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 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 hours and 4-weeks post-injury. Seed-to-voxel analyses were used to explore associations between resilience and connectivity with the default-mode, central executive, and salience networks longitudinally and at both timepoints separately. Regions-of-interest analyses were used to explore associations between resilience and within-network connectivity. Results A total of 69 children with a concussion (median age = 12.81 [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-hour resilience and central executive network connectivity in the concussion group, and a positive correlation between 72-hour resilience and salience network connectivity in the orthopedic injury group. Group was a moderator of 72-hour resilience and salience network connectivity, and a moderator of longitudinal resilience and default-mode network connectivity. Regions-of-interest analyses identified group as a moderator of longitudinal resilience and within-default-mode network connectivity. In the orthopedic injury group, longitudinal resilience was associated with within-default-mode network connectivity, while 72-hour resilience was associated with within-salience network connectivity. Conclusions These results suggest that resilience may be implicated in functional neuroimaging outcomes in pediatric concussion and should further be investigated for its clinical utility as a protective or restorative factor following injury.