Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.
Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.
J Neurotrauma. 2024 Mar;41(5-6):635-645. doi: 10.1089/neu.2023.0168. Epub 2023 Sep 15.
Thematically grouped symptom clusters are present during the acute timeline of post-mild traumatic brain injuries (mTBI), representing clinical profiles called subtypes. Exercise intolerance has not been evaluated within the subtype classifications and, because guidelines support early submaximal aerobic exercise, further knowledge is required in regard to the exercise capabilities among the concussion subtypes. This cross-sectional study ( = 78) aimed to characterize the presence of exercise intolerance within the clinical subtypes and to explore performance on the Buffalo Concussion Treadmill Test (BCTT) in the adult subacute (2-12 weeks post-injury) mTBI population. All participants were evaluated using the BCTT to determine exercise tolerance. We first used the Neurobehavioral Symptom Inventory (NSI) questionnaire to assign each participant a primary subtype(s). To further explore all five subtypes (headache, cognitive, vestibular, ocular motor, and mood), participants were assessed using a multitude of thematically grouped assessments including self-reported questionnaires, clinical tests of vestibular and ocular motor function, balance function, and computerized cognitive testing. Thirty-seven (47%) subjects were exercise tolerant and 41 (53%) were exercise intolerant. There was no difference in the distribution of primary subtypes between the exercise tolerant and exercise intolerant groups. In addition, no significant differences were found between the exercise tolerant and exercise intolerant groups on other thematically grouped subtype assessments. The exercise intolerant group had a significantly higher resting heart rate (HR), lower percentage of age-predicted maximum HR achieved, lower Borg Rate of Perceived Exertion (RPE), and could walk on the treadmill for less time (lower duration) compared with the exercise tolerant group. The current findings suggest that exercise intolerance is common and pervasive across all five mTBI subtypes. A comprehensive mTBI assessment should include evaluation for exercise intolerance regardless of the primary clustering of symptoms and across patient populations. Therefore, early referral to physical therapists, athletic trainers, or medical clinics that can perform the BCTT may be helpful to initiate appropriate exercise prescriptions for patients with mTBI.
创伤性脑损伤后轻度脑损伤（mTBI）的急性时间线上存在以症状为主题的聚类，代表了称为亚型的临床特征。在亚型分类中尚未评估运动不耐受，由于指南支持早期亚最大有氧运动，因此需要进一步了解脑震荡亚型的运动能力。这项横断面研究（n=78）旨在描述临床亚型中运动不耐受的存在，并探讨成人亚急性（受伤后 2-12 周）mTBI 人群中布法罗脑震荡跑步机测试（BCTT）的表现。所有参与者都使用 BCTT 评估运动耐量。我们首先使用神经行为症状量表（NSI）问卷为每个参与者分配一个主要亚型。为了进一步探索所有五个亚型（头痛、认知、前庭、眼动和情绪），参与者使用了多种以主题分组的评估方法，包括自我报告问卷、前庭和眼动功能的临床测试、平衡功能和计算机认知测试。37 名（47%）受试者为运动耐受，41 名（53%）为运动不耐受。在运动耐受组和运动不耐受组之间，主要亚型的分布没有差异。此外，在其他以主题分组的亚型评估中，运动耐受组和运动不耐受组之间没有发现显著差异。与运动耐受组相比，运动不耐受组的静息心率（HR）较高，达到预期最大 HR 的百分比较低，Borg 感觉用力等级（RPE）较低，在跑步机上行走的时间（持续时间）较短。目前的研究结果表明，运动不耐受在所有五个 mTBI 亚型中都很常见且普遍存在。全面的 mTBI 评估应包括对运动不耐受的评估，无论症状的主要聚类如何，以及在患者人群中。因此，早期向物理治疗师、运动训练师或可以进行 BCTT 的医疗诊所转介可能有助于为 mTBI 患者制定适当的运动处方。
