Pediatric traumatic brain injury: Language outcomes and their relationship to the arcuate fasciculus

[Display omitted] •Diffusion weighted MRI can assist in the prognosis of neuropsychological deficits.•We explored white matter changes and language outcome in people with brain injury.•Sentence generation impairments were found in dysarthric participants.•Impairments were linked to reduced corpus callosum and left arcuate fasciculus size.•This dual blow seriously reduces the potential for language reorganisation. Pediatric traumatic brain injury (TBI) may result in long-lasting language impairments alongside dysarthria, a motor-speech disorder. Whether this co-morbidity is due to the functional links between speech and language networks, or to widespread damage affecting both motor and language tracts, remains unknown. Here we investigated language function and diffusion metrics (using diffusion-weighted tractography) within the arcuate fasciculus, the uncinate fasciculus, and the corpus callosum in 32 young people after TBI (approximately half with dysarthria) and age-matched healthy controls (n=17). Only participants with dysarthria showed impairments in language, affecting sentence formulation and semantic association. In the whole TBI group, sentence formulation was best predicted by combined corpus callosum and left arcuate volumes, suggesting this “dual blow” seriously reduces the potential for functional reorganisation. Word comprehension was predicted by fractional anisotropy in the right arcuate. The co-morbidity between dysarthria and language deficits therefore seems to be the consequence of multiple tract damage.