Ntikas Michail, Hunter Angus M, Gallagher Iain J, Di Virgilio Thomas G
Department of Psychology, University of Stirling, Stirling, United Kingdom.
Department of Physiology, Exercise and Nutrition Research Group, University of Stirling, Stirling, United Kingdom.
Front Sports Act Living. 2021 Dec 9;3:737712. doi: 10.3389/fspor.2021.737712. eCollection 2021.
The objective of this study was to assess if injury-related alterations in the Sport Concussion Assessment Tool-5 (SCAT5) are matched by changes in transcranial magnetic stimulation-derived intracortical inhibition. We hypothesised that neurophysiological measures would take longer to return to normal than recovery assessed by the SCAT5 following sport related concussion (SRC). Thirteen male contact sport athletes (20.5 ± 4.5 years), who reported a concussion were recruited from local Rugby and American football clubs. Participants were tested at 4 timepoints throughout the concussion recovery period: within 24 h of concussion (day 0), and at 7, 9, and 11 days after concussion. All participants completed the SCAT5 and underwent TMS to assess cortical silent period duration (CSp), a measure of intracortical inhibition. After concussion CSp significantly declined from day 0 (122 ± 28 ms) to day 11 (106 ± 15 ms) [ = 7.80, < 0.001]. SCAT5 measures of symptom number and severity were significantly decreased [symptom number: = 30.44, < 0.01; symptom severity: = 25.75, < 0.001] between the day 0 timepoint and each of the other timepoints. SCAT5 balance errors (mBESS) decreased significantly [ = 19.55, < 0.001] between the day 0 timepoint and each of the other timepoints. CSp and SCAT5 recovery patterns were different. SCAT5 domains recovered faster showing no further significant changes after day 7, whilst CSp was still decreasing between days 7 and 9. Due to the small sample size we also used a Bayesian linear model to investigate the recovery of CSp and mBESS. The posterior distribution of our Bayesian model provided evidence that CSp decreased at day 7 and it continued to decrease at day 9, unlike mBESS which decreased at day 7 and then reached a plateau. There are clinically important discrepancies between clinical and neurophysiological measures of concussion recovery. This finding has important implications for return to play (RTP) protocols and the prevention of complications after sport concussion.
本研究的目的是评估运动性脑震荡评估工具-5（SCAT5）中与损伤相关的改变是否与经颅磁刺激衍生的皮质内抑制的变化相匹配。我们假设，与运动相关的脑震荡（SRC）后，神经生理学指标恢复正常所需的时间比SCAT5评估的恢复时间更长。从当地橄榄球和美式足球俱乐部招募了13名报告有脑震荡的男性接触性运动运动员（20.5±4.5岁）。在脑震荡恢复期的4个时间点对参与者进行测试：脑震荡后24小时内（第0天），以及脑震荡后第7、9和11天。所有参与者均完成SCAT5测试，并接受经颅磁刺激以评估皮质静息期持续时间（CSp），这是一种皮质内抑制的测量指标。脑震荡后，CSp从第0天（122±28毫秒）显著下降至第11天（106±15毫秒）[F = 7.80，P < 0.001]。在第0天时间点与其他每个时间点之间，SCAT5的症状数量和严重程度测量值显著降低[症状数量：F = 30.44，P < 0.01；症状严重程度：F = 25.75，P < 0.001]。在第0天时间点与其他每个时间点之间，SCAT5平衡误差（mBESS）显著降低[F = 19.55，P < 0.001]。CSp和SCAT5的恢复模式不同。SCAT5各领域恢复得更快，在第7天后没有进一步的显著变化，而CSp在第7天至第9天仍在下降。由于样本量较小，我们还使用贝叶斯线性模型来研究CSp和mBESS的恢复情况。我们的贝叶斯模型的后验分布提供了证据，表明CSp在第7天下降，并在第9天继续下降，这与mBESS不同，mBESS在第7天下降，然后达到平稳期。脑震荡恢复的临床测量和神经生理学测量之间存在临床上重要的差异。这一发现对重返比赛（RTP）方案以及运动性脑震荡后并发症的预防具有重要意义。
