The aim of this study was to investigate the occurrence of anosmia (loss of sense of smell) in a paediatric traumatic brain injury (TBI) population and to determine the recovery patterns over a 12 month period. We also aimed to investigate the relationship between anosmia and severity of TBI, specifically we hoped to determine whether more severe TBI resulted in a higher likelihood of anosmia post injury. Thirdly we aimed to better understand the nature of any relationship between the presence of anosmia and dysfunction in executive skills such as behaviour and impulse control. Evaluation of the impact on day to day life of disturbance in sense of smell was also investigated particularly in areas of hygiene, safety and diet
Children with a diagnosis of traumatic brain injury aged between 8 and 16 years of age completed the University of Pennsylvania Smell Identification Test between 1-15 weeks post-injury to evaluate their sense of smell. Follow-up assessments were conducted at 6 and 12 months post injury. At the six month follow up participants completed the UPSIT as a measure of sense of smell and also neuropsychological assessment to assess executive skills such as impulse control, response inhibition, strategic thinking, and attentional flexibility. Parents also completed questionnaire assessing the impact of anosmia on daily life and day to day executive behaviours such as emotional control, inhibition, working memory and planning and organisation. Follow-up assessment at 12 months involved completion of UPSIT and impact of anosmia questionnaire.
This study is ongoing. Preliminary results indicate that six of the 16 participants recruited so far demonstrated anosmia at time of initial assessment, with seven of the sixteen demonstrating some degree of olfactory dysfunction, though not frank anosmia. Interestingly the participants demonstrating anosmia came from each of the three severity groupings (with two each categorised as mild, moderate and severe TBI). Only three of the sixteen participants tested demonstrated age appropriate performance on the smell test at initial assessment. Interestingly only one of the participants reported, when questioned prior to testing, a change in their sense of smell. Preliminary data from the six month follow-up assessments indicated that one out of the seven tested demonstrated anosmia. The remaining six showed largely age appropriate performance on the smell test.
The preliminary data indicates that the presence of anosmia and lesser degrees of olfactory dysfunction are apparent in our small sample of children with TBI. It is expected that continued data collection will provide useful information with regard to the clinical occurrence of anosmia following paediatric TBI and the natural history of anosmia. Given that anosmia has the potential to impact functionally in the form of safety, hygiene and health and quality of life information from this study has the potential to improve care and ongoing rehabilitation management of children who have sustained a TBI. The information gained from this project will ensure that sufferers of anosmia are receiving education and optimum management of their deficits to lessen the impact on their ongoing rehabilitation and their and their family’s lives.
Feedback on the Fellowship from Kathleen Bakker:
“The fellowship has provided the opportunity to pursue clinical research, by providing time dedicated solely to research outside of my clinical role. This has been invaluable and has allowed me to further develop my research skills by giving me the opportunity to undertake PhD studies, allowing me to develop the qualifications and experienced needed to go on to a research career in neurosciences. Throughout the time of the fellowship there have been many opportunities to participate in seminars and workshops that have had a significant impact on my professional skill development as a researcher. The media training and scientific writing courses have improved my ability to communicate about my research, and developed my confidence and clarity as a presenter in a variety of settings. Participating in the neuroimaging course provided valuable skills in research methodology in neurosciences which I have been able to apply to my current research.”
SWAIN MA, JOY PJ, BAKKER K, SHORES EA, WEST C. Object-based visual processing in children with spina bifida and hydrocephalus: A cognitive neuropsychological analysis. Journal of Neuropsychology. 2009;3:229-244.
BAKKER, K, CATROPPA, C. & ANDERSON, V. Anosmia in paediatric traumatic brain injury. Australian Centre for Childhood Neuropsychological Studies Research Seminar, July 2010, Melbourne, Australia.
BAKKER, K. Paediatric Rehabilitation. The University of Melbourne Developmental Neuropsychology Post-graduate Lecture Series; October 2010, Melbourne, Australia.
BAKKER, K. CRICHTON, A., HOUSTON, D., DEAN, N. & KNIGTH, S. Psychology in Paediatric Rehabilitation. Royal Children’s Hospital Psychology Department Professional Development Seminars; November 2010, Melbourne, Australia.
ANDERSON, V., CRICHTON, A., BAKKER, K., DEAN, N. & WOODS, D. Child based intervention for acquired brain injury: translating evidence into practice. 16th Conference of the Australian Psychological Society College of Clinical Neuropsychologists; October 2010, Fremantle, Australia.