there were no significant differences in reported functioning between surgical and nonsurgical candidates. Principal component analysis was also run on the PROMIS measures and revealed two underlying general constructs indicating the ability to further shorten and tailor this metric to a population with CM-I.

__Discussion: This was the first study to explore perceived cognitive, emotional/behavioral, and physical functioning via parent proxy report for children with CM-I. The findings provide insight into the functioning of pediatric patients with CM-I and may inform clinical interventions by helping clinicians and researchers better characterize this population with the aim of guiding treatment planning (surgical decision making), as well as to enhance overall outcomes. Further research with a larger sample, longitudinal design, and the utilization of pediatric self-report measures, in addition to parent proxy, is warranted to enhance our understanding of the impact of CM-I on the cognitive, emotional/behavioral, and physical functioning of this cohort, both with and without surgical intervention.