Fino Peter C, Weightman Margaret M, Dibble Leland E, Lester Mark E, Hoppes Carrie W, Parrington Lucy, Arango Jorge, Souvignier Alicia, Roberts Holly, King Laurie A
Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States.
Courage Kenny Research Center, Allina Health, Minneapolis, MN, United States.
Front Neurol. 2021 Jan 15;11:544812. doi: 10.3389/fneur.2020.544812. eCollection 2020.
Determining readiness for duty after mild traumatic brain injury (mTBI) is essential for the safety of service members and their unit. Currently, these decisions are primarily based on self-reported symptoms, objective measures that assess a single system, or standardized physical or cognitive tests that may be insensitive or lack ecological validity for warrior tasks. While significant technological advancements have been made in a variety of assessments of these individual systems, assessments of isolated tasks are neither diagnostically accurate nor representative of the demands imposed by daily life and military activities. Emerging evidence suggests that complex tasks, such as dual-task paradigms or turning, have utility in probing functional deficits after mTBI. Objective measures from turning tasks in single- or dual-task conditions, therefore, may be highly valuable for clinical assessments and return-to-duty decisions after mTBI. The goals of this study are to assess the diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation of objective, dual-task turning measures within an mTBI population. These goals will be accomplished over two phases. Phase 1 will enroll civilians at three sites and active-duty service members at one site to examine the diagnostic accuracy and predictive capacity of dual-task turning outcomes. Phase 1 participants will complete a series of turning tasks while wearing inertial sensors and a battery of clinical questionnaires, neurocognitive testing, and standard clinical assessments of function. Phase 2 will enroll active-duty service members referred for rehabilitation from two military medical treatment facilities to investigate the responsiveness to rehabilitation of objective dual-task turning measures. Phase 2 participants will complete two assessments of turning while wearing inertial sensors: a baseline assessment prior to the first rehabilitation session and a post-rehabilitation assessment after the physical therapist determines the participant has completed his/her rehabilitation course. A variable selection procedure will then be implemented to determine the best task and outcome measure for return-to-duty decisions based on diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation. Overall, the results of this study will provide guidance and potential new tools for clinical decisions in individuals with mTBI. : clinicaltrials.gov, Identifier NCT03892291.
确定轻度创伤性脑损伤（mTBI）后是否适合执行任务对于军人及其部队的安全至关重要。目前，这些决策主要基于自我报告的症状、评估单一系统的客观指标，或可能对作战任务不敏感或缺乏生态效度的标准化身体或认知测试。虽然在对这些单个系统的各种评估中已经取得了重大技术进步，但对孤立任务的评估在诊断上既不准确，也不能代表日常生活和军事活动所带来的需求。新出现的证据表明，复杂任务，如双任务范式或转身，在探究mTBI后的功能缺陷方面具有实用价值。因此，单任务或双任务条件下转身任务的客观指标对于mTBI后的临床评估和重返工作岗位决策可能具有很高的价值。本研究的目的是评估mTBI人群中客观双任务转身指标的诊断准确性、预测能力和对康复的反应性。这些目标将分两个阶段完成。第一阶段将在三个地点招募平民，在一个地点招募现役军人，以检查双任务转身结果的诊断准确性和预测能力。第一阶段的参与者将在佩戴惯性传感器的同时完成一系列转身任务，并填写一系列临床问卷、进行神经认知测试和标准临床功能评估。第二阶段将招募从两个军事医疗设施转介来进行康复治疗的现役军人，以研究客观双任务转身指标对康复的反应性。第二阶段的参与者将在佩戴惯性传感器的情况下完成两次转身评估：第一次康复治疗前的基线评估和物理治疗师确定参与者已完成其康复疗程后的康复后评估。然后将实施变量选择程序，根据诊断准确性、预测能力和对康复的反应性，确定用于重返工作岗位决策的最佳任务和结果指标。总体而言，本研究的结果将为mTBI患者的临床决策提供指导和潜在的新工具。：clinicaltrials.gov，标识符NCT03892291。
