Identification of Athletes at Risk for Traumatic Brain Injuries

描述（由申请人提供）：大脑的多重创伤是最常见的灾难性损伤类型，也是运动员死亡的主要原因。由于单一轻度创伤性脑损伤（MTBI）导致的长期残疾往往被忽视，并且最明显的临床症状似乎很快就会消退，因此可能发生多发性脑损伤。大多数先前的研究有：a)未能提供MBTI受试者的纯粹损伤前状态，这可能导致对单一脑损伤后持续或新的神经和行为缺陷的误诊；b)主要关注单次MTBI后的短暂缺陷，未能检查多次MTBI的长期缺陷和症状；c)主要关注孤立的MTBI的病理生理、神经认知或行为后遗症；d)未能识别和预测有创伤性脑损伤风险的运动员。我们将在之前工作的基础上，计划识别和检查受MTBI交互影响的短期和长期行为、感觉-运动、神经心理学和神经机制。我们的目标是提供直接证据，证明MTBI患者存在长期残留残疾。我们假设脑损伤症状的解决率预测了运动员多发脑损伤的可能性。我们的具体目标是：1)确定与单次和多次MTBI导致的短暂和长期残余姿势异常相关的神经机制；2)识别与神经认知缺陷相关的异常机制，包括与MTBI患者姿势控制相关的异常机制；3)通过操纵视野运动来研究MTBI受试者不稳定的神经机制；4)开发和测试无监督模式识别算法，用于预测运动员的单次和多次MTBI风险。本研究采用纵向设计，对学生运动员在单次和多次脑损伤前后的行为、神经认知和神经功能障碍进行测试。将开发一套基于计算机图形学和虚拟现实（VR）技术，结合现代人体运动分析和脑成像（EEG和MRI）技术的轻度创伤性脑损伤评估工具。我们实验室的初步研究为该方法的可行性提供了强有力的证据，该方法可以检查大脑、认知和平衡的功能变化，并识别有单一和多重MTBI风险的运动员。脑损伤被称为“无声的流行病”，主要是因为它的发病率很高，而且与许多其他大规模健康问题相比，人们对它缺乏认识。仅在体育和娱乐活动中，美国每年就有大约30万例脑震荡，用于急性护理和康复的费用高达90亿至100亿美元。在这种情况下，单次和多次脑震荡与一般的脑损伤研究和运动员等高危人群的创伤性脑损伤研究有关，作为短期和长期脑障碍的典型例子。该项目旨在开发新的综合脑震荡评估程序，旨在预测有脑震荡风险的受试者，并最终预防多重创伤性脑损伤。

DESCRIPTION (provided by applicant): Multiple traumas to the brain are the most common type of catastrophic injury and a leading cause of death in athletes. Multiple brain injuries may occur as the long-term disabilities resulting from a single mild traumatic brain injury (MTBI) are often overlooked and the most obvious clinical symptoms appear to resolve rapidly. Most previous research has: a) failed to provide pure pre-injury status of MBTI subjects which may lead to misdiagnosis of the persistent or new neurological and behavioral deficits following a single brain injury; b) focused primarily on transient deficits after single MTBI, and failed to examine long-term deficits and symptoms of multiple MTBI; c) focused primarily on pathophysiology, neurocognitive or behavioral sequelae of MTBI in isolation; and d) failed to identify and predict athletes at risk for traumatic brain injury. We will build on our previous work and plan to identify and examine both transient and long-term behavioral, sensory-motor, neuropsychological, and neural mechanisms that are interactively affected by MTBI. We aim to provide direct evidence that there are long-lasting residual disabilities in subjects suffering from MTBI. We hypothesize that the rate of brain injury symptom resolution predicts the probability of multiple brain injuries in athletes at risk. Our specific aims are: 1) to identify neural mechanisms associated with transient and long-term residual postural abnormalities as a result of single and multiple MTBI; 2) to identify abnormal mechanisms associated with neurocognitive deficits, including those specifically involved in postural control in subjects suffering from MTBI; 3) to examine destabilizing neural mechanisms in MTBI subjects via manipulations of visual field motion; and, 4) to develop and test unsupervised pattern recognition algorithms for predicting athletes at risk for a single and multiple MTBI. The behavioral, neurocognitive and neural dysfunctions will be tested in student-athletes at risk prior to and after a single and multiple brain injuries using a longitudinal design. A set of tools for assessment of mild traumatic brain injury will be developed based on computer graphics and virtual reality (VR) technologies incorporated with modern human movement analysis and brain imaging (EEG and MRI) techniques. Preliminary research in our laboratory has provided strong evidence for the feasibility of the proposed approach to examine the functional changes in the brain, cognition and balance and to identify athletes at risk for a single and multiple MTBI. Brain damage has been referred to as the "silent epidemic," primarily due to its high level of incidence and the lack of acknowledgement when compared to many other large-scale health issues. In sport and recreational activities alone, there are approximately 300,000 concussions in the United States annually, carrying a $9 to $10-billion price tag for acute care and rehabilitation. In this context, single and multiple concussions are relevant to the study of brain injury in general and in traumatic brain injury in those at risk, such as athletes, as a prototypical example of both short and long-term brain disorders. This project seeks to develop new comprehensive concussion assessment procedures aimed at predicting subjects at risk for concussion and ultimately preventing multiple traumatic brain injuries.