Elucidating Brainstem Contributions to Visceral and Somatic Motor Dysfunction after mTBI

项目摘要/摘要 对轻度创伤性脑损伤患者的康复和医疗管理通常由 根据自我报告的症状和临床体征将患者分为不同的亚型。然而，普通电机 体征和症状不容易被分析成亚型分类，而潜在的病理生理学 运动症状仍不清楚。我们的长期目标是通过指导患者 根据客观和可量化的标记物，针对关键潜在功能障碍的治疗。普普通通 症状，如头痛和头晕，以及临床体征，如心血管不稳定和姿势 失衡，与关键的内脏运动(自主神经)和躯体运动(平衡和步态)有关，可能 在脑干内有共同的神经解剖学起源。然而，脑干并没有受到多少关注。 患有mTBI的人，没有研究检查内脏(自主神经)和躯体(平衡和步态)是否 运动功能障碍有共同的神经解剖学起源。该探索性项目将检查结构和 脑干损伤患者脑干损伤的新神经影像和客观表现 躯体运动和内脏运动功能的评估。我们的中心假设是，mTBI创造了不同的 运动(内脏和躯体)功能异常，具有共同的神经解剖学来源 脑干。我们的第一个具体目标是确定mtbi患者和健康对照组之间的差异。 在脑干完整性方面，通过神经成像在结构上和功能上通过定量评估 躯体和内脏运动功能的评估。脑干完整性将由分数决定 使用高密度纤维束成像的白质束各向异性(FA)。躯体和内脏运动 将使用客观的仪器化活动测试和心血管自主神经测量来评估功能 压力感受器功能。《特殊目的II》将探讨急性脑干 目标运动功能和自我报告症状的完整性和纵向恢复。 脑干FA值将与内脏运动和躯体运动功能的客观测量进行比较，并 自我报告的症状。我们还将比较脑干结构完整性的程度， 用FA量化，可以预测3个月后目标运动功能的恢复和自我报告的症状。 这项创新的研究将是第一次收集身体和内脏运动的客观测量数据的同类研究 多发性脑损伤患者的功能与新的神经成像相结合。这项研究将为以下工作奠定基础 一项未来的提案寻求表征脑干结构完整性、运动功能、 并在mTBI后将症状自我报告给有针对性的康复治疗。归根结底，这项重要的研究 可能通过揭示运动功能障碍的起源和提供 补充临床分类以指导治疗的生理和结构神经标记物 使用mTBI。

PROJECT SUMMARY/ABSTRACT Rehabilitation and medical management for those with mild traumatic brain injury (mTBI) is often guided by classifying people into subtypes based on self-reported symptoms and clinical signs. However, common motor signs and symptoms are not easily parsed into subtype classifications, and the underlying pathophysiology of motor symptoms remains unclear. Our long-term goal is to improve clinical care of mTBI by directing patients to treatment that targets the key underlying dysfunction based on objective and quantifiable markers. Common symptoms, such as headache and dizziness, and clinical signs, such as cardiovascular instability and postural imbalance, relate to key visceral motor (autonomic) and somatic motor (balance and gait) function that may share a common neuroanatomical origin within the brainstem. Yet, the brainstem has received little attention in people with mTBI, and no research has examined whether visceral (autonomic) and somatic (balance and gait) motor dysfunction share a common neuroanatomical origin. This exploratory project will examine structural and functional manifestations of brainstem injury in people with mTBI through novel neuroimaging and objective assessments of somatic motor and visceral motor function. Our central hypothesis is that mTBI creates distinct abnormalities in motor (visceral and somatic) function that have a common neuroanatomical origin within the brainstem. Our first Specific Aim will determine differences between people with mTBI and healthy controls in brainstem integrity, as assessed structurally by neuroimaging and functionally by quantitative assessment of somatic and visceral motor function. Brainstem integrity will be determined from fractional anisotropy (FA) of white matter tracts imaged using high density fiber tractography. Somatic and visceral motor function will be assess using objective, instrumented mobility tests and cardiovascular autonomic measures of baroreceptor function, respectively. Specific Aim II will explore the relationship between acute brainstem integrity and the longitudinal recovery of objective motor function and self-reported symptoms. Brainstem FA values will be compared to objective measures of visceral motor and somatic motor function and to self-reported symptoms. We will also compare the extent to which structural integrity of the brainstem, quantified using FA, can predict recovery of objective motor function and self-reported symptoms over 3 months. This innovative study will be the first of its kind to collect objective measures of somatic and visceral motor function in conjunction with novel neuroimaging in people with mTBI. This study will establish the foundation for a future proposal seeking to characterize the response of structural integrity of the brainstem, motor function, and self-reported symptoms to targeted rehabilitation treatments after mTBI. Ultimately, this significant study may shift the paradigm of mTBI management by revealing the origin of motor dysfunction and providing physiological and structural neural markers that complement clinical classifications to guide treatment for those with mTBI.