While a quick Google search of “TREES + Wisconsin” will inform you of the types of trees native to that area (Sugar Maple, Bur Oak, and the Red Musclewood, if you’re curious), an entry of “TREES + Lab + Wisconsin” will guide you right to Dr. Melissa Carrasco McCaul’s research lab, which is paving the way for more effective strategies to help improve long-term cognitive outcomes for children with early brain injuries. Is this a vastly different search result? Yes. But it’s one that is really pertinent to our HIE families.
This past month, Dr. McCaul sat down with Hope for HIE to chat about the current unknowns in this field of research, what we’ve learned thus far about perinatal brain injuries and their long-term effects on cognition, and how her lab is working to fill these gaps.
Missed the live stream Q&A? No worries. We took notes, and like any good partner, we are willing to share! Read our key takeaways below.
The world of cognitive development research for children with perinatal brain injuries is complex and incredibly promising. It’s a field where understanding early signs can make a significant difference in a child’s future, and the TREES Lab is at the forefront of this exploration.
An abbreviation for “Timely Recognition of Early and Emerging Signs Of Neurological and Cognitive Dysfunction in Infancy,” this lab focuses on first identifying early signs and markers of cognitive and learning issues as well as the development of executive function in children who experienced a perinatal brain injury and, secondly, discovering the key to unlocking the immense potential that these children have as they grow into school-age.
So, what’s the key? Two words. Early rehabilitation. As Dr. McCaul explains, they’re still figuring out what these children can most benefit from, especially from this rehabilitative standpoint: they aim to understand how soon interventions can begin to take full advantage of a critical period in brain development — known as its “plasticity” phase — and what these interventions can and should look like to optimize that development.
After all, little kids are sponges. They have a natural curiosity and motivation to engage with the world around them. By tapping into this phase, the lab can better explore how early interventions can lead to greater independence, school readiness, and a stronger sense of self-confidence as they enter a school environment. And as we know, school isn’t just about academic learning; it’s also about learning how to be part of a community. Dr. McCaul’s hypothesis? Early rehabilitation can play a significant role in helping children navigate this complex role in an environment that mandates the use of so many cognitive and social skills.
Since children learn by playing, it makes sense that the TREES Lab is learning through their play. At the core of their methodology is the belief that play is not just a pastime but a powerful tool that can be harnessed to promote and rehabilitate language, learning development, and executive functions.
What exactly are executive functions? Think of them as fundamental skills we start developing from birth that help us manage our daily lives and interact with the world around us. Dr. McCauls likens executive functions to the brain’s brake system. Just like a car needs brakes to navigate safely, our brains rely on these functions to help us stop, observe, and take in the information from our environment to make thoughtful decisions, react appropriately to different scenarios, pause to assess a situation, focus our attention on a task, and keep our emotions in check.
While the occasional puppet does make its way into these research scenarios, there’s more to it than that. The process includes examining early MRIs and how these images correlate with the development of executive functions in infants as young as six months. Children come into the lab at various stages— 6, 9, and 18 months of age— having already undergone brain MRIs. During these visits, they participate in fun tasks and play-based activities to assess their cognitive abilities. By analyzing how these early MRI findings relate to a child’s performance during these assessments, the researchers aim to determine if these early brain scans can predict future outcomes in executive function and overall learning abilities.
Preliminary data has led to two main findings. First, and perhaps not so surprisingly, there seems to be a correlation that children who suffered more global, extensive injuries at birth struggle with executive functions and learning as early as six months old.
The second preliminary finding took the researchers a little more by surprise, and it all has to do with the brain’s white matter. For those who need a crash course in brain anatomy, take a look at this breakdown below:
Even children without severe brain injuries can face cognitive and executive function challenges if their white matter is affected — an area of the brain whose microscopic injuries are not always captured by an MRI, and one that is not as well protected as grey matter by current interventions like cooling therapy.
So, while cooling therapy has been a groundbreaking intervention, particularly in protecting the brain’s grey matter in mild to moderate cases of HIE, it has its limitations. It suggests that there is a profound need for additional therapies alongside cooling that are necessary to protect this vulnerable area of the brain and support the full spectrum of cognitive development in children with HIE.
Why don’t we know more about the relationship between perinatal brain injuries and long-term cognitive outcomes?
Yes, there’s a lot we have yet to uncover, but let’s take a look at this from a glass-half-full perspective and outline what we do know about early brain injuries and long-term cognitive outcomes:
The TREES Lab’s SPRINT study — Sparking Potential, Revealing Infant Neurocognitive Traits — is an exciting initiative to improve our understanding of cognitive development in children with HIE and other perinatal brain injuries. Here’s a snapshot of what the study is all about:
The primary goal of the SPRINT study is to explore specific aspects of cognitive development that might be affected by HIE and premature birth. Researchers focus on how children manage attention, handle distractions, and switch between tasks, and in doing so, can identify areas where children might face challenges and discover new ways to support their growth. Alongside direct assessments, the study also collects questionnaire data from parents about their child’s executive functioning.
The study consists of children ages 0-36 months who have HIE, children who were born prematurely (before 28 weeks), and children without these neurological histories. This broad inclusion helps ensure relevant findings across different experiences and conditions.
Recruitment for this study is underway, and they’re looking for a large cohort (around 2,000 participants) to help create reliable and generalizable data. To get involved and learn more, you can either:
In essence, the SPRINT study seeks to answer crucial questions about cognitive development that have been left open until now. As Dr. McCaul points out, “We don’t know what we don’t know.” We can’t create targeted rehabilitation strategies until we gather more data and understand what specific aspects of cognitive development need support. This study could pave the way for these guidelines and rehabilitative practices.
For Dr. McCaul and her team, health equity and research go hand-in-hand. After all, she says, if we don’t prioritize inclusive research practices and the ability to make our findings widely applicable and accessible, then what are they even doing?
For now, the TREES Lab website is the best place to learn about this study, the lab’s research objectives, ways to get involved, and stay informed regarding their latest publications.
When it comes to reading up on long-term cognitive impacts, it’s important to recognize that progress in this field is just beginning. Consider the evolution of research and interventions for autism: what started as a relatively small area of focus has grown into a major field with extensive support and resources. The hope is that the same trajectory will apply to the study of HIE and cognitive development. As we keep pushing forward with research and raising awareness, we’re excited about the possibility of better support and more effective rehabilitative strategies down the line.
To watch the full live stream of this Q&A, visit our YouTube channel below, or click on our Key Takeaways for an at-a-glance view of this session!
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