Identification of Persistent Impairments in Postural Control Following Concussion

识别脑震荡后姿势控制的持续损伤

• 批准号: 8180443
• 负责人: Laura H Gunn
• 金额: $ 38.57万
• 依托单位: GEORGIA SOUTHERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8180443
• 关键词: Acute; Affect; Aging; Alzheimer' s Disease; American; Amyotrophic Lateral Sclerosis; Athletic; Biomechanics; Brain Concussion; Brain Injuries; Chronic; Clinical; Clinical assessments; Cognitive; Commit; Complex; Coupled; Data; Decision Making; Diagnosis; Diagnostic; Disease; Equilibrium; Future; Gait; Health; Image; Impairment; Individual; International; Lateral; Life; Locomotion; Measurement; Measures; Medical; Mental Depression; Methods; Mild Concussions; Mission; Modeling; Motor; Musculoskeletal Equilibrium; Neurocognitive; Neurologic; Neuropsychological Tests; Oral; Outcome Measure; Parkinson Disease; Patient Self-Report; Patients; Performance; Personal Satisfaction; Presenile Alzheimer Dementia; Protocols documentation; Public Health; Quality of life; Reaction; Recovery; Reporting; Resolution; Risk; Seasons; Spinal; Sports Medicine; Stroke; Survival Analysis; Symptoms; Syndrome; System; Techniques; Testing; Time; Traumatic Brain Injury; United States; United States National Institutes of Health; Work; base; early onset; equilibration disorder; improved; innovation; mild neurocognitive impairment; mortality; neuropsychological; premature; pressure; primary outcome; prospective; research clinical testing; spatiotemporal; tool

DESCRIPTION (provided by applicant): Concussions, affecting 1.6 - 3.8 million Americans annually, can pose potentially serious consequences including second impact syndrome, with a 50% mortality rate, in the short term and elevated risk of chronic traumatic encephalopathy, amyotrophic lateral sclerosis, mild cognitive impairment, clinically diagnosed depression, and a potentially earlier onset of Alzheimer disease in the long term. While current assessment techniques for identifying the presence of a concussion has made substantial progress in recent years, the assessment protocols are typically not useful in making return to participation decisions due, in large part, to practice effects and low sensitivity to subtle impairments. Specifically, postural control is assessed utilizing the Balance Error Scoring System (BESS), however this test is has low inter- and intra-rater reliability and is subject to a practice effect. Therefore, a pressing need exists to develop an objective method to identify critical subtle, lingering impairments in postural control following a concussion and to develop a practical method of ongoing assessment for clinicians. Biomechanical assessment of gait initiation (GI), gait, and gait termination (GT) provides an objective method of identifying postural instabilities in a wide range of balance impaired groups. Further, the addition a secondary cognitive task challenges the limited functional reserves of the individual post-concussion. Therefore, the general hypothesis of this proposal is that single and dual-task GI, gait, and GT will individually and collectively identify impairments in postural stability following a concussion and these impairments will persist after the individual has returned to baseline on traditional clinical measures of concussion recovery; symptom resolution, BESS, and neuropsychological performance. Our hypothesis will be tested by 2 specific aims: 1) determine if impairments in postural stability following a concussion can be identified through single and dual task GI, gait, and GT, and 2) to compare the performance of G, gait, and GT to internationally recommended protocols to assess recovery. Thirty-six subjects with acute concussions will be tested daily from the day after their concussion until they return to participation and will be matched with thirty- six non-concussed subjects. The primary outcome measures; center of pressure displacements and velocity, spatiotemporal parameters of locomotion, and ground reaction forces will be compared both within and between subjects utilizing survival analysis. We hypothesize, supported by our preliminary data, that GI, gait, and GT will identify impairments in postural stability and these impairments will persist beyond return to baseline of the BESS assessment. These findings, if objectively documented, would demonstrate that current clinical assessments of postural stability are insufficient and will provide a new, clinically practical method of identifying persistent impairments in dynamic postural stability following a concussion. PUBLIC HEALTH RELEVANCE: Premature return to participation following a concussion leads to elevated risk of both repeat concussions and the potential for long term risk of brain damage; thus, accurate and timely concussion assessment and reassessment is a vital component of making medically correct decisions on return to participation. This project aims to improve the current standards of ongoing concussion assessment by identifying lingering and persistent subtle impairments in postural control and thus providing clinicians with an additional set of tools to assist in ongoing recovery assessment. The results of this project support the NIH's stated mission of extending the healthy life by potentially reducing premature return to participation and therefore limiting the risks of the potentially fatal second impact syndrome as well as repeat concussions and their associated life-long consequences.

描述(申请人提供)：脑震荡，每年影响160-380万美国人，可造成潜在的严重后果，包括二次冲击综合征，短期内死亡率为50%，并增加慢性创伤性脑病、肌萎缩侧索硬化症、轻度认知障碍、临床诊断为抑郁症的风险，长期而言可能更早出现阿尔茨海默病。虽然目前用于识别脑震荡存在的评估技术在最近几年取得了实质性进展，但评估方案在做出恢复参与决定时通常没有用处，主要是由于练习的影响和对细微损伤的低敏感性。具体地说，姿势控制是利用平衡误差评分系统(BESS)进行评估的，但这项测试在评分员之间和评分员内部的可靠性较低，并受到练习效果的影响。因此，迫切需要开发一种客观的方法来识别脑震荡后姿势控制中关键的、细微的、挥之不去的损害，并为临床医生开发一种实用的持续评估方法。步态起始(GI)、步态和终止(GT)的生物力学评估提供了一种客观的方法来识别各种平衡受损人群中的姿势不稳定性。此外，第二次认知任务的增加对脑震荡后个体有限的功能储备构成了挑战。因此，这项建议的一般假设是，单任务和双任务GI、步态和GT将单独和共同识别脑震荡后姿势稳定性的损害，这些损害将在个体恢复到脑震荡恢复、症状缓解、BESS和神经心理表现的传统临床指标的基线后持续存在。我们的假设将通过两个具体的目标来检验：1)确定脑震荡后姿势稳定性的损害是否可以通过单任务和双任务GI、步态和GT来识别，以及2)将G、步态和GT的性能与国际推荐的评估恢复的方案进行比较。36名患有急性脑震荡的受试者将从脑震荡后的第二天起每天接受测试，直到他们恢复参与，并将与36名非脑震荡受试者进行匹配。主要结果指标：压力中心、位移和速度、运动的时空参数和地面反作用力将通过生存分析在受试者内和受试者之间进行比较。我们假设，在我们的初步数据支持下，GI、步态和GT将识别姿势稳定性方面的损害，这些损害将持续到Bess评估的基线之后。这些发现，如果被客观地记录下来，将证明目前对姿势稳定性的临床评估是不够的，并将提供一种新的临床实用方法来识别脑震荡后动态姿势稳定性的持续性损害。 与公共卫生相关：脑震荡后过早恢复参与会增加反复脑震荡的风险和长期脑损伤的可能性；因此，准确和及时的脑震荡评估和重新评估是做出恢复参与的医学正确决定的重要组成部分。该项目旨在通过识别姿势控制中挥之不去的和持续的细微损害来改进目前正在进行的脑震荡评估的标准，从而为临床医生提供一套额外的工具来协助正在进行的恢复评估。该项目的结果支持了NIH的既定使命，即通过潜在地减少过早恢复参与来延长健康寿命，从而限制潜在致命的二次冲击综合征以及反复脑震荡及其相关终身后果的风险。

项目成果

Comparison of Psychological Response between Concussion and Musculoskeletal Injury in Collegiate Athletes.

大学运动员脑震荡和肌肉骨骼损伤的心理反应比较。

• DOI: 10.1037/spy0000099
• 发表时间: 2017
• 期刊: Sport, exercise, and performance psychology
• 作者: Turner,Samantha;Langdon,Jody;Shaver,George;Graham,Victoria;Naugle,Kelly;Buckley,Thomas
• 通讯作者: Buckley,Thomas

Altered dynamic postural control during gait termination following concussion.

• DOI: 10.1016/j.gaitpost.2016.07.327
• 发表时间: 2016-09
• 期刊: GAIT & POSTURE
• 影响因子: 2.4
• 作者: Oldham, Jessie R.;Munkasy, Barry A.;Evans, Kelsey M.;Wikstrom, Erik A.;Buckley, Thomas A.
• 通讯作者: Buckley, Thomas A.

Evidence of a conservative gait strategy in athletes with a history of concussions.

• DOI: 10.1016/j.jshs.2015.03.010
• 发表时间: 2016-12
• 期刊: Journal of sport and health science
• 影响因子: 11.7
• 作者: Buckley TA;Vallabhajosula S;Oldham JR;Munkasy BA;Evans KM;Krazeise DA;Ketcham CJ;Hall EE
• 通讯作者: Hall EE

Does baseline concussion testing aid in identifying future concussion risk?

基线脑震荡测试是否有助于识别未来的脑震荡风险？

• DOI: 10.1080/15438627.2019.1641500
• 发表时间: 2020
• 期刊: Research in sports medicine (Print)
• 作者: Caccese,JaclynB;Johns,KassandraE;Langdon,JodyL;Shaver,GeorgeW;Buckley,ThomasA
• 通讯作者: Buckley,ThomasA

Sideline Performance of the Balance Error Scoring System during a Live Sporting Event.

• DOI: 10.1097/jsm.0000000000000141
• 发表时间: 2015-05
• 期刊: Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine
• 作者: Rahn C;Munkasy BA;Barry Joyner A;Buckley TA
• 通讯作者: Buckley TA