Perceptual-cognitive training after pediatric mild traumatic brain injury: Towards a sensitive marker of recovery Laurie-Ann Corbin-Berrigan B.Sc (Athletic Therapy), CAT(C), M.Sc (Experimental Medicine) School of Physical and Occupational Therapy Faculty of Medicine McGill University, Montreal December, 2018 A thesis submitted to McGill University in partial fulfillment of the requirements of the degree of Doctorate in Philosophy (Rehabilitation Science) ©Laurie-Ann Corbin-Berrigan, 2018 For Sylvie & Kenneth, my greatest collaborators For Émy, may auntie’s work have a positive impact on your generation ii Table of Contents LIST OF TABLES ..................................................................................................................................... VI LIST OF FIGURES ................................................................................................................................. VII ABSTRACT ............................................................................................................................................ VIII ABRÉGÉ .................................................................................................................................................. XII ACKNOWLEDGEMENTS ..................................................................................................................... XV PREFACE ............................................................................................................................................ XVIII Statement of originality ........................................................................................................................................................... xviii Contribution of authors .............................................................................................................................................................. xix CHAPTER 1: INTRODUCTION ............................................................................................................. 1 CHAPTER 2: BACKGROUND ................................................................................................................ 3 MILD TRAUMATIC BRAIN INJURY ........................................................................................................................... 3 Definition .............................................................................................................................................................................................. 3 Incidence ............................................................................................................................................................................................... 3 Clinical Presentation of mTBI .......................................................................................................................... 4 Physical and cognitive presentation of mTBI ....................................................................................................................... 4 Pathophysiology .................................................................................................................................................... 5 Potential lasting deficits of mTBI and their clinical implication ..................................................... 5 MTBI markers of recovery ............................................................................................................................................................ 6 MTBI recovery in the pediatric population ............................................................................................... 6 Clinical Management of MTBI ......................................................................................................................... 7 Interventions for delayed recovery ........................................................................................................................................... 8 Proposed suggestions with regards to mTBI clinical recovery ......................................................... 9 PERCEPTUAL-COGNITIVE TRAINING ............................................................................................ 10 Perceptual-Cognition ....................................................................................................................................... 10 Targeting brain plasticity ........................................................................................................................................................... 10 Multiple object tracking .............................................................................................................................................................. 11 Multiple object tracking in the pediatric population ...................................................................................................... 12 Perceptual-Cognitive training through Three-Dimensional Multiple Object tracking ....... 12 3D-Multiple object tracking as a detection tool ................................................................................... 16 3D-Multiple object tracking in the pediatric population ................................................................. 16 CHAPTER 3: RATIONALE AND OBJECTIVES ................................................................................ 18 CHAPTER 4: INTRODUCTION TO THE 1ST MANUSCRIPT ........................................................ 20 CHAPTER 5: MANUSCRIPT I ............................................................................................................. 21 POST-CONCUSSION SYMPTOMS AS A MARKER OF DELAYED RECOVERY IN CHILDREN AND YOUTH WHO RECENTLY SUSTAINED A CONCUSSION: A BRIEF REPORT ................................................................................ 21 Abstract .............................................................................................................................................................................................. 22 Introduction ...................................................................................................................................................................................... 23 Methods .............................................................................................................................................................................................. 24 Statistical analyses ......................................................................................................................................................................... 25 Results ................................................................................................................................................................................................. 25 Discussion .......................................................................................................................................................................................... 28 References ......................................................................................................................................................................................... 30 CHAPTER 6: INTEGRATION OF MANUSCRIPT I AND II ............................................................ 32 CHAPTER 7: MANUSCRIPT II ............................................................................................................ 33 iii ENHANCING BRAIN PLASTICITY THROUGH PERCEPTUAL COGNITIVE TRAINING: THREE DIMENSIONAL MULTIPLE OBJECT TRACKING AND ITS POTENTIAL ROLE IN POST-CONCUSSION SYMPTOM RESOLUTION IN THE PEDIATRIC POPULATION ............................................................................................................................... 33 Abstract .............................................................................................................................................................................................. 34 Introduction ...................................................................................................................................................................................... 35 Underlying brain mechanisms of active rehabilitation after mTBI .......................................................................... 36 Potential causes of Post-Concussive Symptoms ............................................................................................................... 37 An innovative research/training method: Three Dimensional Multiple Object Tracking ............................. 39 Active components of the NeuroTracker platform .......................................................................................................... 40 Discussion .......................................................................................................................................................................................... 43 References ......................................................................................................................................................................................... 45 CHAPTER 8: INTEGRATION OF MANUSCRIPTS II AND III ....................................................... 55 CHAPTER 9: MANUSCRIPT III .......................................................................................................... 56 THE USE OF THREE-DIMENSIONAL MULTIPLE OBJECT TRACKING AS A MEAN OF ACTIVE REHABILITATION IN CHILDREN WHO ARE EXPERIENCING