Neural Mechanisms of MTBI: A Prospective fMRI Approach

描述（由申请人提供）：尽管已经提出了几种机制来解释轻度创伤性脑损伤（MTBI）后观察到的神经心理缺陷和随后的功能恢复，但迄今为止，轴突形态学改变、大范围神经功能和行为恢复之间的联系尚未建立。该建议代表了一种综合方法，以建立MTBI引起的结构损伤，随之而来的神经功能缺陷以及认知和行为症状的外在表现之间的联系。该方法是基于发现和假设驱动的，其中神经重组和再生的动物模型，以及可能的认知补偿过程都受到实证检验。运动员损伤前基线测量的可及性使脑震荡成为MTBI和功能恢复前瞻性研究的理想切入点。在连续五年的时间里，将根据脑震荡评估综合成像方案（CIPAC）收集FAU足球运动员（N=80/年）的季前基线测量数据。CIPAC将结合使用：a)功能性磁共振成像（fMRI）和弥散张量成像（DTI）， b)专为前瞻性测试设计的基于网络的神经认知评估系统（脑震荡解决指数，Headminder Inc.）， c) NeuroCom(R)感觉组织测试和d)自我报告症状。在赛季中被确定患有脑震荡的球员将进入脑震荡后的记录时间表，他们将在受伤后24小时内进行测试，在恢复期间定期进行测试，并在1个月和3个月的随访中进行测试。在这种前瞻性方法中，在基线测试中获得的损伤前行为和神经功能水平将用于独立评估每个个体的脑震荡后缺陷。特别关注以下问题：1)（多发性）脑震荡的形态学、生理学和行为学后果；2) MTBI后的可塑性和功能恢复机制；3)神经功能缺损与脑震荡标准化行为测量的关系；4)对当前评估技术和重返赛场指导方针的影响。这种个性化的方法应该为人类大脑功能恢复的结构和动态机制提供重要的见解。

DESCRIPTION (provided by applicant): Although several mechanisms have been proposed to underlie observed neuropsychological deficits and subsequent recovery of function following Mild Traumatic Brain Injury (MTBI), to date the link between alterations in axonal morphology, large scale neural functioning and behavioral recovery has not been established. This proposal represents an integrated approach to establishing a connection between structural damage resulting from MTBI, consequent deficits in neural functioning and the outward manifestations of cognitive and behavioral symptoms. The approach is both discovery-based and hypothesis driven, in which animal models of neural reorganization and regeneration, as well as possible cognitive compensatory processes are subject to empirical test. The accessibility to pre-injury baseline measures in athletes makes concussion an ideal entry point into the prospective study of MTBI and recovery of function. Over five consecutive years, pre-season baseline measures will be collected from FAU football players (N=80/year) on a Comprehensive Imaging Protocol for the Assessment of Concussion (CIPAC). The CIPAC will employ a combination of: a) functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), b) a Web-based neurocognitive assessment battery designed specifically for prospective testing (Concussion Resolution Index, Headminder Inc.), c) the NeuroCom(R) sensory organization test and d) self reported symptoms. Players identified as suffering a concussion during the course of the season will enter a post-concussion recording schedule in which they will be tested within 24 hours following injury and at regular intervals during recovery and during follow-up at 1 and 3 months. In this prospective approach, pre-injury levels of behavioral and neural functioning acquired during baseline testing will be used to evaluate post-concussion deficits independently for each individual. Particular focus will be on questions concerning: 1) the morphological, physiological and behavioral consequences of (multiple) concussions; 2) mechanisms of plasticity and recovery of function following MTBI; 3) the relationship between deficits in neural functioning and standardized behavioral measures of concussion; and 4) the implications for current assessment techniques and return to play guidelines. This individualized approach should provide important insights into the structural and dynamic mechanisms underlying recovery of function in the human brain.