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姿势控制缺陷可识别脑震荡后持续存在的神经功能缺陷。

Postural control deficits identify lingering post-concussion neurological deficits.

作者信息

Buckley Thomas A, Oldham Jessie R, Caccese Jaclyn B

机构信息

Department of Kinesiology and Applied Physiology, Interdisciplinary Program in Biomechanics and Movement Science, 150 Human Performance Laboratory, University of Delaware, Newark, DE 19716, USA.

Interdisciplinary program in Biomechanics and Movement Science, University of Delaware, Newark, DE 19716, USA.

出版信息

J Sport Health Sci. 2016 Mar;5(1):61-69. doi: 10.1016/j.jshs.2016.01.007. Epub 2016 Jan 11.

Abstract

Concussion, or mild traumatic brain injury, incidence rates have reached epidemic levels and impaired postural control is a cardinal symptom. The purpose of this review is to provide an overview of the linear and non-linear assessments of post-concussion postural control. The current acute evaluation for concussion utilizes the subjective balance error scoring system (BESS) to assess postural control. While the sensitivity of the overall test battery is high, the sensitivity of the BESS is unacceptably low and, with repeat administration, is unable to accurately identify recovery. Sophisticated measures of postural control, utilizing traditional linear assessments, have identified impairments in postural control well beyond BESS recovery. Both assessments of quiet stance and gait have identified lingering impairments for at least 1 month post-concussion. Recently, the application of non-linear metrics to concussion recovery have begun to receive limited attention with the most commonly utilized metric being approximate entropy (ApEn). ApEn, most commonly in the medial-lateral plane, has successfully identified impaired postural control in the acute post-concussion timeframe even when linear assessments of instrumented measures are equivalent to healthy pre-injury values; unfortunately these studies have not gone beyond the acute phase of recovery. One study has identified lingering deficits in postural control, utilizing Shannon and Renyi entropy metrics, which persist at least through clinical recovery and return to participation. Finally, limited evidence from two studies suggest that individuals with a previous history of a single concussion, even months or years prior, may display altered ApEn metrics. Overall, non-linear metrics provide a fertile area for future study to further the understanding of postural control impairments acutely post-concussion and address the current challenge of sensitive identification of recovery.

摘要

脑震荡,即轻度创伤性脑损伤,其发病率已达到流行程度,而姿势控制受损是其主要症状。本综述的目的是概述脑震荡后姿势控制的线性和非线性评估。目前对脑震荡的急性评估采用主观平衡误差评分系统(BESS)来评估姿势控制。虽然整个测试组的敏感性较高,但BESS的敏感性低得令人无法接受,并且重复使用时无法准确识别恢复情况。利用传统线性评估的复杂姿势控制测量方法已经确定,姿势控制的损伤远远超出了BESS恢复的范围。对安静站立和步态的评估都发现,脑震荡后至少1个月存在持续的损伤。最近,将非线性指标应用于脑震荡恢复的研究开始受到有限关注,最常用的指标是近似熵(ApEn)。ApEn最常用于中外侧平面,即使仪器测量的线性评估与受伤前健康值相当,也已成功识别出脑震荡后急性期受损的姿势控制;不幸的是,这些研究尚未超出恢复的急性期。一项研究利用香农熵和雷尼熵指标确定了姿势控制方面的持续缺陷,这些缺陷至少持续到临床恢复并恢复参与活动。最后,两项研究的有限证据表明,即使在数月或数年之前有过单次脑震荡病史的个体,其ApEn指标也可能发生改变。总体而言,非线性指标为未来研究提供了一个丰富的领域,以进一步了解脑震荡后急性期的姿势控制损伤,并应对当前敏感识别恢复情况的挑战。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6297/6191989/1a3dcf362be3/jshs250-fig-0001.jpg

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