Longitudinal Multimodal Assessment To Quantify Concussion Recovery Trajectory Among Youth Athletes

Abstract

PURPOSE: Our aim was to evaluate a quantitative and multifaceted approach for determination of concussion recovery among youth athletes across different functional domains. METHODS: Youth athletes 8-18 years of age and diagnosed with a concussion were tested 3 times: within 10 days of injury (T1), approximately 3 weeks post-injury (T2), and after clinical recovery, defined as symptom resolution and return to sport clearance (T3). Control participants completed the protocol in similar temporal increments as concussion participants. All participants completed a multifaceted protocol that included a symptom inventory (PCSS), a dual-task gait evaluation, an electroencephalography (EEG)-based auditory oddball task, and objective eye tracking. Repeated measures ANCOVAs were used to evaluate between group differences with sex, age, and prior concussions as covariates. We also examined if the rate of change across time for each outcome variable was different between groups using analysis of response profiles for longitudinal data. RESULTS: Sixty-seven athletes participated: 36 post-concussion (age= 14.0±2.6 years; 44% female) and 31 controls (age=14.6±2.2 years; 39% female). Concussion symptoms were significantly higher for the concussion group compared to controls at T1 (PCSS=31.7±18.8 vs. 1.9±2.9; p<0.001) and T2 (PCSS=10.8±11.2 vs. 1.8±3.6; p=0.001), but resolved by T3 (PCSS=1.7±3.6 vs. 2.0±3.8; p=0.46). The concussion group walked significantly slower during dual-task gait than controls at each of the three tests (0.83±0.19 vs. 0.95±0.15 m/s; p=0.049). We found no significant differences between groups for the EEG oddball task or objective eye tracking measures. The EEG auditory oddball connectivity recovery trajectory differed significantly between groups, where the concussion group scores decreased and the control group scores increased across the testing timeline (χ2=14.1, p=0.001). CONCLUSIONS: Despite symptom resolution, athletes with concussion displayed altered dual-task gait speeds at their final visit and their auditory oddball connectivity scores worsened throughout the test timeline. A multimodal and objective approach to concussion monitoring may support clinicians in the detection of brain function deficits that are undetectable with standard clinical assessments.