Motor deficits and recovery during the first year following mild closed head injury

Van der Veer Institute for Parkinson's & Brain Research, Christchurch, New Zealand.
Brain Injury (Impact Factor: 1.81). 08/2006; 20(8):807-24. DOI: 10.1080/02699050600676354
Source: PubMed


This study examined motor impairments over 1 year following mild closed head injury (CHI). It is the first study to serially assess long-term oculomotor and upper-limb visuomotor function following mild head trauma.
Thirty-seven patients with mild CHI and 37 matched controls were compared at 1 week, 3 months and 6 months and 31 available pairs at 12 months post-injury on measures of saccades, oculomotor smooth pursuit, upper-limb visuomotor function and neuropsychological performance. Symptomatic recovery was sampled using the Rivermead Postconcussion Symptoms Questionnaire.
At 1 week, the group with CHI reported high levels of post-concussional symptoms and exhibited prolonged saccade latencies, increased directional errors, decreased saccade accuracy and impaired fast sinusoidal smooth pursuit concomitant with increased arm movement reaction time, decreased arm movement speed and decreased motor accuracy on upper-limb visuomotor tracking tasks. Neuropsychological testing identified deficits only in verbal learning and speed of processing while attention, short-term/working memory and general cognitive performance were preserved. At 3 and 6 months, the group with CHI continued to show deficits on several oculomotor and upper-limb visuomotor measures in combination with some deficits on verbal learning and improved, yet abnormal, levels of post-concussional symptoms. At 12 months, the group with CHI had no cognitive impairment but residual deficits in eye and arm motor function and continued to show elevated levels of post-concussional symptoms.
The findings indicate that multiple motor systems are measurably impaired up to 12 months following mild CHI and that instrumented motor assessment may provide sensitive and objective markers of cerebral dysfunction during recovery from mild head trauma independent of neuropsychological assessment and patient self-report.

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Available from: John C Dalrymple-Alford, Oct 10, 2015
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    • "Eye–hand coordination deficits are of central concern in rehabilitation because they limit flexible behavioral adjustments to the ever-changing environment . Previous behavioral studies revealed that predictive visual and manual tracking of a target is impaired in children (Caeyenberghs et al., 2009) and adolescents with TBI (Heitger et al., 2006; Suh, Kolster, Sarkar, McCandliss, & Ghajar, 2006; Suh et al., 2006). Here, we studied WM changes in dedicated anatomical structures associated with visuomotor performance. "
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    ABSTRACT: Traumatic brain injury (TBI) patients have a high incidence of eye-hand coordination deficits. Diffuse axonal injury is common in TBI and is presumed to contribute to persistent motor problems. Using Diffusion Tensor Imaging (DTI), this study sought to identify changes in (sensori)motor white matter (WM) pathways/regions in a TBI group during the chronic recovery stage. A secondary objective was to examine the relationship between WM integrity and upper-limb visuomotor tracking performance. A young TBI (n=17) and control (n=14) group performed a dynamic tracking task, characterized by increasing information processing speed and predictive movement control. DTI scans were administered along with standard anatomical scans. The TBI group was found to perform inferior to the control group on the tracking task. Decreased fractional anisotropy was found in the TBI group in dedicated pathways involved in transmission of afferent and efferent information, i.e., corticospinal tract, posterior thalamic radiation, and optic radiation, due to increased diffusivity parallel and perpendicular to axonal fibre direction. This decrease in WM integrity was associated with inferior visuomotor tracking performance. Moreover, discriminant function analysis demonstrated that the model, based on the combined application of DTI and behavioral measures, was the most effective in distinguishing between TBI patients and controls. This study shows that specific eye-hand coordination deficits in a young TBI group are related to microstructural abnormalities in task-specific cerebral WM structures. Measures of white matter integrity are potentially important biomarkers for TBI that may support prognosis of motor deficits.
    Neuropsychologia 04/2010; 48(5):1472-82. DOI:10.1016/j.neuropsychologia.2010.01.017 · 3.30 Impact Factor
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    • "Subjects had to answer the written questions in the presence of the examiner. Details of this assessment have been described previously [5] [6]. The three health status questionnaires provided 38 variables for the discriminant function analyses. "
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    ABSTRACT: Following on from our earlier findings of a close relationship between motor function and outcome after mild traumatic brain injury (mTBI), this study examined whether it might be possible to predict poor recovery in the form of postconcussion syndrome (PCS) based upon early eye and arm motor function. Within 1 week post-injury, we assessed 37 mTBI patients on measures of saccades, oculomotor smooth pursuit, upper-limb visuomotor function, neuropsychological status, and self-reported health condition. At 3 months, 8 patients met the criteria for PCS. Using discriminant function analyses, we examined whether this future PCS-group could be identified prospectively based on motor function, neuropsychological status, and self-reported health condition at 1 week post-injury. Early eye movement function was the most effective in distinguishing between PCS and non-PCS patients, achieving a sensitivity and specificity of 100% in the present sample. This was followed by self-reported early health condition (sensitivity: 87%, specificity: 97%), early upper-limb motor performance (87%, 97%), neuropsychological function (62%, 100%), and age, gender, education and clinical measures of trauma severity (37%, 87%). Leave-one-out validation analyses confirmed eye movements as the most robust discriminator (sensitivity: 62%, specificity: 97%). Assessment of eye movement function after mTBI may contribute to a prospective identification of patients who develop PCS, supporting the targeting of early health-care intervention.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 02/2008; 2008:3570-3. DOI:10.1109/IEMBS.2008.4649977
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    • "It has to be kept in mind, however, that the current models were based on a limited sample size of 37 patients. While this sample size was sufficient to examine deficits in eye and arm motor function during the first year post-injury [45] and compare the association of different functional modalities at 1 week with later outcome, it may be insufficient to support an expectation that the principle of a motor-based outcome prediction will be applicable to the general mild CHI population . Validation of the current models and the relationships between early motor function and outcome in a larger cohort of mild CHI patients is essential before any clinical use of this method can be considered. "
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    ABSTRACT: Based on previous findings of impaired eye and arm motor control after mild closed head injury (CHI), this study examined whether early eye and arm motor function, and the level of post-injury cerebral dysfunction manifested in motor control, relates systematically to recovery at 3 and 6 months after mild CHI. At 1 week post-injury, we assessed oculomotor function, upper-limb visuomotor performance, and cognitive status in 37 mild CHI patients. Re-examination at 3 and 6 months determined outcome in terms of postconcussional symptoms and performance of everyday tasks, as assessed by the Rivermead Postconcussion Symptoms Questionnaire, the Rivermead Head Injury Follow-up Questionnaire and the SF-36 Health Survey. We then examined the association of early motor function, cognitive status and self-reported health condition with outcome using linear regression. Motor-based regression models explained a high proportion of the variance in outcome (70-89%), with motor function at 1 week being more closely related to outcome at 3 and 6 months than early psychometric assessment (13-32%) or self-reported health status (54-79%). These motor-based models incorporated subcortical/subconscious motor functions alongside motor functions that are subject to volitional control and are primarily mediated by frontal, parietal and temporal cortical brain regions. Early assessment of eye and arm motor function may help in improving accuracy of outcome prediction after mild CHI. Such assessment may assist in the better targeting of early health care intervention and help decrease head-trauma-related morbidity and rehabilitation costs.
    Journal of the Neurological Sciences 03/2007; 253(1-2):34-47. DOI:10.1016/j.jns.2006.11.007 · 2.47 Impact Factor
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