Neurosensory Assessments of Concussion

描述（由申请人提供）：摘要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作用的日益认识，已经突出了对诊断和量化急性轻度TBI（mTBI）作用的有效方法的日益增长的需求。脑成像技术可用于识别整体功能连接和时间不连贯性（fMRI、MEG、EEG）、白色物质完整性（DTI）和一些神经递质浓度变化（MRS）的大规模变化，但目前使用成像评估脑震荡的护理标准是脑的CT或MRI，这两者都可用于识别总体形态学变化，但不能排除mTBI。此外，即使在成功检测mTBI时，这些成像方法也是昂贵的、相对缓慢的并且对于广泛的用户来说是不切实际的。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。神经心理学测试可以有效地表征mTBI后神经认知功能的变化，但容易受到来自次优努力和基线表现个体差异的潜在偏见的影响。类似地，脑震荡后症状的自我报告受到潜在的报告不足或过度报告的影响，并且缺乏特异性，因为脑震荡后综合征的许多症状在没有TBI病史的个体中普遍存在。为了解决这个问题，我们开发了一种新的方法来进行感官测试，为了实现这种方法，我们设计并制造了一种新的设备，这是一种低成本的便携式计算机外围设备，可以进行高分辨率的触觉感官测试。该方法的设计和验证是基于非人类灵长类动物神经生理学研究，并且由于这些研究中诱发的皮层活动与从随后的人类感官知觉研究获得的度量之间的高度相关性，这些测量被称为皮层度量。设计用于提供这些测试的系统不需要大量的培训来管理，并且可以快速提供单个测试或协议（每个测试1-3分钟）。一 这些测试中的许多非侵入性地将触觉错觉传递到皮肤，这在健康的中枢神经系统条件下导致受试者在感觉评估任务中表现更差。具有某种类型神经损伤的受试者或患者通常在这些错觉任务上比健康对照表现得更好，并且利用一组协议和组合数学方法，我们的试点数据显示了区分脑震荡与非脑震荡个体的99%置信水平。本申请提出建立可靠的概念验证，该方法可以用作区分脑震荡与非脑震荡个体的CNS健康状态的可靠指标，并进一步优化该方法。这项工作的总体长期目标是制定CNS健康的标准化措施，这些措施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/TBI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.