The Treble-Barna Lab for Pediatric Traumatic Brain Injury Research

Understanding Factors Influencing Neurobehavioral Recovery From Pediatric TBI

Understanding Factors Influencing Neurobehavioral Recovery Under the leadership of Amery Treble-Barna, PhD, researchers of this lab aim to to account for unexplained heterogeneity in outcomes following pediatric traumatic brain injury (TBI), with the long-term goal of moving the field towards precision medicine to improve individual prognostication, predict response to rehabilitation, and identify novel targets for treatment development.

TBI is a leading cause of morbidity and mortality in childhood. The scientific evidence available to guide prognosis, management, and treatment is disproportionately low relative to TBI’s medical and societal burden. Children sustaining moderate to severe TBI often demonstrate neurobehavioral impairments that hamper their long-term functioning. Current prediction models, however, explain only about 35% of variance in these outcomes. Without the identification of additional factors influencing recovery, this unexplained heterogeneity will remain one of the most critical barriers to accurate prognostication and to the development of evidence-based treatments for the neurobehavioral consequences of pediatric TBI.

Working from biopsychosocial and precision medicine frameworks, the Treble-Barna Lab is studying the effects of a variety of factors influencing neurobehavioral recovery from pediatric TBI, including:

Environmental – psychosocial risk, social determinants of health
Personal biological – epigenetic, genetic, and protein biomarkers
Therapeutic – rehabilitation service use

The lab aims to use this knowledge to improve individual prognostication, predict response to rehabilitation, and identify novel targets for treatment development.

Investigating Epigenetic Influences on Neurobehavioral Recovery From Pediatric TBI

Dr. Treble-Barna is Principal Investigator of the Epigenetic Effects on pediatric Traumatic Brain Injury (EETR) study, which has been enrolling since 2017 and consistently funded by the National Institutes of Health (NIH) since 2019 (K01HD097030; R01NS135492). The aims of the project are to examine DNA methylation (a major epigenetic regular of gene expression) in association with acute TBI occurrence, long-term neurobehavioral outcomes, and psychosocial adversity.

Development and Initial Validation of a Caregiver-report Measure of Rehabilitation Utilization Following Pediatric TBI

One factor that may explain differences in pediatric TBI recovery is inconsistent use of the broad variety of available rehabilitation services; however, this has not been confirmed because no scientifically rigorous, comprehensive, standardized, or validated measure of rehabilitation utilization currently exists. TBI rehabilitation encompasses a wide range of multidisciplinary services spanning the care continuum from the ICU to the community. Utilization of rehabilitation services following pediatric TBI is highly variable. Our long-term goal is to examine whether variance in rehabilitation utilization accounts for some of the unexplained heterogeneity in outcomes following pediatric TBI. If we can reduce heterogeneity in our models of TBI recovery, we can provide more accurate prognostication and improve our ability to test the efficacy of treatments. As a critical first step, we are developing, refining, and conducting initial validation of a caregiver-report measure of rehabilitation utilization, the Rehabilitation Utilization Measure (RUM). We are combining qualitative and quantitative methods to engage caregiver, clinician, and scientist experts in measure development and refinement and conducting initial measure validation.

In collaboration with Dr. Bailey Petersen, PhD, DPT, we are investigating physical activity as a potential treatment to promote neurobehavioral recovery following pediatric TBI. In this study, physical activity is measured using wearable monitors during the sub-acute and chronic phases of recovery and is then examined in association with neurobehavioral outcomes and protein and epigenetic biomarkers. We are also co-designing a physical activity intervention with children, their families, and their medical providers using human-centered design methods to promote feasibility and effectiveness of the intervention to be tested in a randomized controlled trial.

Amery Treble-Barna, PhD

Principal Investigator
amery.treble@chp.edu
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Sanjana Das
Clinical Research Coordinator
sanjanadas@pitt.edu

Contact Us

The Treble-Barna Lab
UPMC Children’s Hospital of Pittsburgh
Administrative Office Building, Suite 4217
4401 Penn Avenue
Pittsburgh, PA 15224
412-692-6418

2022

Research Assistant Aboli Kesbhat, BS, and Amery Treble-Barna, PhD, delivered a poster presentation virtually, entitled “Psychosocial Risk in Pediatric TBI: Reliability of the Psychosocial Assessment Tool,” at the Annual Meeting of the International Neuropsychological Society.

Lauren Kaseman, BS, and Amery Treble-Barna, PhD, conducted a poster presentation virtually, entitled “Racial, Health Insurance, and Urban-rural Disparities in Rehabilitation Utilization and Unmet Needs Among Pediatric Patients with Traumatic Brain Injury,” at the Annual Meeting of the International Neuropsychological Society.

2021

Amery Treble-Barna, PhD, presented “BDNF Val66Met and Neuropsychological Function Following Pediatric Traumatic Brain Injury” at the National Academy of Neuropsychology meeting in Washington, D.C.

2020

Clinical research coordinator Jamie Patronick, BS, was accepted to present a poster entitled, “Review of genetic factors associated with recovery after traumatic brain injury: A 4-year update,” at the 2021 annual meeting of the International Neuropsychological Society (a virtual event).

Research assistant Namita Thomas, BS, presented a poster, entitled “Needs and service utilization following pediatric traumatic brain injury,” at the annual meeting of the International Neuropsychological Society in Denver.

2019

Amery Treble-Barna, PhD, presented, “Caregiver-reported rehabilitation utilization in the first 6 months following early childhood traumatic brain injury,” at the 13th World Congress on Brain Injury in Toronto, Canada.

Research coordinator, Srivatsan Uchani, BS, presented a poster, entitled “Brain Derived Neurotrophic Factor (BDNF) DNA Methylation and Brain-related Clinical Outcomes: A Systematic Review,” at the annual meeting of the International Neuropsychological Society in New York.

Research coordinator, Jamie Patronick, BS, presented a poster, entitled “Assessment of Acute Neuropsychological Functioning Following Pediatric TBI Using the NIH Toolbox-Cognition Battery,” at the annual meeting of the International Neuropsychological Society in New York.

Research assistant, Noelle Marousis, BS, presented a poster, entitled “Can Personal Biology Account for Unexplained Heterogeneity in Neurobehavioral Outcomes Following Pediatric TBI? Feasibility and Acceptability of Research Methods,” at the annual meeting of the International Neuropsychological Society in New York.

Dr. Treble-Barna presented, “Influence of Candidate Inflammation-related Genes on Neurobehavioral Recovery Following Traumatic Brain Injury During Early Childhood,” at the annual meeting of the International Neuropsychological Society in New York.

2018

Graduate student, Navya Kamath, PhD, presented a poster, entitled “Ethnicity, SES, and Adaptive Function as Predictors of Health-related Quality of Life Among Children and Adolescents with Spina Bifida Myelomeningocele,” at the Annual Meeting of the International Neuropsychological Society in Washington, D.C.

Research coordinator, Srivatsan Uchani, BS, presented a poster, entitled “Adverse Childhood Experiences and Neuropsychological Outcomes Among Adults with Moderate to Severe Traumatic Brain Injury: Preliminary Results,” at the annual meeting of the International Neuropsychological Society in Washington, D.C.

Brain-derived neurotrophic factor (BDNF) epigenomic modifications and brain-related phenotypes in humans: A systematic review
Treble-Barna A, Heinsberg LW, Stec Z, Breazeale S, Davis TS, Kesbhat AA, Chattopadhyay A, VonVille HM, Ketchum AM, Yeates KO, Kochanek PM, Weeks DE, Conley YP
Neuroscience and Biobehavioral Reviews
2023;147:105078. doi: 10.1016/j.neubiorev.2023.105078. PMID 36764636.

Patient- and caregiver-report measures of rehabilitation service use following acquired brain injury: a systematic review
McCormick S, Jarvis J, Terhorst L, Richardson A, Kaseman L, Kesbhat A, Yepuri Y, Beyene E, VonVille H, Bendixen R, Treble-Barna A*
BMJ Open
2024;20;14(2):e076537. PMID 38382949.

Brain-derived neurotrophic factor in pediatric acquired brain injury and recovery
Treble-Barna A, Petersen BA, Stec Z, Conley YP, Fink EL, Kochanek PM
Biomolecules
2024;4;14(2):191. PMID: 38397427

Evaluating cognitive performance using the NIH Toolbox Cognitive Battery following pediatric traumatic brain injury (TBI)
Petersen B BA, Vo NN, Yeates KO, & Treble-Barna A
Journal of the International Neuropsychological Society
In press

Differential DNA methylation of the brain-derived neurotrophic factor gene is observed after pediatric traumatic brain injury compared to orthopedic injury
Heinsberg LW, Kesbhat A, Petersen B, Kaseman L, Stec Z, Anton N, Kochanek PM, Yeates KO, Weeks DE, Conley YP, Treble-Barna A
J Neurotrauma
In press

Brain-derived Neurotrophic Factor Val66Met and Neuropsychological Functioning After Early Childhood Traumatic Brain Injury
Treble-Barna A, Wade SL, Pilipenko V, Martin LJ, Yeates KO, Taylor HG, Kurowski BG.
Journal of Neurotrauma
2022 Jan 11

Brain-Derived Neurotrophic Factor Val66Met and Behavioral Adjustment after Early Childhood Traumatic Brain Injury
Treble-Barna A, Wade SL, Pilipenko V, Martin LJ, Yeates KO, Taylor HG, Kurowski BG.
Journal of Neurotrauma
2021 Apr 13, Online ahead of print

Acute Brain-Derived Neurotrophic Factor DNA Methylation Trajectories in Cerebrospinal Fluid and Associations With Outcomes Following Severe Traumatic Brain Injury in Adults
Treble-Barna A, Heinsberg LW, Puccio AM, Shaffer JR, Okonkwo DO, Beers SR, Weeks DE, Conley YP
Neurorehabilitation and Neural Repair
2021 Jun 25, Online ahead of print

Epigenetic Effects on Pediatric Traumatic Brain Injury Recovery (EETR): An Observational, Prospective, Longitudinal Concurrent Cohort Study Protocol
Treble-Barna A, Patronick J, Uchani S, Marousis NC, Zigler CK, Fink EL, Kochanek PM, Conley YP, Yeates KO
Frontiers in Neurology
2020 Jun 12

Cumulative Influence of Inflammatory Response Genetic Variation on Long-Term Neurobehavioral Outcomes after Pediatric Traumatic Brain Injury Relative to Orthopedic Injury: An Exploratory Polygenic Risk Score
Treble-Barna A, Pilipenko V, Wade SL, Jegga AG, Yeates KO, Taylor HG, Martin LJ, Kurowski BG
Journal of Neurotrauma
2020 Jul

PICU-based Rehabilitation and Outcomes Assessment: A Survey of Pediatric Critical Care Physicians
Treble-Barna A, Beers SR, Houtrow AJ, Ortiz-Aguayo R, Valenta C, Stanger M, Chrisman C, Orringer M, Smith CM, Pollon D, Duffett M, Choong K, Watson RS, Kochanek PM, Fink EL
Pediatric Critical Care Medicine
2019 Jun

Influence of Dopamine-related Genes on Neurobehavioral Recovery After Traumatic Brain Injury During Early Childhood
Treble-Barna A, Wade SL, Martin LJ, Pilipenko V, Yeates KO, Taylor HG, & Kurowski BG
Journal of Neurotrauma
2017 Jun 1

Long-term Neuropsychological Profiles and Their Role as Mediators of Adaptive Functioning Following Traumatic Brain Injury in Early Childhood
Treble-Barna A, Zang H, Zhang N, Taylor HG, Yeates KO, Wade SL
Journal of Neurotrauma
2017 Jan 15

Observed Parenting Behaviors as Time-varying Moderators of Early Traumatic Brain Injury on Child Behavior Problems
Treble-Barna A, Zang H, Zhang N, Taylor HG, Stancin T, Yeates KO, Wade SL
Developmental Psychology
2016 Nov

Cognitive Intervention for Attention and Executive Function Impairments in Children with Traumatic Brain Injury: A Pilot Study
Treble-Barna A, Sohlberg M, Harn B, Wade SL
Journal of Head Trauma Rehabilitation
2016 Nov/Dec

Functional Significance of Atypical Cortical Organization in Spina Bifida Myelomeningocele: Relations of Cortical Thickness and Gyrification With IQ and Fine Motor Dexterity
Treble A, Juranek J, Stuebing KK, Dennis M. Fletcher JM
Cerebral Cortex
2013 Oct

Working Memory and Corpus Callosum Microstructural Integrity Following Pediatric Traumatic Brain Injury: A Diffusion Tensor Tractography Study
Treble A, Hasan KM, Iftikhar A, Stuebing KK, Kramer LA, Cox CS, Swank PR, Ewing-Cobbs L
Journal of Neurotrauma
2013 Oct 1

We’d Like to Hear From You!

The Treble-Barna Lab is looking for talented graduate students (no funding currently available; contribution to research projects on voluntary basis only) and undergraduate research assistants. Please contact Dr. Treble-Barna via email if you are interested.

Post-doctoral Research Fellow

Applications for individuals interested in pursuing a postdoctoral fellowship in the Treble-Barna lab are reviewed on a rolling basis. Individuals are invited to send a CV and statement of interest to amery.treble-barna@pitt.edu.