EOGElectrooculography ERP Event-related potential LPC Late positivity component mTBI Mild traumatic brain injury AIM Arithmetic difficulties have been reported in children with mild traumatic brain injury (mTBI), but the electrophysiological abnormalities underlying these impairments remain unknown. We therefore used event-related potentials (ERPs) to investigate brain functioning during arithmetic in children in the subacute phase after mTBI.METHOD The participants comprised 16 children with mTBI at the subacute phase of recovery (10 males, mean age 10y 8mo; six females, mean age 10y 8mo) and 16 well-matched comparison children (11 males, mean age 10y 11mo; five females, mean age 10y 6mo). All children were asked to solve single-digit addition problems of small (sum ≤10) and large problem size (sum >10) and ERPs were simultaneously recorded.
RESULTSChildren with mTBI performed significantly less accurately (mean 81%) than comparison children (mean 91%) on the large (p=0.026) but not on the small problems (p=0.171). We observed no group differences in the early ERP components P1, N1, P2, and N2 (all p values ≥0.241), yet significant group differences (p=0.019) emerged for the late positivity component (LPC), which showed smaller mean amplitudes (mean 8.35lV) in mTBI patients than comparison children (mean 12.95lV).INTERPRETATION Immediately after the injury, arithmetic difficulties in children with mTBI are particularly pronounced on more complex arithmetical problems that are less automated. This is reflected in the ERP pattern, with decreased LPC but normal N2 and early ERP components.Paediatric mild traumatic brain injury (mTBI) is known to produce cognitive problems (such as deficits in working memory) as well as academic difficulties (predominantly problems regarding arithmetic) at the subacute stage of the injury. 1-3 These cognitive and arithmetic difficulties are subtle, even though they may influence daily activities or performance at school. 4 Recently, neuroimaging, such as functional magnetic resonance imaging, and electrophysiological techniques, such as event-related potentials (ERPs) have started to unravel the underlying neurophysiological bases of cognitive dysfunctions associated with mTBI. ERPs are an ideal method for monitoring the flow of information in the brain during the performance of a cognitive task, even in the case of subtle cognitive deficits that might not always be detected by means of standard clinical tests, such as arithmetic difficulties in mTBI. This approach has also an excellent temporal resolution, which gives researchers the ability to follow cognitive processes with milliseconds precision. To the best of our knowledge, no ERP study in arithmetic has been conducted in mTBI patients. Moreover, there have been no group studies in children with mTBI investigating the subacute stage of injury. We therefore used ERPs during an arithmetic task to refine our understanding of arithmetical difficulties in pediatric mTBI at the subacute stage of recovery (i.e. 4wks after injury).Va...