Ghent University Hospital, Child Rehabilitation Centre K7, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
Ghent University, Department of Experimental Psychology, Faculty of Psychology and Educational Sciences, Henri Dunantlaan 2, 9000 Ghent, Belgium.
Neuroimage Clin. 2019;23:101827. doi: 10.1016/j.nicl.2019.101827. Epub 2019 Apr 16.
Sustaining a traumatic brain injury (TBI) during adolescence has a profound effect on brain development and can result in persistent executive functioning deficits in daily life. Cognitive recovery from pediatric-TBI relies on the potential of neuroplasticity, which can be fostered by restorative training-programs. However the structural mechanisms underlying cognitive recovery in the immature brain are poorly understood. This study investigated gray matter plasticity following 2 months of cognitive training in young patients with TBI. Sixteen adolescents in the chronic stage of moderate-severe-TBI (9 male, mean age = 15y8m ± 1y7m) were enrolled in a cognitive computerized training program for 8 weeks (5 times/week, 40 min/session). Pre-and post-intervention, and 6 months after completion of the training, participants underwent a comprehensive neurocognitive test-battery and anatomical Magnetic Resonance Imaging scans. We selected 9 cortical-subcortical Regions-Of-Interest associated with Executive Functioning (EF-ROIs) and 3 control regions from the Desikan-Killiany atlas. Baseline analyses showed significant decreased gray matter density in the superior frontal gyri p = 0.033, superior parietal gyri p = 0.015 and thalamus p = 0.006 in adolescents with TBI compared to age and gender matched controls. Linear mixed model analyses of longitudinal volumetric data of the EF-ROI revealed no strong evidence of training-related changes in the group with TBI. However, compared to the change over time in the control regions between post-intervention and 6 months follow-up, the change in the EF-ROIs showed a significant difference. Exploratory analyses revealed a negative correlation between the change on the Digit Symbol Substitution test and the change in volume of the putamen (r = -0.596, p = 0.015). This preliminary study contributes to the insights of training-related plasticity mechanisms after pediatric-TBI.
青少年时期持续遭受创伤性脑损伤（TBI）会对大脑发育产生深远影响，并可能导致日常生活中持续存在执行功能缺陷。儿科 TBI 的认知康复依赖于神经可塑性的潜力，而这可以通过修复性训练计划来促进。然而，未成熟大脑中认知康复的结构机制仍知之甚少。本研究调查了 16 名处于中度至重度 TBI 慢性期的青少年患者在接受 2 个月认知训练后的灰质可塑性。这些患者均为男性（9 名），平均年龄为 15 岁 8 个月±1 岁 7 个月，他们参加了为期 8 周的认知计算机训练计划（每周 5 次，每次 40 分钟）。在干预前、干预后和训练完成后 6 个月，参与者接受了全面的神经认知测试和解剖磁共振成像扫描。我们从 Desikan-Killiany 图谱中选择了与执行功能（EF）相关的 9 个皮质下区域（EF-ROI）和 3 个对照区域。基线分析显示，与年龄和性别匹配的对照组相比，TBI 青少年的额上回（p=0.033）、顶上回（p=0.015）和丘脑（p=0.006）的灰质密度显著降低。对 EF-ROI 纵向体积数据的线性混合模型分析显示，TBI 组没有强烈的训练相关变化证据。然而，与干预后和 6 个月随访之间对照区域的时间变化相比，EF-ROI 的变化显示出显著差异。探索性分析显示，数字符号替代测验的变化与壳核体积的变化呈负相关（r=-0.596，p=0.015）。这项初步研究为儿科 TBI 后的训练相关可塑性机制提供了新的见解。
