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Structural Connectivity Related to Persistent Symptoms After Mild TBI in Adolescents and Response to Aerobic Training: Preliminary Investigation

Yuan, Weihong PhD; Wade, Shari L. PhD; Quatman-Yates, Catherine DPT, PhD; Hugentobler, Jason A. PT; Gubanich, Paul J. MD, MPH; Kurowski, Brad G. MD, MS

Journal of Head Trauma Rehabilitation: November/December 2017 - Volume 32 - Issue 6 - p 378–384
doi: 10.1097/HTR.0000000000000318
Original Articles

Objective: To quantify structural connectivity abnormalities in adolescents with mild traumatic brain injury (mTBI) and to investigate connectivity changes following aerobic training using graph theory and diffusion tensor imaging tractography.

Setting: Outpatient research setting.

Participants: Twenty-two children (age: 15.83 ± 1.77 years, 10 females) with 4 to 16 weeks of persistent symptoms after mTBI and a matched healthy comparison group.

Design: Randomized clinical trial of aerobic training and stretching comparison combined with case-control comparison.

Main Measures: (1) Five global network measures: global efficiency (Eglob), mean local efficiency, modularity, normalized clustering coefficient (γ), normalized characteristic path length (λ), and small-worldness (σ). (2) The self-reported Post-Concussion Symptom Inventory score.

Results: At initial enrollment, adolescents with mTBI had significantly lower Eglob and higher γ, λ, and σ (all P < .05) than healthy peers. After the intervention, significantly increased Eglob and decreased λ (both P < .05) were found in the aerobic training group. Improvement in Post-Concussion Symptom Inventory scores was significantly correlated with the Eglob increase and λ decrease in the aerobic training and λ decrease in the stretching comparison group (all P < .05).

Conclusion: This pilot study showed initial evidence that structural connectivity analysis was sensitive to brain network abnormalities and may serve as an imaging biomarker in children with persistent symptoms after mTBI.

Pediatric Neuroimaging Research Center (Dr Yuan), Division of Physical Medicine and Rehabilitation (Drs Wade and Kurowski), and Division of Sports Medicine (Drs Quatman-Yates and Gubanich and Mr Hugentobler), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and University of Cincinnati, College of Medicine, Cincinnati, Ohio (Drs Yuan, Wade, and Kurowski).

Corresponding Author: Brad G. Kurowski, MD, MS, Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 4009, Cincinnati, OH 45229 (

Funding for this study was supported in part by the Cincinnati Children's Research Foundation Trustees Grant program, Ohio Department of Public Safety, National Institute for Child Health and Human Development K23HD07468, and grant 8 UL1 TR000077 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or other supporting agencies.

The authors declare no conflicts of interest.

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