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June 2022; 12 (3) ResearchOpen Access

Cognitive-Motor Dissociation Following Pediatric Brain Injury

What About the Children?

View ORCID ProfileNayoung Kim, James O'Sullivan, Emily Olafson, Eric Caliendo, Sophie Nowak, Henning U. Voss, Ryan Lowder, William D. Watson, View ORCID ProfileJana Ivanidze, View ORCID ProfileJoseph J. Fins, Nicholas D. Schiff, N. Jeremy Hill, Sudhin A. Shah
First published March 29, 2022, DOI: https://doi.org/10.1212/CPJ.0000000000001169
Nayoung Kim
Department of Radiology (NK, JOS, EO, HUV, JI, SAS) and Department of Rehabilitation Medicine (EC, RL), Weill Cornell Medicine, New York; Blythedale Children's Hospital (SN, WDW), Valhalla, NY; Division of Medical Ethics (JJF), Weill Cornell Medicine and New York Presbyterian Weill Cornell Medical Center; Department of Neurology and BMRI (NDS), Weill Cornell Medicine, New York; National Center for Adaptive Neurotechnologies (NJH), Stratton VA Medical Center; and Department of Electrical and Computer Engineering (NJH), State University of New York at Albany, NY.
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James O'Sullivan
Department of Radiology (NK, JOS, EO, HUV, JI, SAS) and Department of Rehabilitation Medicine (EC, RL), Weill Cornell Medicine, New York; Blythedale Children's Hospital (SN, WDW), Valhalla, NY; Division of Medical Ethics (JJF), Weill Cornell Medicine and New York Presbyterian Weill Cornell Medical Center; Department of Neurology and BMRI (NDS), Weill Cornell Medicine, New York; National Center for Adaptive Neurotechnologies (NJH), Stratton VA Medical Center; and Department of Electrical and Computer Engineering (NJH), State University of New York at Albany, NY.
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Emily Olafson
Department of Radiology (NK, JOS, EO, HUV, JI, SAS) and Department of Rehabilitation Medicine (EC, RL), Weill Cornell Medicine, New York; Blythedale Children's Hospital (SN, WDW), Valhalla, NY; Division of Medical Ethics (JJF), Weill Cornell Medicine and New York Presbyterian Weill Cornell Medical Center; Department of Neurology and BMRI (NDS), Weill Cornell Medicine, New York; National Center for Adaptive Neurotechnologies (NJH), Stratton VA Medical Center; and Department of Electrical and Computer Engineering (NJH), State University of New York at Albany, NY.
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Eric Caliendo
Department of Radiology (NK, JOS, EO, HUV, JI, SAS) and Department of Rehabilitation Medicine (EC, RL), Weill Cornell Medicine, New York; Blythedale Children's Hospital (SN, WDW), Valhalla, NY; Division of Medical Ethics (JJF), Weill Cornell Medicine and New York Presbyterian Weill Cornell Medical Center; Department of Neurology and BMRI (NDS), Weill Cornell Medicine, New York; National Center for Adaptive Neurotechnologies (NJH), Stratton VA Medical Center; and Department of Electrical and Computer Engineering (NJH), State University of New York at Albany, NY.
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Sophie Nowak
Department of Radiology (NK, JOS, EO, HUV, JI, SAS) and Department of Rehabilitation Medicine (EC, RL), Weill Cornell Medicine, New York; Blythedale Children's Hospital (SN, WDW), Valhalla, NY; Division of Medical Ethics (JJF), Weill Cornell Medicine and New York Presbyterian Weill Cornell Medical Center; Department of Neurology and BMRI (NDS), Weill Cornell Medicine, New York; National Center for Adaptive Neurotechnologies (NJH), Stratton VA Medical Center; and Department of Electrical and Computer Engineering (NJH), State University of New York at Albany, NY.
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Henning U. Voss
Department of Radiology (NK, JOS, EO, HUV, JI, SAS) and Department of Rehabilitation Medicine (EC, RL), Weill Cornell Medicine, New York; Blythedale Children's Hospital (SN, WDW), Valhalla, NY; Division of Medical Ethics (JJF), Weill Cornell Medicine and New York Presbyterian Weill Cornell Medical Center; Department of Neurology and BMRI (NDS), Weill Cornell Medicine, New York; National Center for Adaptive Neurotechnologies (NJH), Stratton VA Medical Center; and Department of Electrical and Computer Engineering (NJH), State University of New York at Albany, NY.
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Ryan Lowder
Department of Radiology (NK, JOS, EO, HUV, JI, SAS) and Department of Rehabilitation Medicine (EC, RL), Weill Cornell Medicine, New York; Blythedale Children's Hospital (SN, WDW), Valhalla, NY; Division of Medical Ethics (JJF), Weill Cornell Medicine and New York Presbyterian Weill Cornell Medical Center; Department of Neurology and BMRI (NDS), Weill Cornell Medicine, New York; National Center for Adaptive Neurotechnologies (NJH), Stratton VA Medical Center; and Department of Electrical and Computer Engineering (NJH), State University of New York at Albany, NY.
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William D. Watson
Department of Radiology (NK, JOS, EO, HUV, JI, SAS) and Department of Rehabilitation Medicine (EC, RL), Weill Cornell Medicine, New York; Blythedale Children's Hospital (SN, WDW), Valhalla, NY; Division of Medical Ethics (JJF), Weill Cornell Medicine and New York Presbyterian Weill Cornell Medical Center; Department of Neurology and BMRI (NDS), Weill Cornell Medicine, New York; National Center for Adaptive Neurotechnologies (NJH), Stratton VA Medical Center; and Department of Electrical and Computer Engineering (NJH), State University of New York at Albany, NY.
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Jana Ivanidze
Department of Radiology (NK, JOS, EO, HUV, JI, SAS) and Department of Rehabilitation Medicine (EC, RL), Weill Cornell Medicine, New York; Blythedale Children's Hospital (SN, WDW), Valhalla, NY; Division of Medical Ethics (JJF), Weill Cornell Medicine and New York Presbyterian Weill Cornell Medical Center; Department of Neurology and BMRI (NDS), Weill Cornell Medicine, New York; National Center for Adaptive Neurotechnologies (NJH), Stratton VA Medical Center; and Department of Electrical and Computer Engineering (NJH), State University of New York at Albany, NY.
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Joseph J. Fins
Department of Radiology (NK, JOS, EO, HUV, JI, SAS) and Department of Rehabilitation Medicine (EC, RL), Weill Cornell Medicine, New York; Blythedale Children's Hospital (SN, WDW), Valhalla, NY; Division of Medical Ethics (JJF), Weill Cornell Medicine and New York Presbyterian Weill Cornell Medical Center; Department of Neurology and BMRI (NDS), Weill Cornell Medicine, New York; National Center for Adaptive Neurotechnologies (NJH), Stratton VA Medical Center; and Department of Electrical and Computer Engineering (NJH), State University of New York at Albany, NY.
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  • ORCID record for Joseph J. Fins
Nicholas D. Schiff
Department of Radiology (NK, JOS, EO, HUV, JI, SAS) and Department of Rehabilitation Medicine (EC, RL), Weill Cornell Medicine, New York; Blythedale Children's Hospital (SN, WDW), Valhalla, NY; Division of Medical Ethics (JJF), Weill Cornell Medicine and New York Presbyterian Weill Cornell Medical Center; Department of Neurology and BMRI (NDS), Weill Cornell Medicine, New York; National Center for Adaptive Neurotechnologies (NJH), Stratton VA Medical Center; and Department of Electrical and Computer Engineering (NJH), State University of New York at Albany, NY.
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N. Jeremy Hill
Department of Radiology (NK, JOS, EO, HUV, JI, SAS) and Department of Rehabilitation Medicine (EC, RL), Weill Cornell Medicine, New York; Blythedale Children's Hospital (SN, WDW), Valhalla, NY; Division of Medical Ethics (JJF), Weill Cornell Medicine and New York Presbyterian Weill Cornell Medical Center; Department of Neurology and BMRI (NDS), Weill Cornell Medicine, New York; National Center for Adaptive Neurotechnologies (NJH), Stratton VA Medical Center; and Department of Electrical and Computer Engineering (NJH), State University of New York at Albany, NY.
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Sudhin A. Shah
Department of Radiology (NK, JOS, EO, HUV, JI, SAS) and Department of Rehabilitation Medicine (EC, RL), Weill Cornell Medicine, New York; Blythedale Children's Hospital (SN, WDW), Valhalla, NY; Division of Medical Ethics (JJF), Weill Cornell Medicine and New York Presbyterian Weill Cornell Medical Center; Department of Neurology and BMRI (NDS), Weill Cornell Medicine, New York; National Center for Adaptive Neurotechnologies (NJH), Stratton VA Medical Center; and Department of Electrical and Computer Engineering (NJH), State University of New York at Albany, NY.
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Full PDF
Citation
Cognitive-Motor Dissociation Following Pediatric Brain Injury
What About the Children?
Nayoung Kim, James O'Sullivan, Emily Olafson, Eric Caliendo, Sophie Nowak, Henning U. Voss, Ryan Lowder, William D. Watson, Jana Ivanidze, Joseph J. Fins, Nicholas D. Schiff, N. Jeremy Hill, Sudhin A. Shah
Neurol Clin Pract Jun 2022, 12 (3) 248-257; DOI: 10.1212/CPJ.0000000000001169

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    Figure 1 Structural and Metabolic Integrity

    Left panels A–F: 16-year-old male P1 (traumatic brain injury at age 9). Right panels G–L: 18-year-old male P2 (anoxic brain injury at age 13). Panels A, C, and E for P1 and Panels G, I, and K for P2 show axial, coronal, and sagittal fused PET/CT windowed at 0–9 standardized uptake value (SUV) for P1 and 0–13 SUV for P2; Panels B, D, and F for P1 and Panels H, J, and L for P2 show the corresponding T1 MPRAGE MRI.

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    Figure 2 Command-Following Using EEG and fMRI

    Scalp maps show changes in EEG spectral power during attempted hand movement in the alpha (8–12 Hz) frequency band. EEG results are show from P1's session 3 (panels A–D) and P2's session 2 (F–I): colored scalp maps display average difference in log spectral power between attempted movement and baseline at rest. Grayscale maps represent the p value of a two-group test performed separately at each electrode position. Overall p value is from a 1-sided permutation test of a statistic reflecting contralateral desynchronization (reduction in EEG spectral power) and ipsilateral synchronization (increase in power). Panels (E) and (J) show bilateral fMRI responses in BA6 to the command “Move your left arm” (highlighting activation in the right hemisphere in the leftmost panel) for the second of P1's 2 sessions and P2's single session, respectively; colors indicate significant t-statistics.

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    Figure 3 EEG Correlates of Auditory Stimulus Processing

    The log noise-corrected magnitudes of the auditory evoked potential (AEP, A) and P300 event-related potential (ERP, B) are shown for P1 and P2 in comparison with 10 other pediatric participants with brain injury.13 Participants are split into 4 groups according to whether they were in a disorder of consciousness (DoC) or had emerged from DoC into confusional state (CS) and whether they had positive or negative EEG findings in motor command-following (MCF-EEG + or – ).

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    Figure 4 Time-Locked EEG Correlates of Semantic Processing

    From a single representative session with P1 (A) and another with P2 (B), event-related potentials from electrode position Cz are shown time-locked to the onset of the last word in a sentence, which is either semantically congruent (blue) or incongruent (orange) with the preceding sentence context. Time points at which there was a statistically significant difference (p < 0.05) between conditions are indicated with a black line and asterisks.

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