多模式的方法来评估恢复的青少年运动员脑震荡之后
Summary
This article provides an overview of a multi-modal approach to assessing recovery following concussion in youth athletes. The described protocol uses pre- and post-concussion assessment of performance across a wide variety of domains and can inform the development of improved concussion rehabilitation protocols specific to the youth sport community.
Abstract
脑震荡是最常见的伤病当中涉及的体育参与儿童和青年中的一个。经过震荡，青年可以体验一系列短期和长期的神经行为症状（躯体，认知和情绪/行为），可以在日常活动和兴趣的追求（ 如学校，体育，工作，一个人的参与的显著影响，家庭/社会生活等 ）。尽管如此，仍然存在于临床驱动的研究贫乏的青年运动人口内探索震荡旨在具体，更具体地讲，多模式的方法来测量恢复。本文提供了一种新型的多模态方式测量复苏之中的青年运动员脑震荡如下概述。所提出的方法包括使用两个受伤前/基准测试和伤后/后续测试在各种不同的领域，以评估业绩（后concus锡永的症状，认知，平衡，力量，敏捷/运动技能和静息状态下心脏心率变异）。本研究的目的是为了获得恢复之后震荡青年运动员（年龄10-18岁）更客观，准确的认识。从这个研究结果可以帮助告知开发和利用改进的办法，以震荡的管理和康复具体到青少年体育界。
Introduction
震荡可以被定义为1“影响引起的外伤性生物机械力的大脑复杂的病理生理过程”，并且可能导致短期和长期的躯体，认知和/或情绪/行为症状2。从功能上讲，脑震荡及相关症状可以在日常活动中对一个人的参与的显著影响，追求3。据估计，在美国，1.6至380万脑震荡，每年发生的体育参与4的结果。具体到参与体育的儿童和青少年，脑震荡是最常见的受伤5-7中的一个。尽管冲击震荡可能对日常活动和脑震荡是儿童和青少年的患病率，但仍然缺乏科学数据报告如何青年大脑反应在各种性能领域为脑震荡。
基准吨十分有趣的，或使用受伤前的测试成绩为基准，对伤后的测试成绩对比，告知恢复，是日益普及青少年体育界内的做法，并已建议国际8是“有益的补充有用脑震荡的管理过程中的信息“（第3页）。以最好地代表了脑震荡后症状（躯体，认知和情绪/行为）的各种性质，重要的是，脑震荡后恢复的评估包括各种结果的措施。此外，目前震荡的管理很大程度上依赖于脑震荡后的症状主观的报告。这种主观报告的有效性可通过多种因素9的影响，并可能导致两个报告不足的症状10,11和不准确的，可靠的恢复的指标。其结果是，有一个显著需要探索的方法来跨performan测量脑震荡后恢复CE域是客观和敏感。
它已被证明，认知，平衡，力量和敏捷可以在以下的青年脑震荡和脑损伤12-17被削弱。被选中列入本试验的方案中的措施提供以下震荡洞察在这些领域的恢复，并合并使用常常被认为是整个集中管理的脑震荡的临床环境中使用经过验证的临床测试工具。此外，从更为解释性透视，静息状态的HRV可以看作是交感平衡18,19的精确测量。在健康人群中，交感平衡被定义为在副交感神经系统占优势处于静止状态，而交感神经系统处于强直抑制控制。它是假设，脑震荡后，由于生理应力，这两个系统之间的不平衡会存在与静止状态可以转换到的动交感神经系统和副交感神经系统20的活动减退。
这项研究的协议的目的是为了获得恢复之后震荡更加全面，客观，准确地了解行为前后脑震荡的表现之间的青年运动员（年龄10-18岁）的多模态评估。本研究的目的是提供洞察开发和交付的特定于儿童和青年震荡的管理和康复方案。
Protocol
Representative Results
Discussion
该协议提出了一种多模态方式测量下震荡回升的青年运动员。该协议的一个关键特征是在广泛的性能域的脑震荡后的数据（认知，平衡，力量，敏捷，静息状态下心脏心率变异性等 ）到受伤前/基准的比较。这些数据作为一种手段，表明复苏之中以下震荡个别青年运动员。通过使用的认知，平衡，力量和敏捷性能常见和容易得到的临床测量，以及实验使用静息状态的HRV，该协议的目的是提?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
We would like to thank the Canadian Institutes of Health Research (CIHR) who have provided funding for this research. Further, we would like to acknowledge Dr. Tim Taha and Dr. Scott Thomas from the University of Toronto for their assistance with the development of our protocol for the collection of resting state heart rate variability data.
Materials
| Name of Reagent/ Equipment | Company | Catalog Number | Comments/Description |
| Scale | Weight Watchers: Conair | WW30WB | |
| Measuring Tape | Hi-Viz Lufkin | HVC716CME | |
| Heart Rate Monitor (Chest Strap and Watch) | Polar | RS800CX GPS | |
| Exercise/Yoga Mat | Pur Athletics | WTE10126 | |
| Sportline Stopwatch (Model 228) | EB Sport Group | #2787 | |
| Laptop – MacBook Pro | Apple | A1278 | |
| Computerized Cognitive Assessment- Immediate Post-Concussion Assessment and Cognitive Task | ImPACT Application's Inc. | ||
| Hand Grip Dynamometer | Sammons Preston- Smedley-Type | 5032P | |
| BioSway | Biodex Medical Supplies Inc. | 950-510 | |
| Painter's Mate Green Tape | ShurTech Brands LLC | #49462 | |
| Pylons/Cones (12") | Canadian Tire | 84-295-4 | |
| Basket | Canadian Tire | 42-9919-2 | |
| Bean Bags | Eastpoint/Go Gater | 1-1-16392 |
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