Examining Cognitive-Motor Integration, Persistent Symptoms, and Brain Function in Individuals with Concussion

In everyday life we interact with our environment in an indirect way, where there is a mapping between the viewed goal of our action and the required movement (e.g., using a computer mouse). Such tasks require cognitive-motor integration (CMI), where rules dictate the relationship between perception and action. The underlying CMI control networks that rely on intact frontal, parietal, and subcortical brain region connectivity may be compromised following concussion, resulting in an impaired ability to engage in complex movements. Here we investigate whether such relationships also exist in working-aged adults with persistent post-concussion symptoms (PPCS). Methods: Twenty-two individuals (5 males) performed two visuomotor tasks: one requiring direct (standard) interaction with visual targets, and one comprising a plane-change and feedback reversal (non-standard interaction) between viewed target and required hand motion (CMI). PPCS and dizziness were related to brain network function via resting state functional connectivity (RSFC) in six networks and structural integrity via cortical thickness in CMI-related brain regions and white matter tracts via diffusion tensor imaging. Results: We observed that lower cortical thickness in the inferior and superior parietal cortices were associated with dizziness and impaired non-standard visuomotor performance, respectively. Furthermore, higher PPCS severity was associated with hyperconnectivity within the visual, sensorimotor control, frontoparietal control, and dorsal attention networks, whilst hyperconnectivity within the salience ventral attention network was associated with higher non-standard visuomotor performance. Lastly, we found that lower white matter tract integrity in several long associative, projection, and commissural tracts were associated with lower visuomotor performance, PPCS severity, and dizziness. Conclusions: These findings characterise the impact of PPCS on the structure and function underlying impaired visuomotor performance, and suggest that CMI may be a non-invasive, easily accessible tool for brain network function assessment in those affected by concussion.