Neurosensory Assessments of Concussion

描述(申请人提供)：医学科学的最新进展，以及公众对运动员和退伍军人脑震荡潜在致残影响的日益认识，突显了对诊断和量化急性轻度脑损伤(MTBI)影响的有效方法的日益增长的需求。脑成像技术可用于识别全局功能连通性和时间不一致性(fMRI、MEG、EEG)、白质完整性(DTI)和某些神经递质浓度变化(MRS)的大范围变化，但目前使用成像评估脑震荡的标准是脑部CT或MRI，这两者都有助于识别大体形态变化，但不能排除mTBI。此外，这些成像方法，即使在成功地检测到mTBI时，也是昂贵的、相对缓慢的，并且不适用于广泛的用户。临床神经系统检查对可能与mTBI相关的细微变化相对不敏感。神经心理学测试可能有效地表征mTBI后神经认知功能的变化，但容易受到次优努力和基线表现个体差异所产生的潜在偏差的影响。同样，脑震荡后症状的自我报告可能会低估或过度报告，而且缺乏特异性，因为许多脑震荡后综合征的症状在没有脑损伤病史的人中很常见。为了解决这个问题，我们开发了一种新的感觉测试方法，并且为了实现这种方法，我们设计并制造了一种新的设备，这是一种能够实现高分辨率触觉感觉测试的低成本便携式计算机外围设备。这些方法的设计和验证是基于非人类灵长类动物的神经生理学研究，由于这些研究中诱发的皮质活动与随后的人类感官感知研究获得的度量之间的高度相关性，这些度量被称为皮质度量。为交付这些测试而设计的系统不需要进行大量培训即可管理，并且可以快速交付单个测试或协议(每次测试1-3分钟)。一个 这些测试中的一些是非侵入性的，会给皮肤带来触觉错觉，在健康的中枢神经系统条件下，这会导致受试者在感觉评估任务中表现得更差。在这些虚幻的任务中，患有某种神经损伤的受试者或患者通常比健康对照组表现得更好，利用一系列方案和组合数学方法，我们的试点数据显示出99%的置信度，可以区分脑震荡和非脑震荡的个体。这项申请建议建立可靠的概念证明，该方法可以用作区分脑震荡和非脑震荡患者的中枢神经系统健康状况的可靠指标，并进一步优化该方法。这项工作的总体长期目标是开发中枢神经系统健康的标准化测量方法，可用于补充目前在临床和运动训练中心环境中用于脑震荡/脑损伤的评估。

DESCRIPTION (provided by applicant): ABSTRACT Recent advances in medical science, as well as growing public awareness of the potentially disabling effects of concussions in athletes and in combat veterans, have highlighted the growing need for effective methods for diagnosing and quantifying the effects of acute mild TBI (mTBI). Brain imaging techniques can be useful in identifying large scale changes in global functional connectivity and temporal incoherence (fMRI, MEG, EEG), white matter integrity (DTI), and some neurotransmitter concentration changes (MRS), but the current standard of care for evaluating concussion using imagery is a CT or MRI of the brain, both of which are useful in identifying gross morphological changes but cannot rule out mTBI. Additionally, these imaging methodologies, even when successful in detecting mTBI, are costly, relatively slow and impractical to make available to a wide spectrum of users. Clinical neurological examinations are relatively insensitive to subtle changes which may be associated with mTBI. Neuropsychological testing may be effective in characterizing changes in neurocognitive functioning following mTBI but is vulnerable to potential biases arising from suboptimal effort and individual differences in baseline performance. Similarly, self-report of post-concussive symptoms is subject to potential under- or over-reporting, and lacks specificity, as many symptoms of post-concussion syndrome are prevalent in individuals with no history of TBI. To address this problem, we developed a novel approach to sensory testing, and to enable this approach we designed and fabricated a new device, which is a low cost portable computer peripheral that enables high resolution tactile sensory testing. Design and validation of the methods was based on non-human primate neurophysiological studies, and because of the high degree of correlation between the evoked cortical activity in those studies, and the metrics obtained from subsequent human sensory perceptual studies, the measures are referred to as cortical metrics. The system designed to deliver these tests does not require significant training to administer, and individual tests or protocols can be delivered rapidly (1-3 minutes per test). A number of these tests non-invasively deliver tactile illusions to the skin, which in healthy CNS conditions, causes subjects to perform worse on sensory assessment tasks. Subjects or patients with some type of neurological insult typically perform better than healthy controls on these illusory tasks, and utilizing a battery of protocols and a combinatorial mathematical approach, our pilot data demonstrates a 99% confidence level for differentiating concussed vs. non-concussed individuals. This application proposes to establish solid proof-of-concept that the methodology can be used as a reliable indicator of CNS health status for differentiating concussed vs. non-concussed individuals and to further optimize the method. The overall long term goal of the work is to develop standardized measures of CNS health that can be utilized to compliment the assessments currently used for concussion/TBI in both clinical and sports training center environments.