Auditory processing in children recovering from a concussion: biological insights

Background: Medical management of concussions remains an imperfect science. Clinicians must weigh self-reported symptoms across multiple systems; recognition of the visual and vestibular sequelae of concussions has augmented concussion care. We now aim to understand auditory processing in children recovering from a concussion, with the idea that. Our central hypothesis is that concussions disrupt the brain mechanisms that support auditory processing, meaning we predict that sensitive tests of auditory processing provide important clinical information in children recovering from a concussion. Aims: The goals of this project are to characterize auditory processing in a diverse group of children diagnosed with a concussion and to accurately map stepwise improvement in auditory processing skills as children recover from their concussions. Study Design: Children diagnosed with a concussion (N = 150; ages 8-18 yr) will be recruited from a tertiary-care sports medicine clinic (from a pool of 300/yr). Children are boys and girls with diverse injury mechanisms (multiple sports, falls, and accidents). Diagnoses and clearance follow the Berlin consensus statement (McCrory et al., 2017, Br J Sports Med). Children will be tested on behavioral and electrophysiological measures of auditory processing when are diagnosed with a concussion and again at each visit until they are cleared to resume all athletic activities (≈2-4 visits/patient). Materials and Methods: We use two tests of auditory processing: (1) a test of the ability to understand speech in noise environments (SIN), which simulates everyday environments such as classrooms; and (2) an objective electrophysiological test of the integrity of sound processing in the central nervous system, called the frequency-following response (FFR). Uniquely, the FFR requires no behavioral response from patients, meaning it is a completely objective test. Main Outcome Measure: Our preliminary work shows that children with postconcu