Paniccia Melissa, Taha Tim, Keightley Michelle, Thomas Scott, Verweel Lee, Murphy James, Wilson Katherine, Reed Nick
Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital;
Faculty of Kinesiology and Physical Education, University of Toronto.
J Vis Exp. 2018 Sep 21(139):58203. doi: 10.3791/58203.
Participation in organized sports makes a significant contribution to youth development, but places youth at a higher risk for sustaining a concussion. To date, return-to-activity decision-making has been anchored in the monitoring of self-reported concussion symptoms and neurocognitive testing. However, multi-modal assessments that corroborate objective physiological measures with traditional subjective symptom reporting are needed and can be valuable. Heart rate variability (HRV) is a non-invasive physiological indicator of the autonomic nervous system, capturing the reciprocal interplay between the sympathetic and parasympathetic nervous systems. There is a dearth of literature exploring the effect of concussion on HRV in youth athletes, and developmental differences preclude the application of adult findings to a pediatric population. Further, the current state of HRV methodology has primarily included short-term (5-15 min) recordings, by using resting state or short-term physical exertion testing to elucidate changes following concussion. The novelty in utilizing a 24 h recording methodology is that it has the potential to capture natural variation in autonomic function, directly related to the activities a youth athlete performs on a regular basis. Within a prospective, longitudinal research setting, this novel approach to quantifying autonomic function can provide important information regarding the recovery trajectory, alongside traditional self-report symptom measures. Our objectives regarding a 24 h recording methodology were to (1) evaluate the physiological effects of a concussion in youth athletes, and (2) describe the trajectory of physiological change, while considering the resolution of self-reported post-concussion symptoms. To achieve these objectives, non-invasive sensor technology was implemented. The raw beat-to-beat time intervals captured can be transformed to derive time domain and frequency domain measures, which reflect an individual's ability to adapt and be flexible to their ever-changing environment. By using non-invasive heart rate technology, autonomic function can be quantified outside of a traditional controlled research setting.
参与有组织的体育运动对青少年发展有重大贡献，但也使青少年遭受脑震荡的风险更高。迄今为止，恢复活动的决策一直基于对自我报告的脑震荡症状和神经认知测试的监测。然而，需要将客观生理指标与传统主观症状报告相结合的多模式评估，且这种评估可能很有价值。心率变异性（HRV）是自主神经系统的一种非侵入性生理指标，反映交感神经系统和副交感神经系统之间的相互作用。目前缺乏关于脑震荡对青少年运动员HRV影响的文献，而且发育差异使得不能将成人的研究结果应用于儿科人群。此外，目前HRV方法主要包括短期（5 - 15分钟）记录，通过静息状态或短期体力消耗测试来阐明脑震荡后的变化。采用24小时记录方法的新颖之处在于它有可能捕捉自主功能的自然变化，这与青少年运动员日常进行的活动直接相关。在一项前瞻性纵向研究中，这种量化自主功能的新方法可以与传统的自我报告症状测量一起，提供有关恢复轨迹的重要信息。我们关于24小时记录方法的目标是：（1）评估脑震荡对青少年运动员的生理影响；（2）描述生理变化轨迹，同时考虑自我报告的脑震荡后症状的缓解情况。为实现这些目标，采用了非侵入性传感器技术。捕获的逐搏时间间隔原始数据可以进行转换，以得出反映个体适应不断变化环境能力的时域和频域测量值。通过使用非侵入性心率技术，可以在传统的受控研究环境之外量化自主功能。
