Diminished Motor Performance in Athletes Cleared to Return to Play after Sports-Related Concussion

项目摘要/摘要 运动相关脑震荡是一种轻度创伤性脑损伤(TBI)，是一个重大的公共卫生问题， 尤其是考虑到最近的发现，有脑震荡病史的运动员更有可能维持新的 当他们回到高风险活动时，他们会受到伤害，这与不利的长期健康后果有关。 重要的是，在年轻运动员中发现了这种新受伤的高风险，这些年轻运动员已经被排除在外，可以回到 使用当前的临床评估方案，表明这些方案不是最优的。一个选项，用于 改进的评估是双重任务评估-增加了次要任务的运动性能评估， 通常是一项认知分心任务。值得注意的是，双重任务评估导致儿童运动能力下降。 年轻运动员在脑震荡后获得了重返赛场的许可。这些减弱的运动能力可能 然而，目前尚不清楚为什么临床评估方案会增加新损伤的可能性。 无法检测到它们。因此，作为合乎逻辑的第一步，当前提案的目标是更好地理解 为什么临床评估方案会漏掉运动能力减退。初步的神经成像数据和 双重任务表现数据表明，有脑震荡病史的年轻人可以弥补 通过招募额外的神经注意力资源来支持单一任务表现，从而削弱了运动能力， 或者在没有认知干扰任务的情况下进行运动表现。可以想象，这种补偿性的招聘是 双重任务表现不足，这就是双重任务评估会导致运动能力下降的原因。 目前的临床评估方案包括主观症状报告和行为评估 在单一任务设计中进行管理(即没有次要任务分心)。然而，几乎所有的运动都需要 在注意力分散的情况下的运动表现。该提案包括改进了的行为措施 生态效度(即双重任务评估)，并试图阐明削弱的神经基础 最近脑震荡的年轻运动员的运动能力。神经成像方法包括一口井- 已建立的脑电(EEG)范式和创新技术--功能性近红外 光谱学(FNIRS)系统，可适应粗大运动。年轻的运动员们已经通过了 最近的脑震荡将与从未脑震荡的年轻运动员进行比较，并在单任务和双任务上进行评估 同时进行神经记录的性能。可以预见的是，这些“过关”的年轻运动员将会展现出 与之相当的单任务性能，但--重要的是--双任务性能较差，并表现出 与从未脑震荡的同龄人相比，神经注意区域的异常招募。这些发现将 这表明一些“出线”的运动员还没有完全从脑震荡中恢复过来。通过识别 与运动能力减弱和新损伤风险增加相关的神经特征，这项工作将 有显著的影响：1)更好地描述脑震荡的神经生理学和2)奠定 为未来旨在识别和降低脑震荡的短期和长期风险的研究奠定基础。

PROJECT SUMMARY/ABSTRACT Sports-related concussion, a type of mild traumatic brain injury (TBI), is a significant public health concern, especially given recent discoveries that athletes with a history of concussion are more likely to sustain new injuries when they return to high-risk activity, which is linked to adverse long-term health outcomes. Importantly, this heightened risk of new injury has been found in young athletes who were “cleared” to return to play using current clinical evaluation protocols, suggesting that these protocols are suboptimal. An option for improved evaluation is dual task assessment – appraisal of motor performance with a secondary task added, typically a cognitive distractor task. Notably, dual task assessments have elicited diminished motor abilities in young athletes who were “cleared” to return to play after concussion. These diminished motor abilities may underlie the increased likelihood for new injury, however, it is currently unclear why clinical evaluation protocols fail to detect them. Therefore, as a logical first step, the objective of the current proposal is to better understand why diminished motor abilities are missed with clinical evaluation protocols. Preliminary neuroimaging data and dual task performance data suggest that “cleared” youth with a history of concussion compensate for diminished motor ability by recruiting additional neural attention resources to support single task performance, or motor performance without a cognitive distractor task. Conceivably, this compensatory recruitment is insufficient for dual task performance, which is why dual task assessments elicit diminished motor abilities. Current clinical evaluation protocols include subjective symptom reporting and behavioral assessments administered in a single task design (i.e. without secondary task distraction). However, nearly all sports require motor performance in the presence of distraction. This proposal includes behavioral measures with improved ecological validity (i.e. dual task assessments) and seeks to elucidate neural underpinnings of diminished motor abilities in “cleared” young athletes with recent concussion. Neuroimaging methods include a well- established electroencephalography (EEG) paradigm and an innovative technique – a functional near-infrared spectroscopy (fNIRS) system that can accommodate gross motor movement. “Cleared” young athletes with recent concussion will be compared to never-concussed young athletes and evaluated on single and dual task performance with simultaneous neural recording. It is anticipated that these “cleared” young athletes will show comparable single task performance but – importantly – have poorer dual task performance and demonstrate aberrant recruitment of neural attention regions compared to never-concussed peers. These findings would suggest that some “cleared” athletes have not completely recovered from their concussion. By identifying neural characteristics associated with diminished motor abilities and increased risk for new injury, this work will have a significant impact by: 1) better describing the neurophysiology of concussion and 2) laying the foundation for future studies designed to identify and reduce short- and long-term risk of concussion.