Related Experiment Video
Updated: Feb 1, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Subtle Motor Signs in Children With Chronic Traumatic Brain Injury
Jewel E Crasta1, Jamie Sibel, Beth S Slomine
1From the Kennedy Krieger Institute, Baltimore, Maryland (JEC, JS, BSS, EMM, SHM, SJS); Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland (JEC, BSS, SJS); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland (SHM); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland (SJS); and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (BSS, EMM).
Insights
Subtle motor signs, like overflow, are common in children with traumatic brain injury (TBI). The Physical and Neurological Examination of Subtle Signs (PANESS) effectively identifies these chronic TBI-related motor deficits.
Area of Science:
- Neurology
- Pediatrics
- Neuroscience
Background:
- Traumatic brain injury (TBI) in children can lead to long-term neurological deficits.
- Subtle motor signs are often overlooked in the chronic phase of pediatric TBI.
- Understanding these signs is crucial for comprehensive patient evaluation.
Purpose of the Study:
- To characterize subtle motor signs in children with moderate-to-severe TBI.
- To assess the utility of the Physical and Neurological Examination of Subtle Signs (PANESS) in chronic pediatric TBI.
- To explore the neural correlates of these motor signs using neuroimaging.
Main Methods:
- Evaluated 14 children (ages 11-18) with moderate-severe TBI and 14 age-matched controls.
- Utilized the Physical and Neurological Examination of Subtle Signs (PANESS) to assess motor performance.
- Correlated PANESS findings with neuroimaging measures (total cerebral volume, motor/premotor volume).
Main Results:
- Children with TBI showed significantly poorer PANESS performance compared to controls.
- Severe TBI was associated with greater motor overflow than moderate TBI.
- Motor overflow correlated with reduced total cerebral volume; reduced motor/premotor volume correlated with lower PANESS scores in TBI patients.
Conclusions:
- Subtle motor signs, including overflow, are important indicators in chronic pediatric TBI.
- The PANESS is a clinically useful tool for detecting subtle motor signs in this population.
- Neuroimaging reveals correlations between brain volume and motor deficits in pediatric TBI survivors.
Objective:
The aim of the study was to characterize subtle motor signs in children with moderate-severe traumatic brain injury in the chronic phase of injury.
Design:
Fourteen children with moderate (n = 6) or severe (n = 8) traumatic brain injury, ages 11-18 yrs, who had sustained their injury at least 1-yr before study participation (range 1-14 yrs since injury), and 14 matched typically developing controls were examined using the Physical and Neurological Examination of Subtle Signs (PANESS). To examine the neural correlates of subtle motor signs, measures of total cerebral volume and motor/premotor volume were derived from magnetic resonance imaging.
Results:
Children with traumatic brain injury had significantly poorer PANESS performance than controls on the total timed subscore, proximal overflow, and the PANESS total score. Participants with severe traumatic brain injury had greater proximal overflow than those with moderate injury, after controlling for age at injury. Across all participants, greater proximal overflow correlated with reduced total cerebral volume, whereas within the traumatic brain injury group, reduced motor/premotor volume correlated with lower PANESS total score.
Conclusions:
The study highlights the importance of examining subtle motor signs including overflow during clinical evaluation of chronic pediatric traumatic brain injury and establishes the clinical utility of the PANESS as a measure sensitive to chronic subtle motor signs in this population.
To Claim Cme Credits:
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Define subtle motor signs including motor overflow; (2) Identify subtle motor signs such as motor overflow during clinical evaluation of children with brain injury; and (3) Explain the relevance of examining subtle motor signs in chronic pediatric brain injury during clinical evaluations.
Level:
Advanced.
Accreditation:
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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