Identification of Persistent Impairments in Postural Control Following Concussion

识别脑震荡后姿势控制的持续损伤

• 批准号: 8180443
• 负责人: Laura H Gunn
• 金额: $ 38.57万
• 依托单位: GEORGIA SOUTHERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8180443
• 关键词: Acute; Affect; Aging; Alzheimer' s Disease; American; Amyotrophic Lateral Sclerosis; Athletic; Biomechanics; Brain Concussion; Brain Injuries; Chronic; Clinical; Clinical assessments; Cognitive; Commit; Complex; Coupled; Data; Decision Making; Diagnosis; Diagnostic; Disease; Equilibrium; Future; Gait; Health; Image; Impairment; Individual; International; Lateral; Life; Locomotion; Measurement; Measures; Medical; Mental Depression; Methods; Mild Concussions; Mission; Modeling; Motor; Musculoskeletal Equilibrium; Neurocognitive; Neurologic; Neuropsychological Tests; Oral; Outcome Measure; Parkinson Disease; Patient Self-Report; Patients; Performance; Personal Satisfaction; Presenile Alzheimer Dementia; Protocols documentation; Public Health; Quality of life; Reaction; Recovery; Reporting; Resolution; Risk; Seasons; Spinal; Sports Medicine; Stroke; Survival Analysis; Symptoms; Syndrome; System; Techniques; Testing; Time; Traumatic Brain Injury; United States; United States National Institutes of Health; Work; base; early onset; equilibration disorder; improved; innovation; mild neurocognitive impairment; mortality; neuropsychological; premature; pressure; primary outcome; prospective; research clinical testing; spatiotemporal; tool

DESCRIPTION (provided by applicant): Concussions, affecting 1.6 - 3.8 million Americans annually, can pose potentially serious consequences including second impact syndrome, with a 50% mortality rate, in the short term and elevated risk of chronic traumatic encephalopathy, amyotrophic lateral sclerosis, mild cognitive impairment, clinically diagnosed depression, and a potentially earlier onset of Alzheimer disease in the long term. While current assessment techniques for identifying the presence of a concussion has made substantial progress in recent years, the assessment protocols are typically not useful in making return to participation decisions due, in large part, to practice effects and low sensitivity to subtle impairments. Specifically, postural control is assessed utilizing the Balance Error Scoring System (BESS), however this test is has low inter- and intra-rater reliability and is subject to a practice effect. Therefore, a pressing need exists to develop an objective method to identify critical subtle, lingering impairments in postural control following a concussion and to develop a practical method of ongoing assessment for clinicians. Biomechanical assessment of gait initiation (GI), gait, and gait termination (GT) provides an objective method of identifying postural instabilities in a wide range of balance impaired groups. Further, the addition a secondary cognitive task challenges the limited functional reserves of the individual post-concussion. Therefore, the general hypothesis of this proposal is that single and dual-task GI, gait, and GT will individually and collectively identify impairments in postural stability following a concussion and these impairments will persist after the individual has returned to baseline on traditional clinical measures of concussion recovery; symptom resolution, BESS, and neuropsychological performance. Our hypothesis will be tested by 2 specific aims: 1) determine if impairments in postural stability following a concussion can be identified through single and dual task GI, gait, and GT, and 2) to compare the performance of G, gait, and GT to internationally recommended protocols to assess recovery. Thirty-six subjects with acute concussions will be tested daily from the day after their concussion until they return to participation and will be matched with thirty- six non-concussed subjects. The primary outcome measures; center of pressure displacements and velocity, spatiotemporal parameters of locomotion, and ground reaction forces will be compared both within and between subjects utilizing survival analysis. We hypothesize, supported by our preliminary data, that GI, gait, and GT will identify impairments in postural stability and these impairments will persist beyond return to baseline of the BESS assessment. These findings, if objectively documented, would demonstrate that current clinical assessments of postural stability are insufficient and will provide a new, clinically practical method of identifying persistent impairments in dynamic postural stability following a concussion. PUBLIC HEALTH RELEVANCE: Premature return to participation following a concussion leads to elevated risk of both repeat concussions and the potential for long term risk of brain damage; thus, accurate and timely concussion assessment and reassessment is a vital component of making medically correct decisions on return to participation. This project aims to improve the current standards of ongoing concussion assessment by identifying lingering and persistent subtle impairments in postural control and thus providing clinicians with an additional set of tools to assist in ongoing recovery assessment. The results of this project support the NIH's stated mission of extending the healthy life by potentially reducing premature return to participation and therefore limiting the risks of the potentially fatal second impact syndrome as well as repeat concussions and their associated life-long consequences.

描述（由申请人提供）：脑震荡每年影响1.6-380万美国人，可能会带来潜在的严重后果，包括第二次影响综合征，在短期内，死亡率为50％，死亡率升高，慢性创伤性脑病的风险升高，肌萎缩性脊柱巩膜，轻度的认知障碍症状症状，临时抑郁症和较早的疾病症状，并可能诊断出较早的抑郁症。尽管目前确定脑震荡的存在的评估技术近年来取得了重大进展，但评估方案通常对于使参与决策的重返参与决策通常没有用，这在很大程度上是对练习效果和对微妙障碍的敏感性低的敏感性。具体而言，利用平衡误差系统（BES）评估了姿势控制，但是该测试的评估者间可靠性较低，并且具有实践效果。因此，存在一种迫切的需求，以开发一种客观方法，以识别脑震荡后姿势控制中的临界微妙，挥之不去的障碍，并开发一种对临床医生进行的实际评估方法。步态起始（GI），步态和步态终止（GT）的生物力学评估提供了一种客观的方法，可以在广泛的平衡群体中识别姿势不稳定性。此外，加法次要认知任务挑战了个人脑后的有限功能储量。因此，该提议的一般假设是，脑震荡后，单个和双任务GI，步态和GT将单独，集体地识别姿势稳定性的损害，并且在个人已经基于传统的脑震荡恢复临床量测量的基础之后，这些障碍将持续下去；症状解决，贝斯和神经心理学表现。我们的假设将通过2个特定目的对我们的假设进行检验：1）确定是否可以通过单个和双重任务GI，步态和GT识别脑震荡后的姿势稳定性损害，以及2）比较G，步态和GT与国际推荐方案的性能，以评估恢复。从脑震荡后的第二天，将每天对36名患有急性脑震荡的受试者进行测试，直到他们恢复参与，并将与36个不被脑子的受试者进行匹配。主要结果措施；压力位移和速度，运动的时空参数和地面反作用力的时空参数将在利用生存分析的受试者内部和受试者之间进行比较。我们假设在初步数据的支持下，GI，步态和GT将确定姿势稳定性的损害，这些障碍将持续到贝斯评估的基线之外。这些发现，如果有客观的记录，将证明当前对姿势稳定性的临床评估不足，并且将提供一种新的，临床上实用的方法来识别脑震荡后动态姿势稳定性的持续障碍。 公共卫生相关性：脑震荡后过早的参与会导致重复脑震荡的风险升高，并可能长期遭受脑损伤的风险；因此，准确，及时的脑震荡评估和重新评估是在恢复参与时做出医学正确决定的重要组成部分。该项目旨在通过确定姿势控制中的挥之不去和持续的微妙障碍，从而为临床医生提供一套其他工具，以帮助进行持续的恢复评估，从而提高正在进行的脑震荡评估的当前标准。该项目的结果支持NIH指出的使命，即通过潜在地减少参与的早期恢复，从而限制潜在致命的第二影响综合征的风险以及重复的脑震荡及其相关的终身后果，从而延长了健康的生活。

项目成果

Comparison of Psychological Response between Concussion and Musculoskeletal Injury in Collegiate Athletes.

大学运动员脑震荡和肌肉骨骼损伤的心理反应比较。

• DOI: 10.1037/spy0000099
• 发表时间: 2017
• 期刊: Sport, exercise, and performance psychology
• 作者: Turner,Samantha;Langdon,Jody;Shaver,George;Graham,Victoria;Naugle,Kelly;Buckley,Thomas
• 通讯作者: Buckley,Thomas

Altered dynamic postural control during gait termination following concussion.

• DOI: 10.1016/j.gaitpost.2016.07.327
• 发表时间: 2016-09
• 期刊: GAIT & POSTURE
• 影响因子: 2.4
• 作者: Oldham, Jessie R.;Munkasy, Barry A.;Evans, Kelsey M.;Wikstrom, Erik A.;Buckley, Thomas A.
• 通讯作者: Buckley, Thomas A.

Evidence of a conservative gait strategy in athletes with a history of concussions.

• DOI: 10.1016/j.jshs.2015.03.010
• 发表时间: 2016-12
• 期刊: Journal of sport and health science
• 影响因子: 11.7
• 作者: Buckley TA;Vallabhajosula S;Oldham JR;Munkasy BA;Evans KM;Krazeise DA;Ketcham CJ;Hall EE
• 通讯作者: Hall EE

Does baseline concussion testing aid in identifying future concussion risk?

基线脑震荡测试是否有助于识别未来的脑震荡风险？

• DOI: 10.1080/15438627.2019.1641500
• 发表时间: 2020
• 期刊: Research in sports medicine (Print)
• 作者: Caccese,JaclynB;Johns,KassandraE;Langdon,JodyL;Shaver,GeorgeW;Buckley,ThomasA
• 通讯作者: Buckley,ThomasA

Sideline Performance of the Balance Error Scoring System during a Live Sporting Event.

• DOI: 10.1097/jsm.0000000000000141
• 发表时间: 2015-05
• 期刊: Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine
• 作者: Rahn C;Munkasy BA;Barry Joyner A;Buckley TA
• 通讯作者: Buckley TA