Perceptual-cognitive training after pediatric mild traumatic brain injury: Towards a sensitive marker of recovery

Background: Pediatric mild traumatic brain injury (mTBI) has drastically increased in incidence over the past years. This condition can present itself through various forms rendering its diagnosis and management difficult for clinicians working with its population. While most cases recuperate over two to four weeks, about a third of children who sustain an mTBI will experience delayed recovery, and could benefit from rehabilitation interventions. Even after recovery is complete, when children go back to their normal life activities, they are at higher risk of sustaining a second injury than others without a history of such an injury, perhaps because we fail to fully identify subtle deficits. Objective: The overarching goal of this work was to address current research gaps in the clinical management of pediatric mTBI, by following three lines of inquiry. The first line of inquiry consisted of identifying predicting factors of delayed recovery. The second line of inquiry aimed to explore the use of three-dimensional multiple object tracking (3D-MOT) as an intervention for children who experience delayed recovery after mTBI. Finally, the use of 3D-MOT was explored as a mean to detect clinical recovery in pediatric mTBI. Methods and results: The first study consisted of identifying predictors of delayed recovery in children who sought care in a specialized mTBI outpatient clinic (N=213). Results showed that total post-concussion symptom score at their initial visit was a predictor of delayed recovery. The second study used theoretical foundations of 3D-MOT to explore the tolerability and safety of six 3D-MOT training sessions in symptomatic children after mTBI (n=10). To investigate tolerability, protocol adherence and deviations were recorded; safety was evaluated through symptom presentation at each training session. No adverse events were reported, minimal protocol deviations were performed and adherence to the training regimen was predominantly maintained. third study explored differences in 3D-MOT training trajectories between children post-mTBI (n=20) and healthy control children (n=14). This study aimed to explore if learning on this training task occurred similarly across groups. Results demonstrated that both groups improved their task performance over time, however, the gains from initial trainings visits occurred more slowly for the mTBI group. The fourth study compared 3D-MOT training gains in children that had been followed in a specialized mTBI outpatient clinic and had been clinically cleared for return to activities (clinically recovered n=10) to those of healthy controls (n=10). Results demonstrated that clinically recovered individuals performed similarly to controls on 3D-MOT over time. The fifth study compared 3D-MOT training gains in children who had been followed in a specialized mTBI clinic and had been clinically cleared for return to activities (clinically recovered n=10) to those of children with recent history of mTBI and being in various phases of recovery (n=12) recruited through community partnerships. Significant group differences were found in initial training sessions where children with a history of mTBI exhibit lower training gains than clinically recovered children on 3D-MOT. Conclusions: This work revealed that it is possible to predict which children will be more likely to experience delayed recovery after a mTBI, within an outpatient clinical setting. It also demonstrated that perceptual-cognitive training through the use of 3D-MOT was a potentially safe and tolerated intervention for children who experience persisting symptoms. Last, it demonstrated that training differences can be perceived in 3D-MOT across groups of individuals, and that this training task can identify differences between healthy controls and children having a history of mTBI. This work show promising use of 3D-MOT in the management of mTBI and sets ground for future studies using this training paradigm.

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