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

J Head Trauma Rehabil. Nov/Dec 2017;32(6):378-384. doi: 10.1097/HTR.0000000000000318.


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.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Brain Concussion / diagnostic imaging
  • Brain Concussion / rehabilitation
  • Case-Control Studies
  • Diffusion Tensor Imaging / methods*
  • Exercise / physiology*
  • Exercise Therapy / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Image Processing, Computer-Assisted*
  • Magnetic Resonance Imaging / methods
  • Male
  • Monitoring, Physiologic / methods
  • Pilot Projects
  • Post-Concussion Syndrome / diagnostic imaging*
  • Post-Concussion Syndrome / rehabilitation*
  • Risk Assessment
  • Sickness Impact Profile
  • Time Factors
  • Treatment Outcome