Corrigan Frances, Wee Ing Chee, Collins-Praino Lyndsey E
Head Injury Lab, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia.
Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia.
Front Neurol. 2023 May 11;14:1180353. doi: 10.3389/fneur.2023.1180353. eCollection 2023.
Traumatic brain injury (TBI) is now known to be a chronic disease, causing ongoing neurodegeneration and linked to increased risk of neurodegenerative motor diseases, such as Parkinson's disease and amyotrophic lateral sclerosis. While the presentation of motor deficits acutely following traumatic brain injury is well-documented, however, less is known about how these evolve in the long-term post-injury, or how the initial severity of injury affects these outcomes. The purpose of this review, therefore, was to examine objective assessment of chronic motor impairment across the spectrum of TBI in both preclinical and clinical models.
PubMed, Embase, Scopus, and PsycINFO databases were searched with a search strategy containing key search terms for TBI and motor function. Original research articles reporting chronic motor outcomes with a clearly defined TBI severity (mild, repeated mild, moderate, moderate-severe, and severe) in an adult population were included.
A total of 97 studies met the inclusion criteria, incorporating 62 preclinical and 35 clinical studies. Motor domains examined included neuroscore, gait, fine-motor, balance, and locomotion for preclinical studies and neuroscore, fine-motor, posture, and gait for clinical studies. There was little consensus among the articles presented, with extensive differences both in assessment methodology of the tests and parameters reported. In general, an effect of severity was seen, with more severe injury leading to persistent motor deficits, although subtle fine motor deficits were also seen clinically following repeated injury. Only six clinical studies investigated motor outcomes beyond 10 years post-injury and two preclinical studies to 18-24 months post-injury, and, as such, the interaction between a previous TBI and aging on motor performance is yet to be comprehensively examined.
Further research is required to establish standardized motor assessment procedures to fully characterize chronic motor impairment across the spectrum of TBI with comprehensive outcomes and consistent protocols. Longitudinal studies investigating the same cohort over time are also a key for understanding the interaction between TBI and aging. This is particularly critical, given the risk of neurodegenerative motor disease development following TBI.
创伤性脑损伤（TBI）如今被认为是一种慢性疾病，会导致持续的神经退行性变，并与神经退行性运动疾病（如帕金森病和肌萎缩侧索硬化症）的风险增加有关。虽然创伤性脑损伤后急性运动功能障碍的表现已有充分记录，然而，对于这些功能障碍在损伤后的长期演变情况，或者损伤的初始严重程度如何影响这些结果，我们了解得较少。因此，本综述的目的是在临床前和临床模型中，研究对不同严重程度创伤性脑损伤患者慢性运动功能障碍的客观评估。
使用包含创伤性脑损伤和运动功能关键检索词的检索策略，对PubMed、Embase、Scopus和PsycINFO数据库进行检索。纳入报告了成年人群中明确界定的创伤性脑损伤严重程度（轻度、反复轻度、中度、中重度和重度）的慢性运动结果的原创性研究文章。
共有97项研究符合纳入标准，其中包括62项临床前研究和35项临床研究。临床前研究中所考察的运动领域包括神经评分、步态、精细运动、平衡和运动能力，临床研究中则包括神经评分、精细运动、姿势和步态。在所呈现的文章中几乎没有达成共识，在测试的评估方法和所报告的参数方面都存在广泛差异。总体而言，观察到了严重程度的影响，更严重的损伤会导致持续的运动功能障碍，不过临床上反复受伤后也会出现细微的精细运动功能障碍。只有六项临床研究调查了损伤后10年以上的运动结果，两项临床前研究调查了损伤后18 - 24个月的运动结果，因此，既往创伤性脑损伤与衰老对运动表现的相互作用尚未得到全面研究。
需要进一步研究以建立标准化的运动评估程序，从而通过全面的结果和一致的方案，充分描述不同严重程度创伤性脑损伤患者的慢性运动功能障碍。对同一队列进行长期跟踪研究也是理解创伤性脑损伤与衰老之间相互作用的关键。鉴于创伤性脑损伤后发生神经退行性运动疾病的风险，这一点尤为重要。
