Subtle Motor Functioning and Functional Connectivity in Youth Medically Cleared after Mild TBI

项目总结 青少年轻度创伤性脑损伤(mTBI，脑震荡)在美国是一个公共卫生问题。青春是 认为在从mTBI恢复期间，特别有可能出现额外损伤的不良后果。因此，一个 护理的关键方面是确定儿童何时从mTBI中恢复，从而使儿童能够在医学上 允许重返体育和其他高风险娱乐活动，而不会增加不利的短期或 长期结果。虽然mTBI被定义为一种生理性脑损伤，但目前的临床措施 确定体检合格后重返赛场，并不是直接尝试脑生理学。整体而言 该项目的目标是评估经医学许可重返赛场的青年的脑生理学指标。 MTBI和这些标记物如何与医疗许可后的一年中的不良事件相关。具体来说， 我们将调查那些已经被专家使用目前的 临床评估的黄金标准显示更多细微的运动体征和/或功能异常的大脑 与从未患过mTBI的同龄人进行比较，以及这些发现持续了多长时间。我们还将 评估运动和影像表现是否能预测再损伤率(肌肉骨骼或mTBI)或临床 在接下来的一年里，情绪或认知功能或与健康相关的生活质量发生了重大变化 体检许可。该项目的目的是：1)评估青年在mTBI后是否在医学上被清除。 在医疗许可时以及3个月和12个月后，在临床可行的措施上显示更细微的运动迹象， 2)评估静息状态(默认模式和背侧)的功能连通性在组间的差异 注意)在医疗许可时以及3个月和12个月后，具有运动前和运动脑区的网络，3) 确定细微运动体征是否与药物清除后的青年脑功能连接性有关 MTBI，以及4)评估运动和影像表现与不良事件发生的关系 在体检通过后的一年里。我们将在3周内对70名10-17岁的青少年进行评估 康复后体检合格，并将在3个月和12个月后对同一名青年进行重新评估。我们会 同样地，在三个时间点对70名年龄和性别匹配的从未接受过mTBI的青年进行评估，基线 3个月和12个月后。在每个时间点，我们将比较各组的运动细微体征和 背侧注意网络和默认模式网络与前驱运动和初级注意的功能连接 大脑中的运动区，无论是在休息时还是在运动任务中。我们将评估是否异常 MTBI组的功能连接模式与细微运动体征的存在有关。 最后，我们评估运动和影像表现与再损伤发生的关系。 在医疗许可后的一年中，在临床上有显著的功能变化。这个项目将会有所帮助 确定当前评估青年mTBI后医疗许可的临床措施的充分性 为制定和评估减少与青年mTBI相关的短期和长期风险的战略奠定基础。

PROJECT SUMMARY Youth mild traumatic brain injury (mTBI, concussion) is a public health problem in the United States. Youth are felt to be particularly at risk for adverse outcomes from additive injury during recovery from mTBI. Thus, a critical aspect of care is determining when a child has recovered from mTBI such that a child can be medically cleared to return to sports and other high risk recreational activities without increased risk for adverse short- or long-term outcomes. While mTBI is defined as a physiological brain injury, current clinical measures for determining medical clearance to return to play after mTBI are not directly tried to brain physiology. The overall goal of this project is to evaluate markers of brain physiology in youth medically cleared to return to play after mTBI and how these markers relate to adverse events over the year following medical clearance. Specifically, we will investigate whether youth who have been medically cleared from mTBI by experts using the current gold-standard of clinical assessments show more subtle motor signs and/or anomalous functional brain connectivity compared to peers who have never had a mTBI and how long these findings persist. We will also evaluate whether motor and imaging findings predict rate of re-injury (musculoskeletal or mTBI) or clinically significant changes in emotional or cognitive functioning or health-related quality of life over the year following medical clearance. The aims of this project are to 1) evaluate whether youth medically cleared after mTBI show more subtle motor signs on a clinically-feasible measure at medical clearance and 3 and 12 months later, 2) evaluate for between-group differences in functional connectivity of resting state (default mode and dorsal attention) networks with premotor and motor brain regions at medical clearance and 3 and 12 months later, 3) determine if subtle motor signs are associated with functional brain connectivity in youth medically cleared after mTBI, and 4) evaluate the relationship between motor and imaging findings and occurrence of adverse events over the year following medical clearance. We will evaluate 70 youth aged 10-17 within 3 weeks of being medically cleared as recovered from mTBI and will re-evaluate the same youth 3 and 12 months later. We will similarly evaluate 70 age- and sex-matched youth who have never had a mTBI at three time points, baseline and 3 and 12 months later. At each time point we will compare groups with respect to motor subtle signs and functional connectivity of the dorsal attention network and default mode network with premotor and primary motor regions in the brain, both at rest and during a motor task. We will evaluate whether anomalous functional connectivity patterns in the mTBI group are associated with the presence of subtle motor signs. Lastly, we evaluate the relationship between motor and imaging findings and occurrence of re-injury or clinically significant change in functioning over the year following medical clearance. This project will help determine the adequacy of current clinical measures for evaluating medical clearance after youth mTBI and will set the stage for devising and evaluating strategies to reduce short- and long-term risks related to youth mTBI.