Wilkerson Gary B, Colston Marisa A, Acocello Shellie N, Hogg Jennifer A, Carlson Lynette M
Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN, United States.
Front Sports Act Living. 2023 Jan 25;5:1046572. doi: 10.3389/fspor.2023.1046572. eCollection 2023.
A lack of obvious long-term effects of concussion on standard clinical measures of behavioral performance capabilities does not preclude the existence of subtle neural processing impairments that appear to be linked to elevated risk for subsequent concussion occurrence, and which may be associated with greater susceptibility to progressive neurodegenerative processes. The purpose of this observational cohort study was to assess virtual reality motor response variability and survey responses as possible indicators of suboptimal brain function among military cadets and college athletes with self-reported history of concussion (HxC).
The cohort comprised 75 college students (20.7 ± 2.1 years): 39 Reserve Officer Training Corp (ROTC) military cadets (10 female), 16 football players, and 20 wrestlers; HxC self-reported by 20 (29.2 ± 27.1 months prior, range: 3-96). A virtual reality (VR) test involving 40 lunging/reaching responses to horizontally moving dots (filled/congruent: same direction; open/incongruent: opposite direction) was administered, along with the Sport Fitness and Wellness Index (SFWI) survey. VR Dispersion (standard deviation of 12 T-scores for neck, upper extremity, and lower extremity responses to congruent vs. incongruent stimuli originating from central vs. peripheral locations) and SFWI response patterns were the primary outcomes of interest.
Logistic regression modeling of VR Dispersion (range: 1.5-21.8), SFWI (range: 44-100), and an interaction between them provided 81% HxC classification accuracy (Model [2] = 26.03, < .001; Hosmer & Lemeshow [8] = 1.86, = .967; Nagelkerke = .427; Area Under Curve = .841, 95% CI: .734, .948). Binary modeling that included VR Dispersion ≥3.2 and SFWI ≤86 demonstrated 75% sensitivity and 86% specificity with both factors positive (Odds Ratio = 17.6, 95% CI: 5.0, 62.1).
DISCUSSION/CONCLUSION: Detection of subtle indicators of altered brain processes that might otherwise remain unrecognized is clearly important for both short-term and long-term clinical management of concussion. Inconsistency among neck, upper extremity, and lower extremity responses to different types of moving visual stimuli, along with survey responses suggesting suboptimal well-being, merit further investigation as possible clinical indicators of persisting effects of concussion that might prove to be modifiable.
脑震荡对行为表现能力的标准临床测量缺乏明显的长期影响，这并不排除存在细微的神经加工障碍，这些障碍似乎与后续发生脑震荡的风险升高有关，并且可能与对进行性神经退行性过程的更高易感性相关。这项观察性队列研究的目的是评估虚拟现实运动反应变异性和调查反应，作为有自我报告脑震荡病史（HxC）的军校学员和大学生运动员中脑功能欠佳的可能指标。
该队列包括75名大学生（20.7±2.1岁）：39名后备军官训练团（ROTC）军校学员（10名女性）、16名足球运动员和20名摔跤运动员；20人自我报告有脑震荡病史（平均29.2±27.1个月前，范围：3 - 96个月）。进行了一项虚拟现实（VR）测试，包括对水平移动点的40次冲刺/伸手反应（实心/一致：相同方向；空心/不一致：相反方向），以及运动健康与幸福指数（SFWI）调查。VR离散度（颈部、上肢和下肢对来自中央与外周位置的一致与不一致刺激反应的12个T分数的标准差）和SFWI反应模式是主要关注的结果。
对VR离散度（范围：1.5 - 21.8）、SFWI（范围：44 - 100）及其之间的相互作用进行逻辑回归建模，HxC分类准确率为81%（模型[2]=26.03，<0.001；Hosmer和Lemeshow[8]=1.86，=0.967；Nagelkerke =0.427；曲线下面积=0.841，95%CI：0.734，0.948）。包含VR离散度≥3.2和SFWI≤86的二元建模显示，当两个因素均为阳性时，敏感性为75%，特异性为86%（优势比=17.6，95%CI：5.0，62.1）。
讨论/结论：检测可能 otherwise remain unrecognized的脑过程改变的细微指标，对于脑震荡的短期和长期临床管理显然都很重要。颈部、上肢和下肢对不同类型移动视觉刺激的反应不一致，以及调查反应表明幸福感欠佳，作为脑震荡持续影响的可能临床指标值得进一步研究，这些指标可能被证明是可改变的。
