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Functional Near-Infrared Spectroscopy Identifies Differences in Cognitive Workload Following Pediatric Concussion Associated with Symptom Provocation
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Functional Near-Infrared Spectroscopy Identifies Differences in Cognitive Workload Following Pediatric Concussion Associated with Symptom Provocation

Christina Master, Hasan Ayaz, Eileen Storey, Lei Wang, Olivia Podolak, Matthew Grady, Andrew Mayer and Kristy Arbogast
Pediatrics (Evanston), v 144(2_MeetingAbstract), 197
01 Aug 2019
url
https://doi.org/10.1542/peds.144.2ma2.197View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze) Open

Abstract

Accuracy Cognitive ability Concussion Infrared spectra Infrared spectroscopy Near infrared radiation Oxygenation Prefrontal cortex Prolongation Spectrum analysis Working conditions Workload Workloads Change Detection Medical Imaging Neuroimaging Spectroscopy
PURPOSE: To determine whether functional near infrared spectroscopy (fNIRS), a noninvasive imaging modality detecting oxygenation changes reflective of cognitive workload, distinguishes physiologic differences between concussion subjects and healthy controls during King-Devick (KD) testing, a rapid number naming task that has been shown to identify those with concussion METHODS: A total of 226 participants volunteered for the study. We recruited 114 cases of concussion, ages 7 to 21 years, 51% female, and 112 healthy controls, ages 10-21 years, 47% female from a subspecialty referral concussion program for this prospective case control study where the subjects performed the KD test while wearing a fNIRS device consisting of a headband which records anterior prefrontal cortex oxygenation changes with 4 optodes at a 4Hz sampling rate. The main outcome measures were KD completion times, accuracy, symptom provocation and cortical oxygenation changes during KD testing. RESULTS: Concussion subjects demonstrated longer times, worse accuracy and greater oxygenation change on fNIRS compared to healthy controls. However, KD times and accuracy did not distinguish between those with and without symptom provocation upon testing. In contrast, fNIRS was able to detect significant task-related activity differences between symptomatic and asymptomatic subjects (F1,2559=22.4, p<0.0001), with the symptomatic group exhibiting greater oxygenation change with testing. CONCLUSIONS: Based on our data, the prolongation of KD times observed following concussion has physiologic correlates with increased cognitive workload. Among subjects with concussion, KD times did not distinguish between those with and those without symptom provocation upon testing. In contrast, fNIRS was able to differentiate between these two subgroups of concussion, with symptomatic subjects exhibiting a pattern of greater cognitive workload compared to asymptomatic. As a modality, fNIRS has utility in detecting subclinical differences in cognitive workload in concussion. In addition, our data supports the concept that the physiologic basis for symptom provocation in concussion may be related to cognitive overload.

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