Elucidating Brainstem Contributions to Visceral and Somatic Motor Dysfunction after mTBI

阐明脑干对 mTBI 后内脏和躯体运动功能障碍的影响

• 批准号: 10247086
• 负责人: Peter C Fino
• 金额: $ 19.06万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10247086
• 关键词: Acute; Affect; Aftercare; Anatomy; Anisotropy; Attention; Autonomic nervous system; Baroreflex; Blood Pressure; Brain Stem; Cardiovascular system; Caring; Cell Nucleus; Classification; Clinical; Complement; Diffusion Magnetic Resonance Imaging; Dizziness; Elements; Equilibrium; Fiber; Foundations; Functional disorder; Future; Gait; Gait abnormality; Goals; Headache; Heart Rate; Image; Individual; Injury; Interdisciplinary Study; Measures; Medical; Methods; Midbrain structure; Mission; Modeling; Mood Disorders; Motor; Neurocognitive Deficit; Participant; Pathology; Patient Self-Report; Patients; Peripheral; Physiological; Pontine structure; Posture; Pressoreceptors; Pupil light reflex; Recovery; Regulation; Rehabilitation therapy; Research; Resources; Reticular Formation; Role; Sensory; Signs and Symptoms; Structure; Symptoms; Testing; Time; Travel; Visceral; Vision; Visit; Walking; Work; base; clinical care; clinical subtypes; common symptom; density; experience; improved; innovation; instrument; mild traumatic brain injury; motor deficit; motor disorder; motor function recovery; motor rehabilitation; motor symptom; multimodality; neuroimaging; neurophysiology; novel; persistent symptom; rehabilitative care; relating to nervous system; response; systematic review; tractography; white matter

PROJECT SUMMARY/ABSTRACT Rehabilitation and medical management for those with mild traumatic brain injury (mTBI) is often guided by classifying people into subtypes based on self-reported symptoms and clinical signs. However, common motor signs and symptoms are not easily parsed into subtype classifications, and the underlying pathophysiology of motor symptoms remains unclear. Our long-term goal is to improve clinical care of mTBI by directing patients to treatment that targets the key underlying dysfunction based on objective and quantifiable markers. Common symptoms, such as headache and dizziness, and clinical signs, such as cardiovascular instability and postural imbalance, relate to key visceral motor (autonomic) and somatic motor (balance and gait) function that may share a common neuroanatomical origin within the brainstem. Yet, the brainstem has received little attention in people with mTBI, and no research has examined whether visceral (autonomic) and somatic (balance and gait) motor dysfunction share a common neuroanatomical origin. This exploratory project will examine structural and functional manifestations of brainstem injury in people with mTBI through novel neuroimaging and objective assessments of somatic motor and visceral motor function. Our central hypothesis is that mTBI creates distinct abnormalities in motor (visceral and somatic) function that have a common neuroanatomical origin within the brainstem. Our first Specific Aim will determine differences between people with mTBI and healthy controls in brainstem integrity, as assessed structurally by neuroimaging and functionally by quantitative assessment of somatic and visceral motor function. Brainstem integrity will be determined from fractional anisotropy (FA) of white matter tracts imaged using high density fiber tractography. Somatic and visceral motor function will be assess using objective, instrumented mobility tests and cardiovascular autonomic measures of baroreceptor function, respectively. Specific Aim II will explore the relationship between acute brainstem integrity and the longitudinal recovery of objective motor function and self-reported symptoms. Brainstem FA values will be compared to objective measures of visceral motor and somatic motor function and to self-reported symptoms. We will also compare the extent to which structural integrity of the brainstem, quantified using FA, can predict recovery of objective motor function and self-reported symptoms over 3 months. This innovative study will be the first of its kind to collect objective measures of somatic and visceral motor function in conjunction with novel neuroimaging in people with mTBI. This study will establish the foundation for a future proposal seeking to characterize the response of structural integrity of the brainstem, motor function, and self-reported symptoms to targeted rehabilitation treatments after mTBI. Ultimately, this significant study may shift the paradigm of mTBI management by revealing the origin of motor dysfunction and providing physiological and structural neural markers that complement clinical classifications to guide treatment for those with mTBI.

项目摘要/摘要 对脑损伤轻度创伤（MTBI）的康复和医疗管理通常由 根据自我报告的症状和临床体征将人们分为亚型。但是，公共电动机 体征和症状不容易被解析为亚型分类，以及基本的病理生理学 运动症状尚不清楚。我们的长期目标是通过指示患者来改善MTBI的临床护理 基于客观和可量化标记的关键基础功能障碍的处理。常见的 症状，例如头痛和头晕以及临床体征，例如心血管不稳和姿势 不平衡，与关键的内脏电机（自主）和体细胞电动机（平衡和步态）功能有关 在脑干内共享一个共同的神经解剖学。然而，脑干几乎没有关注 MTBI的人，没有研究检查内脏（自主）和躯体（平衡与步态）是否 运动功能障碍具有共同的神经解剖学起源。这个探索性项目将检查结构和 通过新颖的神经影像和客观 评估体运动和内脏运动功能。我们的中心假设是MTBI创造了独特的 运动（内脏和躯体）功能的异常（内脏和躯体）功能，在该功能中具有共同的神经解剖学起源 脑干。我们的第一个特定目标将决定MTBI和健康对照者之间的差异 在脑干完整性中，通过神经成像在结构上评估，并在功能上通过定量来评估 评估体细胞和内脏运动功能。脑干完整性将从分数确定 使用高密度纤维段摄影成像的白质道各向异性（FA）。躯体和内脏电动机 功能将使用客观的，仪器的移动性测试和心血管自主措施进行评估 压力感受器功能分别。特定的目标II将探索急性脑干之间的关系 诚信和目标运动功能和自我报告的症状的纵向恢复。 脑干FA值将与内脏运动和体细胞运动功能的客观度量进行比较 自我报告的症状。我们还将比较脑干的结构完整性的程度， 使用FA进行量化，可以预测3个月内目标运动功能和自我报告的症状的恢复。 这项创新的研究将是第一个收集体细胞和内脏电动机的客观度量的此类研究 MTBI患者的新神经影像学结合起作用。这项研究将为 未来的建议，旨在表征脑干，运动功能的结构完整性的响应， MTBI后，自我报告的症状是针对有针对性的康复治疗的。最终，这项重大研究 可以通过揭示电动机功能障碍的起源并提供的MTBI管理范式 生理和结构神经标志物，补充临床分类以指导那些人的治疗 与mtbi。