Neurosensory Assessments of Concussion

脑震荡的神经感觉评估

基本信息

批准号：
8583797
负责人：
Mark A Tommerdahl
金额：
$ 22.8万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-07-15 至 2015-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8583797
关键词：
Acute Address Affect Age Athletic Awareness Basic Science Brain Brain Concussion Brain imaging Clinic Clinical Clinical Research Computer Peripherals Computers Data Devices Diagnosis Diagnostic Effectiveness Electroencephalography Environment Evaluation Foundations Functional Magnetic Resonance Imaging Goals Health Health Personnel Health Status Health system Human Image Imagery Imaging Techniques In Vitro Individual Individual Differences Investigation Magnetic Resonance Imaging Measures Mediating Medical Methodology Methods Metric Neuraxis Neurocognitive Neurologic Neurologic Examination Neurons Neuropsychological Tests Neurotransmitters Patient Self-Report Patients Performance Physicians Population Post-Concussion Syndrome Protocols documentation Public Health Recording of previous events Recovery Recruitment Activity Reporting Research Resolution Science Sensory Site Skin Solid Specificity Sports Standardization Stimulus Symptoms System Tactile Tactile Illusions Techniques Technology Testing Time Training Trauma Treatment Efficacy Validation Veterans Work base combat combinatorial cost cost effective design diagnosis evaluation human old age (65+)human subject improved in vivo information processing instrument laptop nervous system disorder neurophysiology nonhuman primate novel novel strategies portability programs public health relevance response standard of care standardize measure treatment strategy university student white matter

Acute Address Affect Age Athletic Awareness Basic Science Brain Brain Concussion Brain imaging Clinic Clinical Clinical Research Computer Peripherals Computers Data Devices Diagnosis Diagnostic Effectiveness Electroencephalography Environment Evaluation Foundations Functional Magnetic Resonance Imaging Goals Health Health Personnel Health Status Health system Human Image Imagery Imaging Techniques In Vitro Individual Individual Differences Investigation Magnetic Resonance Imaging Measures Mediating Medical Methodology Methods Metric Neuraxis Neurocognitive Neurologic Neurologic Examination Neurons Neuropsychological Tests Neurotransmitters Patient Self-Report Patients Performance Physicians Population Post-Concussion Syndrome Protocols documentation Public Health Recording of previous events Recovery Recruitment Activity Reporting Research Resolution Science Sensory Site Skin Solid Specificity Sports Standardization Stimulus Symptoms System Tactile Tactile Illusions Techniques Technology Testing Time Training Trauma Treatment Efficacy Validation Veterans Work base combat combinatorial cost cost effective design diagnosis evaluation human old age (65+)human subject improved in vivo information processing instrument laptop nervous system disorder neurophysiology nonhuman primate novel novel strategies portability programs public health relevance response standard of care standardize measure treatment strategy university student white matter

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项目摘要

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.

描述（由申请人提供）：医学科学的摘要最新进展，以及公众对脑震荡对运动员和战斗退伍军人的潜在残疾影响的认识，强调了对诊断和量化急性轻度TBI（MTBI）影响的有效方法的需求日益增长的需求。 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.此外，即使成功检测MTBI，这些成像方法也是代价高昂，相对较慢且不切实际的，可以为广泛的用户提供。临床神经检查对可能与MTBI相关的细微变化相对不敏感。神经心理学测试可能有效地表征了MTBI后神经认知功能的变化，但很容易受到次优的努力和基线表现的个体差异引起的潜在偏见。同样，脑震荡症状的自我报告会受到潜在的不足或过度报告的影响，并且缺乏特异性，因为在没有TBI史的人群中，许多脑抑制综合征的症状都普遍存在。为了解决这个问题，我们开发了一种新颖的感觉测试方法，为了启用这种方法，我们设计和制造了一种新设备，这是一种低成本的便携式计算机外围设备，可实现高分辨率的触觉感觉测试。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唤起的皮质活性之间的高度相关性，以及从随后的人类感觉知觉研究获得的指标，这些度量被称为皮质衡量。旨在提供这些测试的系统不需要进行重大培训来管理，并且可以迅速提供单个测试或协议（每次测试1-3分钟）。一个这些测试的数量非侵入性地向皮肤提供触觉幻觉，在健康的中枢神经系统条件下，受试者在感觉评估任务上的表现较差。在这些虚幻的任务上，患有某种神经系统侮辱的受试者或患者通常比健康对照表现更好，并利用一系列方案和组合数学方法，我们的试验数据显示出99％的置信水平，以区分脑震荡与无困难的个体。该申请建议确定该方法可以用作CNS健康状况的可靠指标，以区分脑震荡与非引起人们的个人，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，可以用来补充临床和运动培训中心环境中目前用于脑震荡/TBI的评估。