Subtle Motor Signs in Children With Chronic Traumatic Brain Injury.
Jewel E Crasta, Jamie Sibel, Beth S Slomine and 3 others
PMID 30550451WHAT IT FOUND
Children with chronic moderate or severe TBI had subtle motor problems even when walking independently: worse overall motor scores, worse timed motor scores, and more unwanted movement in larger muscles on the same side than matched controls.
The sample was small.
Key findings
01Compared with matched controls, children with TBI had worse overall subtle motor performance and more proximal motor overflow.
02Within the TBI group, broad PANESS scores did not separate moderate from severe injury, but severe injury was associated with more proximal overflow after controlling for age at injury.
03Smaller total cerebral volume was associated with worse timed motor performance and more proximal overflow across the sample.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 14 children with TBI and 14 controls were studied, so the findings are preliminary and need confirmation in a larger sample. All TBI participants could walk independently with no to minimal walking impairment and had IQ scores of 80 or higher, so results may not apply to children with obvious motor impairment or lower cognition. The TBI group varied in age at injury and time since injury; age at injury was highly correlated with time since injury, so the study could not separate the effect of younger age at injury from how long ago the injury happened. One TBI participant did not have an MRI scan. Brain analyses used volumetric MRI only, not connectivity or cerebellar measures, so they cannot identify specific white matter pathways. The study did not examine sex effects or ADHD, which the authors note is a common comorbidity in children with TBI. No treatment was tested, so this is not evidence that therapy changes subtle motor signs.
Declared interests
The paper is listed as supported by NIH extramural research funding. The supplied text does not include a conflicts-of-interest declaration.
The easy way to misread this
Do not read this as showing that severe TBI causes broadly worse chronic motor scores than moderate TBI. The PANESS total, timed, and gaits and stations scores did not differ by severity; only proximal overflow, extra movement in larger muscles on the same side, did after controlling for age at injury.