双任务屏幕的修订和神经成像兼容版本
Summary
我们开发了原来的双任务屏幕 （DTS） 作为便携式，低成本的措施，可以评估运动员与运动引起的轻度创伤性脑损伤。我们修订了原始 DTS 以供将来临床使用，并开发了与神经成像兼容的 DTS 版本，以测量单任务和双任务性能的神经基础。
Abstract
双重任务范式同时评估运动和认知能力，它们可以检测最近患有轻度创伤性脑损伤（mTBI）的运动员的细微残余损伤。然而，过去的双重任务范式只注重下肢技能，并依赖繁琐、昂贵的实验室设备，从而限制了日常 mTBI 评估的实用性。随后，我们开发了双任务屏幕 （DTS），该屏幕需要 lt;10 分钟才能管理和评分，使用低成本便携式设备，包括下肢 （LE） 和上肢 （UE） 子任务。这份手稿的目的是双重的。首先，我们描述了修订后的 DTS 的管理协议，我们修订了该议定书以解决原始 DTS 的局限性。具体来说，修订包括增加智能设备，以获取更详细的步态数据，并包括单一认知条件，以测试在双重任务条件下中断的认知表现。重要的是，修订后的DTS是一项旨在供将来临床使用的措施，我们介绍了三名男性运动员的代表性结果，以说明从该测量中可以获得的临床数据类型。重要的是，我们尚未评估修订后的DTS在运动员与mTBI的敏感性和特殊性，这是下一个研究倡议。此手稿的第二个目的是描述与神经成像兼容的 DTS 版本。我们开发了这个版本，以便我们可以评估单任务和双任务性能的神经基础，以便更好地了解与 mTBI 相关的行为缺陷。因此，本手稿还描述了我们在 DTS 期间为实现同时功能近红外光谱 （fNIRS） 测量而采取的步骤，以及我们如何获取和完成 fNIRS 数据的一级处理。
Introduction
每年，全世界有4200万人遭受轻度创伤性脑损伤（mTBI）1.虽然一旦被认为是良性的，新的研究表明，mTBI，特别是重复的mTBI，可以引起持久的负面后果，如身体，认知和睡眠障碍2，3，4。随后，研究人员和临床医生正在寻求更好的评估和治疗方法，以了解和解决mTBI。
迄今为止，mTBI评估的最佳实践包括自我报告的症状和神经认知和运动功能的客观测量5。然而，一些个人，如竞技大学级别的运动员，已知低估了mTBI相关的症状6，限制了症状报告的效用。客观的神经认知和运动功能测量也有局限性，包括测试重试可靠性差，依赖基线测试，或高性能运动员7，8，9难度不足。然而，双重任务范式 – 同时评估运动和认知能力 – 可以检测细微的，残余的损伤，并可能特别有用的评价高性能运动员10，11，12，13，14。
过去使用双重任务范式的研究往往包括繁琐、昂贵的实验室设备，如运动捕捉系统14，以评估高绩效运动员。虽然这些系统可以准确测量细微的运动损伤，但由于设备成本高、便携性有限和管理时间长（即每人≥ 45 分钟），因此在日常 mTBI 评估中使用它们是不切实际的。此外，许多过去的双重任务范式研究只侧重于下半身或下肢技能，如平衡或步态11，12，13，14。可以说，上肢功能和手眼协调对于许多运动中表现优美的运动员也很重要。因此，我们开发了双任务屏幕 （DTS），这是一个简短的措施，旨在用便携式低成本仪器在 10 分钟内管理和评分。这个原始的DTS包括下肢（LE）和上肢（UE）子任务，它评估步态速度（使用秒表）和手眼协调下单电机和双任务条件15。
在第一次可行性研究中，32名健康、女性青少年参与者完成了最初的DTS。这项研究旨在确定 DTS 可能会导致双重任务电机成本，这在双重任务与单个电机条件下降低电机性能就表明了这一点。我们还试图确定 DTS 可以在 10 分钟内管理和得分。我们发现，所有参与者在至少一个子任务上双任务电机性能较差。此外，我们能够在平均5.63分钟内管理DTS，并在2-3分钟15分钟内完成测试。
虽然第一次可行性研究是成功的，但暴露出一些局限性。最值得注意的是，步态速度是用秒表测量的，秒表容易出现自然的人为错误。因此，在修订后的 DTS 中，我们使用智能设备，每个脚踝上都带有内置加速度计（材料表）。这一补充保持了便携式低成本仪器的使用，同时仍然提供步态速度、步数总数、平均步长、平均步长和步长变化的复杂测量。原始 DTS 的另一个局限性是缺乏单一的认知条件，这妨碍了对双重任务认知成本的评估。双重任务认知成本被定义为在双重任务与单一认知状态期间认知性能较差。随后，对于 LE 和 UE 子任务，我们添加了一个单一的认知条件（在协议中描述）。
除了为未来的临床应用制定衡量标准外，该团队的长期目标之一是评估健康运动员单项和双任务表现的神经基础，并将这些发现与运动诱发的 mTBI 运动员进行对比。因此，我们创建了一个神经成像兼容版本的 DTS。我们寻求确定 DTS 是否可以成功修改，用于同时功能近红外光谱 （fNIRS） 测量，我们使用的移动 fNIRS 设备专门设计用于通过减少运动伪影的影响来适应总电机运动。此外，据我们所知，对于目前可用于研究目的的移动设备，此设备的头部覆盖范围最大（材料表）。
总之，研究协议旨在执行以下工作：
- 描述修订后的双任务屏幕 （DTS） 的管理协议，这是我们为解决原始 DTS15 的局限性而重新设计的一项措施，也是供将来临床使用的措施。
- 描述神经成像兼容双任务屏幕 （DTS） 的研究协议，我们设计用于评估单任务和双任务性能的神经基础。
Protocol
所有研究程序均得到科罗拉多州立大学机构审查委员会（IRB）的批准，所有成年参与者在完成任何学习程序之前均表示书面知情同意。18岁以下参与者的父母提供了书面知情同意，未成年参与者在完成任何学习程序之前也提供了书面同意。 1. 修订后的双任务屏幕 （DTS） 下肢 （LE） 子任务 启动单个电机条件。 沿着 18 米的人行道将三个瑜伽块放在相距 4.5 ?…
Representative Results
参与者参赛者是从当地高中队和大学校际和俱乐部运动队中招募的，他们使用口碑和广告传单。参加者年龄在15-22岁之间，并定期参加有组织的接触运动。接触式运动包括所有运动，在常规比赛期间需要与队友或对手进行身体接触。根据自我报告，参与者还必须有正常或矫正的视力和听力，没有神经或精神病史，也没有中度或严重创伤性脑损伤史。 我们包括来…
Discussion
在此手稿中，我们描述了新修订的双任务屏幕 （DTS） 的管理协议。完成这些修订是为了解决原始 DTS15中确定的限制，包括添加单一认知条件来测试双重任务认知成本。它还包括基于智能设备的加速度计，以更精确地测量步态特征。我们包括具有代表性的结果，说明可以通过 DTS 获得的临床数据类型。我们还描述了神经成像兼容双任务屏幕 （DTS） 的研究协议，我们设计用于评估?…
Offenlegungen
The authors have nothing to disclose.
Acknowledgements
我们要感谢科罗拉多州立大学的伊莎贝尔·布斯女士，她向协助加速测量数据分析的学生表示敬意。我们还要感谢NIH K12 HD055931和K01 HD096047-02向作者J.S.提供的资金。
Materials
| Hardware (in alphabetical order) | |||
| NIRx NIRSport2 Device: NSP2-CORE1616 | NIRx | Reference #: GC359 | "The NIRSport 2 is a user-friendly, modular, and robust wireless functional near-infrared spectroscopy (fNIRS) platform which measures hemodynamic responses to neuroactivation via oxy-, deoxy-, and total hemoglobin changes in the cerebral cortex.The NIRSport 2 comes with a host of ready-to-implement upgrades and modules to meet the needs of a broad range of cognitive neuroscience applications." (Direct quote from nirx.net/nirsport) |
| NIRx NIRSCap (available in 5 difference sizes) | NIRx | N/A | "The NIRScap consists of a measuring cap and optode holders. The optode holders fit into the slits of the measuring cap." (Direct quote from NIRx's NIRScap Getting Started Guide) |
| NIRx Optode Sources (x 2) | NIRx | Reference #: GC359 | "8-source active source bundel for fiberless optical illumination with dual tip; 240 cm long." (Direct quote from NIRx Packing List Description) |
| NIRx Optode Detectors (x 2) | NIRx | Reference #: GC359 | "Bundle of 8x active sensores for fiberless optical detection; dual tip; 240 cm long." (Direct quote from NIRx Packing List Description) |
| NIRx Short Distance Detector Probes | NIRx | N/A | "The probes come in a bundle of eight detector clips that allows coupling of short-distance data from eight independent sources sites to one common detector channel on the instrument." (Direct quote from NIRx's Short Distance Detector Probes Getting Started Guide) |
| Software (in alphabetical order) | |||
| Aurora | NIRx | N/A | "NIRSport 2 Acquistion Software. Aurora fNIRS connects to your NIRSport 2 device via Wi-Fi or USB and can set-up a complete experimental configuration in only several clicks. Thanks to the automated signal optimization algorithm, Aurora fNIRS ensures optimal signal quality before a measurement is started. Raw data, HbO and Hb concentration changtes can be visualized in real-time in several display modes. In addition, high-end whole head visualizations are immediately available. Recorded data can be exported over the integrate Lab Streaming Layer (LSL) protocol, allowing for real-time processing in Brain-Computer Interface (BCI) and Neurofeedback paradigms." (Direct quote from nirx.net/software) |
| Matlab | Math Works | N/A | "MATLAB® combines a desktop environment tuned for iterative analysis and design processes with a programming language that expresses matrix and array mathematics directly. It includes the Live Editor for creating scripts that combine code, output, and formatted text in an executable notebook." (Direct quote from mathworks.com) |
| NIRS Toolbox | Developed by Huppert Brain Imaging Lab | N/A | "NIRS toolbox is a Matlab based analysis program." (Direct quote from huppertlab.net/nirs-toolbox-2/) |
| PsychoPy | Python | N/A | "PsychoPy is an open source software package written in the Python program,ming language primarily for us in neuroscience and experimntal psychology research." (Direct quote from psychopy.org) |
| Lower Tech/Cost Research Supplies* (in alphabetical order) | |||
| AmazonBasics 60-Inch Lightweight Tripod with Bag | Amazon | Item Model #: WT3540 | This lightweight tripod is perfect for most cameras up to 6.6 pounds. Setup is quick and easy. The included bag makes storage and transport a snap.The tripod’s legs can extend from 20” to 48”. Leg locks release smoothly and glide easily to your desired height. Crank up the center post for a tripod that is 60” tall. (Direct quote from Amazon.com) |
| iPod Touch x 2 | Apple | N/A | Smart device with built-in accelerometer. |
| Panasonic Full HD Video Camera Camcorder HC-V180K, 50X Optical Zoom, 1/5.8-Inch BSI Sensor, Touch Enabled 2.7-Inch LCD Display (Black) | Amazon | Item Model #: HC-V180K | Compact, lightweight and easy to use, the Panasonic Full HD Camcorder HC-V180K brings a fun, worry-free experience to high-resolution video capture. Featuring a 5-axis image stabilizer for maximum handheld stability, this 1080p camera’s super-long 50X optical zoom and up to 90X intelligent zoom quickly bring distant objects in focus. A convenient 28mm wide-angle lens allows you to fit more people and scenery into settings like weddings, reunions and vacations. An advanced BSI sensor assures low-light video image quality while Panasonic’s Level Shot function automatically detects and compensates for distracting camera tilting. For added fun, the camera includes creative filter effects like 8mm Movie, Silent Movie, Miniature Effect and Time Lapse Recording, all easily accessible on the 2.7-inch LCD touch screen. A two-channel zoom microphone works in tandem with the zoom to ensure crisp, clear audio up close or at any distance." (Direct quote from Amazon.com) |
| Post-it Notes, 3" x 3", Canary Yellow, Pack Of 18 Pads | Office Depot/Office Max | Item # 1230652 | "Post it® Notes stick securely and remove cleanly, featuring a unique adhesive designed for use on paper." |
| Scotch 232 Masking Tape, 1" x 60 Yd | Office Depot/Office Max | Item # 910588 | "High-performance paper masking tape produces sharp paint lines in medium-temperature paint bake operations. Scotch tape provides clean removal every time, even on traditionally difficult-to-remove surfaces." (Direct quote from officedepot.com) |
| Stanley Tools Leverlock Tape Measure, Standard, 25' x 1" Blade | Office Depot/Office Max | Item #389512 | "Tape rule features a power return with automatic bottom lock for easy operation. High-visibility case color makes it easy to find. Special Tru-Zero hook allows use of nail as pivot to draw circles and arcs. Tape rule offers a multiple riveted hook and polymer-coated blade for longer life, blade wear guard and comfortable rubber grip. Protected blade resists abrasion, oils, dirt and most solvents. Tape rule has Imperial ruling with consecutive feet on top and consecutive inches on bottom after the first foot. Its belt clip allows easy carrying." (Direct quote from officedepot.com) |
| Stopwatch | Office Depot/Office Max | Item # 357698 | "Offers split timing, precise to 1/100 of a second. Includes 6 functions — hour, minute, second, day, month and year." (Direct quote from officedepot.com) |
| Tourna Ballport Deluxe Tennis Ball Hopper with Wheels – Holds 80 Balls | Amazon | Item Model #: BPD-80W | "Balloon port 80 deluxe holds 80 balls and comes with wheels for easy Maneuverability. The handles are an extra long 33 inch for more convenient feed and pickup. Very lightweight yet durable makes this one of the most premium hoppers on the market. Loaded with patented features: legs lock in up and down position. Bars at the top slide closed so your the balls don't fall out during transport. Bars roll at the bottom so the ball slips in the hopper easily." (Direct quote from Amazon.com) |
| Tourna Pressureless Tennis Balls with Vinyl Tote (45 pack of balls) | Amazon | Item Model #: EPTB-45 | "45 Pressure less tennis balls in a vinyl tote bag. Bag has a zipper for secure closure. Balls are regulation size and durable. Suitable for practice or tennis ball machines. Balls are pressure less so they never go dead. Pressure-less means they never go dead, which makes them great for tennis practice, ball machines, filling up ball baskets and hoppers, or just making sure your pet has hours of fun chasing these balls. They fit Chuck-it style dog ball launchers and automatic ball launchers. Durable rubber and a premium felt ensures their use can be universal, whether your a budding tennis player or a pet owner." (Direct quote from Amazon.com) |
| Velcro | Velcro | N/A | Self-adhesive strips and wraps; used to secure smart devices. |
| Yoga Block 2 Pack – 2 High Density Light Weight Exercise Blocks 4 x 6 x 9 Inches Support All Poses – Lightweight Versatile Fitness and Balance Odor Free Bricks (Note: 6 blocks are needed for Dual Task Screen) | Amazon | N/A | "These blocks are made from recycled high density EVA foam and provide firm support in a wide range of different yoga poses. This will improve your posture and you can stay in challenging poses for longer." (Direct quote from Amazon.com) |
| *These items or comparable items can be obtained from a number of other sources |
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Aumen, A. M., Oberg, K. J., Mingils, S. M., Berkner, C. B., Tracy, B. L., Stephens, J. A. Revised and Neuroimaging-Compatible Versions of the Dual Task Screen. J. Vis. Exp. (164), e61678, doi:10.3791/61678 (2020).