脑震荡后接受前庭物理治疗的青少年认知评估与平衡测量之间的关系
Relationship Between Cognitive Assessment and Balance Measures in Adolescents Referred for Vestibular Physical Therapy After Concussion.
作者信息
Alsalaheen Bara A, Whitney Susan L, Marchetti Gregory F, Furman Joseph M, Kontos Anthony P, Collins Michael W, Sparto Patrick J
机构信息
*Department of Physical Therapy, University of Michigan-Flint, Flint, Michigan; Departments of †Physical Therapy; and ‡Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania; §Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia; ¶Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania; and ‖Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
出版信息
Clin J Sport Med. 2016 Jan;26(1):46-52. doi: 10.1097/JSM.0000000000000185.
OBJECTIVE
To examine the relationship between cognitive and balance performance in adolescents with concussion.
DESIGN
Retrospective case series.
SETTING
Tertiary.
PATIENTS
Sixty patients.
INTERVENTIONS
Correlation analyses were performed to describe the relationship between symptoms, cognitive measure, and balance measure at the time of initiation of vestibular physical therapy.
MAIN OUTCOME MEASURES
Cognitive performance was assessed using the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT). The dizziness and balance function measures included dizziness severity rating, Activities-specific Balance Confidence scale (ABC), Dizziness Handicap Inventory (DHI), Functional Gait Assessment, gait speed, Timed "UP and GO," Five Times Sit to Stand, and Sensory Organization Test (SOT). To account for multiple comparisons, the False Discovery Rate method was used.
RESULTS
Performance measures of balance were significantly correlated with cognitive measures. Greater total symptom scores were related to greater impairment in the ABC and DHI (r = 0.35-0.39, P ≤ 0.008) and worse performance in condition 2 of the SOT (r = -0.48, P = 0.004). Among the ImPACT composite scores, lower memory scores were correlated with impaired balance performance measures (r = 0.37-0.59, P ≤ 0.012). Lower visual memory was also correlated with worse ABC scores.
CONCLUSIONS
The significant relationships reported between the cognitive performance scores and balance measures may reflect that similar levels of functioning exist across domains in individuals with protracted recovery who receive vestibular physical therapy.
CLINICAL RELEVANCE
The weak-to-moderate relationships warrant the continuous use of multiple domains of assessment. A better understanding to the relationships between the domains of functioning after concussion may improve the overall management approach for adolescents with concussion.
目的
探讨脑震荡青少年的认知与平衡表现之间的关系。
设计
回顾性病例系列研究。
地点
三级医疗机构。
患者
60例患者。
干预措施
进行相关性分析，以描述前庭物理治疗开始时症状、认知测量和平衡测量之间的关系。
主要结局指标
使用脑震荡后即刻评估和认知测试（ImPACT）评估认知表现。头晕和平衡功能测量包括头晕严重程度评分、特定活动平衡信心量表（ABC）、头晕残障量表（DHI）、功能性步态评估、步速、定时起立行走测试、五次坐立测试和感觉统合测试（SOT）。为了考虑多重比较，采用了错误发现率方法。
结果
平衡表现测量与认知测量显著相关。总症状评分越高，与ABC和DHI的损伤越大相关（r = 0.35 - 0.39，P≤0.008），且SOT条件2中的表现越差（r = -0.48，P = 0.004）。在ImPACT综合评分中，较低的记忆评分与平衡表现测量受损相关（r = 0.37 - 0.59，P≤0.012）。较低的视觉记忆也与较差的ABC评分相关。
结论
认知表现评分与平衡测量之间报告的显著关系可能反映出，接受前庭物理治疗且恢复时间较长的个体在各个领域存在相似的功能水平。
临床意义
弱至中度的关系保证了持续使用多个评估领域。更好地理解脑震荡后功能领域之间的关系可能会改善青少年脑震荡的整体管理方法。
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