Associations Between Changes in Psychological Resilience and Resting-State Functional Connectivity Throughout Pediatric Concussion Recovery

Abstract

Purpose:

This study investigated the association between psychological resilience and resting-state network functional connectivity of three major brain networks in pediatric concussion.

Methods:

This was a substudy of a randomized controlled trial, recruiting children with concussion and orthopedic injury. Participants completed the Connor–Davidson Resilience 10 Scale and underwent magnetic resonance imaging at 72 h and 4-weeks postinjury. We explored associations between resilience and connectivity with the default mode network (DMN), central executive network (CEN), and salience network (SN) at both timepoints and also any change that occurred over time. We also explored associations between resilience and connectivity within each network.

Results:

A total of 67 children with a concussion (median age = 12.87 [IQR: 11.79–14.36]; 46% female) and 30 with orthopedic injury (median age = 12.27 [IQR: 11.19–13.94]; 40% female) were included. Seed-to-voxel analyses detected a positive correlation between 72-h resilience and CEN connectivity in the concussion group. Group moderated associations between resilience and SN connectivity at 72 h, as well as resilience and DMN connectivity over time. Regions-of-interest analyses identified group as a moderator of longitudinal resilience and within-DMN connectivity.

Conclusions:

These results suggest that neural recovery from concussion could be reliant on resilience. Resilience was related to functional connectivity with three of the main networks in the brain that are often impacted by concussion. Improving resilience might be investigated as a modifiable variable in children as both a protective and restorative in the context of concussion.

Clinical Trial Registration Identifier: NCT05105802. PedCARE^+MRI team (see Supplementary Appendix S1)

Impact Statement

This work contributes to recent evidence suggesting an association between psychological resilience and outcomes following pediatric concussion. Specifically, we identified several significant associations between resilience postconcussion and functional connectivity of major resting state networks in the brain. These results compliment findings reported in the literature that resilience is associated with postconcussion symptomatology, as well as quality of life. This study may serve to support future investigations of resilience-targeted interventions following pediatric concussion and its impact on neural and clinical outcomes.