Faculty of Kinesiology and Physical Education, University of Toronto , Toronto, ON , Canada.
Keenan Research Centre for Biomedical Science of St. Michael's Hospital , Toronto, ON , Canada ; Faculty of Medicine, University of Toronto , Toronto, ON , Canada.
Front Neurol. 2014 Apr 14;5:46. doi: 10.3389/fneur.2014.00046. eCollection 2014.
Sport-related concussions are now recognized as a major public health concern: the number of participants in sport and recreation is growing, possibly playing their games faster, and there is heightened public awareness of injuries to some high-profile athletes. However, many clinicians still rely on subjective symptom reports for the clinical determination of recovery. Relying on subjective symptom reports can be problematic, as it has been shown that some concussed athletes may downplay their symptoms. The use of neuropsychological (NP) testing has enabled clinicians to measure the effects and extent of impairment following concussion more precisely, providing more objective metrics for determining recovery. Nevertheless, there is a remaining concern that brain abnormalities may exist beyond the point at which individuals achieve recovery in self-reported symptoms and cognition measured by NP testing. Our understanding of brain recovery after concussion is important, not only from a neuroscience perspective, but also from the perspective of clinical decision-making for safe return-to-play. A number of advanced neuroimaging tools, including blood oxygen level dependent functional magnetic resonance imaging (fMRI), have independently yielded early information on abnormal brain functioning. In the two cases presented in this article, we report contrasting brain activation patterns and recovery profiles using fMRI. Importantly, fMRI was conducted using adapted versions of the most sensitive computerized NP tests administered in our current clinical practice to determine impairments and recovery after sport-related concussion. One of the cases is consistent with the concept of lagging brain recovery.
参与运动和娱乐的人数不断增加，他们可能玩得更快，公众对一些知名运动员受伤的意识也有所提高。然而，许多临床医生仍然依赖主观症状报告来确定恢复情况。依赖主观症状报告可能会出现问题，因为已经表明一些脑震荡运动员可能会淡化他们的症状。神经心理学 (NP) 测试的使用使临床医生能够更准确地测量脑震荡后的影响和损伤程度，为确定恢复提供更客观的指标。然而，仍然存在一种担忧，即大脑异常可能存在于个体在自我报告的症状和 NP 测试测量的认知方面恢复之后。我们对脑震荡后大脑恢复的理解很重要，不仅从神经科学的角度，而且从临床决策的角度来看，这对于安全重返赛场也很重要。一些先进的神经影像学工具，包括血氧水平依赖功能磁共振成像 (fMRI)，已经独立提供了关于异常大脑功能的早期信息。在本文介绍的两个案例中，我们报告了使用 fMRI 观察到的对比鲜明的大脑激活模式和恢复情况。重要的是，fMRI 是使用我们当前临床实践中进行的最敏感的计算机化 NP 测试的改编版本进行的，以确定运动相关性脑震荡后的损伤和恢复情况。其中一个案例符合大脑恢复滞后的概念。
