Weike Lea, Reeschke Rebecca, Reinsberger Claus
Institute of Sports Medicine, Department of Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany.
Division of Sports Neurology & Neurosciences, Department of Neurology, Mass General Brigham, Boston, Massachusetts, USA.
BMJ Open Sport Exerc Med. 2025 Jul 31;11(3):e002447. doi: 10.1136/bmjsem-2024-002447. eCollection 2025.
This cross-sectional study aimed to investigate subjective and objective deficits of neurocognitive function, balance and vestibulo-ocular performance in athletes with sport-related concussion (SRC) compared with healthy control athletes.
72 patients with SRC and 72 matched healthy controls were included. All participants performed computerised testing of neurocognitive function, device-assisted balance testing and objective evaluation of vestibulo-ocular function (video head impulse and dynamic visual acuity test). Clinical symptom clusters (headache/migraine, anxiety/mood, fatigue, cognitive, vestibular, ocular) were determined for each patient using the Sport Concussion Assessment Tool, 5th edition symptom evaluation. Independent t-tests or Mann-Whitney U tests were calculated to test for group differences in the whole cohort and according to clinical symptom clusters.
When investigating the whole cohort, significant differences between patients with SRC and control subjects were found in one parameter of balance testing (sway velocity double-firm), with lower performance in the SRC group (p<0.001, r=0.345). The number of symptom clusters assigned to the SRC patients ranged from 0 (no definite cluster) to 6 (all clusters), and all clusters were frequent in the investigated cohort. Patients with vestibular, cognitive and fatigue symptom clusters demonstrated significantly lower performance in balance testing compared with SRC patients without those clusters (p<0.001 to p=0.005, r=0.368-0.439). Additionally, SRC patients presenting with symptoms of the fatigue cluster demonstrated significantly worse performance in vestibulo-ocular testing compared with SRC patients without the fatigue cluster (p=0.006, d=0.781).
SRC patients presented with variable numbers and qualities of clinical symptom clusters. Some subjective clusters were associated with abnormal objective tests of other clusters (vestibular, cognitive and fatigue with abnormal balance; and fatigue with abnormal vestibulo-ocular performance). Clinical symptom clusters and their overlap should be considered when examining patients with SRC.
本横断面研究旨在调查与运动相关脑震荡（SRC）的运动员与健康对照运动员相比，神经认知功能、平衡和前庭眼动功能的主观和客观缺陷。
纳入72例SRC患者和72例匹配的健康对照者。所有参与者均进行神经认知功能的计算机测试、设备辅助平衡测试以及前庭眼动功能的客观评估（视频头脉冲和动态视力测试）。使用第5版运动脑震荡评估工具症状评估为每位患者确定临床症状群（头痛/偏头痛、焦虑/情绪、疲劳、认知、前庭、眼部）。计算独立t检验或曼-惠特尼U检验，以检验整个队列以及根据临床症状群的组间差异。
在调查整个队列时，SRC患者与对照组在平衡测试的一个参数（双脚稳固时的摇摆速度）上存在显著差异，SRC组表现较差（p<0.001，r=0.345）。分配给SRC患者的症状群数量从0（无明确群）到6（所有群）不等，并且所有群在研究队列中都很常见。与没有这些症状群的SRC患者相比，有前庭、认知和疲劳症状群的患者在平衡测试中的表现明显较差（p<0.001至p=0.005，r=0.368 - 0.439）。此外，与没有疲劳症状群的SRC患者相比，出现疲劳症状群的SRC患者在前庭眼动测试中的表现明显更差（p=0.006，d=0.781）。
SRC患者表现出数量和性质各异的临床症状群。一些主观症状群与其他症状群的客观测试异常相关（前庭、认知和疲劳与平衡异常相关；疲劳与前庭眼动表现异常相关）。在检查SRC患者时应考虑临床症状群及其重叠情况。
