ATLANTA—A recent study by researchers from Georgia State University and the University of Calgary found the brain scans of children who’ve suffered concussions generally show minor differences several months after a concussion as compared to those of children who’ve experienced broken bones and other orthopedic injuries.
Concussions, a type of mild traumatic brain injury, are common in children. As many as 25 percent of children and adults who suffer such injuries are still dealing with symptoms such as fatigue or headaches three to -four weeks after injury, when most people have recovered.
“We’re interested in understanding what can we do to predict or understand what’s going on biologically in the children who don’t recover like their peers,” said Dr. Ashley Ware, an assistant professor of psychology at Georgia State and lead author of the paper.
The study, published in the journal Neurology, examined MRI scans of the brains of 623 children in Canada who were taken to emergency rooms within 48 hours of suffering a concussion or a mild orthopedic injury. The children underwent scans 10 days after the injury and again three or six months later.
Researchers assessed the scans — examining 50 regions of the brain — as well as clinical reports of the children’s symptoms and reports from their parents.
The study did not find noteworthy differences in the first month after the concussion in the brains of children who went to the emergency room with a concussion as compared to those with orthopedic injuries. This confirmed that imaging did not provide a useful tool for diagnosing concussions or predicting which youth would take longer to recover, said Ware, who was a postdoctoral fellow at UCalgary during the studies with her supervisor and co-author Dr. Keith Yeates, a professor in the Department of Psychology.
Some subtle and diffuse differences developed over time in the cortex, the region closest to the skull, among children who were recovering more slowly, suggesting that “concussion is altering the brain structure subtly,” Ware said. But the differences were not pronounced enough or consistent enough at the individual level for MRI scans to be a useful clinical tool for concussions, she said. It’s unclear whether neuroinflammation or another process may be causing the changes among youth whose recovery is poor.
Another recent study by the researchers should provide reassurance to parents who worry about the effects of concussions on their children. The paper, published in the journal Pediatrics, found that children’s IQ and general intelligence are not harmed by concussions.
These findings are important to share with parents, said Ware.
“Understandably, there’s been a lot of fear among parents when dealing with their children’s concussions,” Ware said. “These new findings provide really good news, and we need to get the message to parents.”
The Pediatrics study compared 566 children diagnosed with concussion to 300 with orthopedic injuries who were taken to emergency departments in Canada and Ohio, with a focus on possible effects on IQ and general intelligence.
“Obviously there’s been a lot of concern about the effects of concussion on children, and one of the biggest questions has been whether or not it affects a child’s overall intellectual functioning,” said Yeates, an expert on the outcomes of childhood brain disorders, including concussion and traumatic brain injuries. He noted that data in previous studies has been mixed and opinions have been varied in the medical community.
The research found that socioeconomic status, patient sex, severity of injuries, concussion history and whether there was a loss of consciousness at the time of injury were not factors that made a difference, he said.
“Across the board, concussion was not associated with lower IQ,” Yeates said.
The studies assessed children ranging in age from 8 to 16.
Both studies are noteworthy for using a control group of children who have suffered orthopedic injuries rather than comparing children who have had head injuries only to non-injured children. This allowed researchers to consider whether other factors such as experiencing pain and stress or may be important for understanding why some children take longer to recover from concussions.
The studies are also unusual for following up with the children months after the initial injury.
Ware noted that the time period involved in the IQ study should be especially reassuring to parents.
“We can demonstrate that even in those first days and weeks after concussion, when children do show symptoms such as pain and fatigue, there’s no hit to their global intelligence,” Ware said. “Then it’s the same story three months out, when most children have recovered from their concussion symptoms. Thanks to this study we can say that, consistently, we would not expect IQ to be diminished from when children are symptomatic to when they’ve recovered.”
Ashley L. Ware
Ashley Ware's long-term career goal is to conduct innovative research on mild traumatic brain injury (TBI) that benefits the public and contributes to scientific and clinical advances at local, national, and international levels. Her interdisciplinary research uniquely bridges a gap between cutting-edge neuroimaging techniques and clinical neuropsychology.