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A Functional Near Infrared Spectroscopy Investigation of the Physiological Underpinnings of Visual Cognitive Workload After Concussion
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A Functional Near Infrared Spectroscopy Investigation of the Physiological Underpinnings of Visual Cognitive Workload After Concussion

Christina Master, Eileen Storey, Lei Wang, Matthew Grady, Catherine McDonald, Susan Margulies, Kristy Arbogast and Hasan Ayaz
Orthopaedic journal of sports medicine, v 10(5 supplement 2), 2325967121
01 May 2022
DOI: https://doi.org/10.1177/2325967121S00406
url
https://doi.org/10.1177/2325967121s00406View
Published, Version of Record (VoR)CC BY-NC-ND V4.0,  Open
url
https://doi.org/10.1177/2325967121S00406View
Published, Version of Record (VoR) Open

Abstract

Background: In concussion, functional near infrared spectroscopy (fNIRS) has been shown to detect differences in cortical oxygenation during neurocognitive testing, with concussed adults manifesting less task-based cortical activation compared to controls. In addition, fNIRS has identified significantly reduced interhemispheric coherence in adult concussions relative to controls. In addition, adults with greater post-concussive symptom burden demonstrate lower task-related oxygenation in the frontal and dorsolateral prefrontal cortex (DLPFC) and reduced connectivity compared to controls. Hypothesis: The goal of this study was to use fNIRS to identify any differences in visual task-related cortical activation between concussed adolescents and healthy controls while performing a the King-Devick (KD) test. Methods: We enrolled 112 adolescents, ages 12-18 years, with recent concussion and 165 healthy controls as part of a large observational prospective cohort. Participants were provided standardized instructions to read the KD cards while wearing the fNIRS sensor pad. The relative changes in the difference of oxy-and deoxy-hemoglobin concentrations over each task condition for each optode were calculated via the Modified Beer-Lambert Law using local baselines for each task condition period as its beginning. The averaged oxy-hemoglobin concentration changes for each task period were used for statistical analysis of group (e.g., concussed vs healthy) effect. Results: The concussed adolescents (n=112) and healthy controls (n=165) were demographically comparable with respect to age, sex, and race/ethnicity. The concussed group was more likely to have a history of prior concussion (p = <.0001) and migraine (p = .0001) compared to the healthy control group (Table 1). The concussed adolescents were assessed with fNIRS while performing a visual task a median of 10 days after injury (IQR 4-16). The concussed group had significantly lower oxygenation changes that are the difference between oxygenated and deoxygenated hemoglobin as an indicator of task-evoked response, on left lateral prefrontal area (p<.005, FDR q<.005). As expected, there was also a main effect for task condition (cards) at right lateral prefrontal cortex (p<.001, FDR q<.005). Conclusions: fNIRS is able to distinguish concussed adolescents from healthy controls while performing a visual-cognitive task, the K-D test. Injured adolescents with concussion demonstrated a compensatory pattern of cortical activation, suggesting localized brain dysfunction, recruiting from both hemispheres, distinguishing it from the pattern of cortical activation in healthy controls. fNIRS, as a modality, is not only able to differentiate concussion from healthy controls, but also captures the compensatory mechanisms of cortical activation that underlie visual cognitive function after injury.

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