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Alteration in Cerebral Activation during a Working Memory Task after Pediatric Mild Traumatic Brain Injury: A Prospective Controlled Cohort Study
Abstract
Mild traumatic brain injuries (mTBIs) commonly occur in children and adolescents and can result in persistent cognitive symptoms. The neurophysiological changes that underlie persistent post-concussive symptoms (PPCS) have not been characterized. Our objective was to compare working-memory related functional magnetic resonance imaging (fMRI) response in children with persistent symptoms after mTBI at one month post-injury to children with typical recovery and healthy controls. This was a prospective, controlled cohort study of children with mTBI at one month post-injury. PPCS was defined as children with a 10-point increase in their post-concussion symptom inventory score (compared with pre-injury score) at one month post-injury and a two-point increase in at least two symptom categories compared with pre-injury. One hundred and seven participants (60 PPCS, 30 recovered mTBI, and 17 controls) with a mean age of 14.2 years (standard deviation [SD] 2.5) (44% male) were assessed 38 (SD 5.9) days after mTBI. The primary outcome measures were visuospatial n-back working memory task performance and fMRI blood oxygen level dependent (BOLD) signal change. Children with PPCS had decreased activation relative to children with typical recovery in the posterior cingulate and precuneus during the one-back working memory condition, despite similar task performance. Differences in cortical activation in children with PPCS at one month highlight the persistent neurobiological consequences of pediatric mTBI on working memory cortical activation. These findings encourage recommendations to avoid contact sports and provide continued care at school for children with persistent symptoms at one month post-injury.
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“(1) At one-month post-injury, the symptomatic mTBI (PPCS) group showed decreased brain activation compared to the asymptomatic (recovered) mTBI group during the 1-back working memory condition, specifically in the precuneus, posterior cingulate, and left Broca’s area (DLPFC ROI).”
From A systematic review of brain structural and functional alterations in pediatric mild traumatic brain injury (2026) · cites this paper as Khetani et al. (2019)
In the citing paper
“(2) No significant activation differences were found between either mTBI group and healthy controls.”
From A systematic review of brain structural and functional alterations in pediatric mild traumatic brain injury (2026) · cites this paper as Khetani et al. (2019)
In the citing paper
“In contrast, it was found that symptomatic children at one-month post-injury showed decreased activation in precuneus, posterior cingulate, and left Broca’s area during a 1-back task compared to asymptomatic peers, with no differences from healthy controls, suggesting that activation patterns vary by symptom status and time since injury (Khetani et al., 2019).”
From A systematic review of brain structural and functional alterations in pediatric mild traumatic brain injury (2026) · cites this paper as Khetani et al. (2019)
In the citing paper
“(4) The findings suggest that altered cortical activation, particularly greater default mode network inhibition and reduced task-positive network activation, may underlie persistent symptoms even in the absence of performance deficits.”
From A systematic review of brain structural and functional alterations in pediatric mild traumatic brain injury (2026) · cites this paper as Khetani et al. (2019)
In the citing paper
“(3) Despite the brain activation differences, all three groups (symptomatic, asymptomatic, controls) performed similarly on the working memory task (accuracy and reaction time).”
From A systematic review of brain structural and functional alterations in pediatric mild traumatic brain injury (2026) · cites this paper as Khetani et al. (2019)
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Cited by
Xu, H., Wu, S., Zhan, H., Xu, G., Zhao, J., & Yin, B. (2026) · Frontiers in Neuroscience · doi:10.3389/fnins.2026.1879109
Metadata
- Authors
- Khetani, A., Rohr, C. S., Sojoudi, A., Bray, S., & Barlow, K. M.
- Affiliations
- Department of Neuroscience and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Biomedical Engineering, University of Calgary, Calgary, Alberta, Canada
- Faculty of Medicine, Child Health Research Centre, The University of Queensland, Queensland, Australia.
- Venue
- Journal of Neurotrauma
- Publisher
- SAGE Publications
- Published
- 2019-11-11
- Volume
- 36
- Issue
- 23
- Pages
- 3274-3283
- ISSN
- 0897-7151
- 1557-9042
- Cited by
- 29
- References
- 13
- Language
- en
- Licence
- journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
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