Secondary Logo

Institutional members access full text with Ovid®

Subtle motor signs in children with chronic traumatic brain injury

Crasta, Jewel E., PhD1,2; Sibel, Jamie, MD1*; Slomine, Beth S., PhD1,4,5; Mahone, Mark E., PhD1,5; Mostofsky, Stewart H., MD1,3,4; Suskauer, Stacy J., MD1,2,4

American Journal of Physical Medicine & Rehabilitation: December 13, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001110
Research Article: PDF Only

Objective To characterize subtle motor signs in children with moderate-severe traumatic brain injury (TBI) in the chronic phase of injury.

Design Fourteen children with moderate (n=6) or severe (n=8) TBI, ages 11–18 years, who had sustained their injury at least 1-year prior to study participation (Range 1–14 years since injury), and 14 matched typically-developing controls were examined using the Physical and Neurological Examination of Subtle Signs (PANESS). To examine the neural correlates of subtle motor signs, measures of total cerebral volume and motor/premotor volume were derived from MRI.

Results Children with TBI had significantly poorer PANESS performance than controls on the Total Timed subscore, proximal overflow, and the PANESS total score. Participants with severe TBI had greater proximal overflow than those with moderate injury, after controlling for age at injury. Across all participants, greater proximal overflow correlated with reduced total cerebral volume, while within the TBI group, reduced motor/premotor volume correlated with lower PANESS total score.

Conclusion The study highlights the importance of examining subtle motor signs including overflow during clinical evaluation of chronic pediatric TBI and establishes the clinical utility of the PANESS as a measure sensitive to chronic subtle motor signs in this population.

1 Kennedy Krieger Institute;

2 Johns Hopkins University School of Medicine, Department of Physical Medicine and Rehabilitation;

3 Johns Hopkins University School of Medicine, Department of Neurology;

4 Johns Hopkins University School of Medicine Department of Pediatrics;

5 Johns Hopkins University School of Medicine Department of Psychiatry and Behavioral Sciences

*Work was completed while Dr. Sibel was at Kennedy Krieger Institute; she is currently at MedStar Baltimore Hospitals.

Corresponding author: Stacy J Suskauer, Postal address: Kennedy Krieger Institute, 716 N. Broadway, Baltimore, MD 21205, Phone: (443) 923-9440, Fax: 443-923-9255. Email:


There are no competing interests or financial benefit to the authors to report.

Study Funding:

This research was supported by the National Institutes of Health (S.S: K23HD06161, UL1TR001079-04, and K12 HD001097).

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.