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

项目总结/摘要 运动相关脑震荡是一种轻度创伤性脑损伤（TBI），是一个重要的公共卫生问题， 特别是考虑到最近的发现，有脑震荡史的运动员更有可能维持新的 他们在返回高风险活动时可能会受到伤害，这与不利的长期健康结果有关。 重要的是，在那些被“清除”返回的年轻运动员中发现了这种新损伤的高风险。 使用当前的临床评估协议，表明这些协议是次优的。的一种选择 改进的评估是双任务评估--评估运动性能并增加次要任务， 通常是认知干扰任务。值得注意的是，双重任务评估已经引起了运动能力的下降， 年轻运动员在脑震荡后被“清除”重返赛场。这些运动能力的减弱可能 然而，目前尚不清楚为什么临床评价方案会增加新损伤的可能性， 无法发现它们。因此，作为合乎逻辑的第一步，本提案的目标是更好地了解 为什么临床评估方案忽略了运动能力下降。初步的神经影像学数据和 双重任务表现数据表明，有脑震荡史的“清除”青年弥补了 通过募集额外的神经注意力资源来支持单一任务的表现， 或运动表现。可以想象，这种补偿性征聘是 这就是为什么双重任务评估会导致运动能力下降。 目前的临床评估方案包括主观症状报告和行为评估 在一个单一的任务设计管理（即没有次要任务分心）。然而，几乎所有的运动都需要 注意力分散时的运动表现。该提案包括行为措施， 生态有效性（即双重任务评估），并试图阐明减少的神经基础 运动能力的“清除”年轻运动员与最近的脑震荡。神经成像方法包括良好的- 建立脑电图（EEG）范式和创新技术-功能性近红外 这是一种可以适应粗大运动运动的fNIRS系统。“清除”年轻运动员， 近期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 同步神经记录的性能。预计这些“过关”的年轻运动员将表现出 可比较的单任务性能，但重要的是，具有较差的双任务性能， 神经注意区域的异常募集。这些发现 这表明一些“被清除”的运动员还没有完全从脑震荡中恢复过来。通过识别 与运动能力下降和新损伤风险增加相关的神经特征，这项工作将 产生重大影响：1）更好地描述脑震荡的神经生理学; 2）奠定 未来研究的基础，旨在确定和减少短期和长期的脑震荡风险。

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.