Talavage Thomas M, Nauman Eric A, Breedlove Evan L, Yoruk Umit, Dye Anne E, Morigaki Katherine E, Feuer Henry, Leverenz Larry J
1 Weldon School of Biomedical Engineering, Purdue University , West Lafayette, Indiana.
J Neurotrauma. 2014 Feb 15;31(4):327-38. doi: 10.1089/neu.2010.1512. Epub 2013 Apr 11.
Head trauma and concussion in football players have recently received considerable media attention. Postmortem evidence suggests that accrual of damage to the brain may occur with repeated blows to the head, even when the individual blows fail to produce clinical symptoms. There is an urgent need for improved detection and characterization of head trauma to reduce future injury risk and promote development of new therapies. In this study we examined neurological performance and health in the presence of head collision events in high school football players, using longitudinal measures of collision events (the HIT(™) System), neurocognitive testing (ImPACT(™)), and functional magnetic resonance imaging MRI (fMRI). Longitudinal assessment (including baseline) was conducted in 11 young men (ages 15-19 years) participating on the varsity and junior varsity football teams at a single high school. We expected and observed subjects in two previously described categories: (1) no clinically-diagnosed concussion and no changes in neurological behavior, and (2) clinically-diagnosed concussion with changes in neurological behavior. Additionally, we observed players in a previously undiscovered third category, who exhibited no clinically-observed symptoms associated with concussion, but who demonstrated measurable neurocognitive (primarily visual working memory) and neurophysiological (altered activation in the dorsolateral prefrontal cortex [DLPFC]) impairments. This new category was associated with significantly higher numbers of head collision events to the top-front of the head, directly above the DLPFC. The discovery of this new category suggests that more players are suffering neurological injury than are currently being detected using traditional concussion-assessment tools. These individuals are unlikely to undergo clinical evaluation, and thus may continue to participate in football-related activities, even when changes in brain physiology (and potential brain damage) are present, which will increase the risk of future neurological injury.
足球运动员的头部创伤和脑震荡最近受到了媒体的广泛关注。尸检证据表明，即使单次头部撞击未产生临床症状，反复的头部撞击也可能导致脑部损伤的累积。迫切需要改进头部创伤的检测和特征描述，以降低未来的受伤风险，并促进新疗法的开发。在本研究中，我们使用碰撞事件的纵向测量（HIT™系统）、神经认知测试（ImPACT™）和功能磁共振成像（fMRI），对高中足球运动员在头部碰撞事件中的神经功能和健康状况进行了检查。对一所高中参加校队和初中校队的11名年轻男性（年龄在15 - 19岁之间）进行了纵向评估（包括基线评估）。我们预期并观察到了之前描述的两类受试者：（1）无临床诊断的脑震荡且神经行为无变化；（2）有临床诊断的脑震荡且神经行为有变化。此外，我们还观察到了一类之前未被发现的第三类球员，他们没有表现出与脑震荡相关的临床观察到的症状，但表现出了可测量的神经认知（主要是视觉工作记忆）和神经生理（背外侧前额叶皮层[DLPFC]激活改变）损伤。这一新类别与直接位于DLPFC上方的头部顶部前方的头部碰撞事件数量显著增加有关。这一新类别的发现表明，遭受神经损伤的球员比目前使用传统脑震荡评估工具检测到的要多。这些人不太可能接受临床评估，因此即使存在脑生理变化（以及潜在的脑损伤），他们可能仍会继续参加与足球相关的活动，这将增加未来神经损伤的风险。
