运动相关脑震荡后的神经周期化：阿姆斯特丹重返运动策略中适应性负荷处方的观点

文献信息

中文摘要

背景/目的： 当代运动相关脑震荡管理已从长时间休息转向早期、症状限制性活动以及分阶段重返运动策略。阿姆斯特丹框架提供了必要的安全层级，但未充分操作化临床医生在每个阶段内应如何调控运动剂量、任务复杂性、恢复以及相互作用的康复领域。本观点提出神经周期化，作为嵌套在阿姆斯特丹策略内的、受约束的、基于标准的负荷处方框架。框架开发：该框架区分了规定的外部负荷与内部反应，包括症状变化和持续时间、心率、自觉用力程度、任务质量、信心以及延迟恢复。临床决策通过评估、处方、监测、适应和再评估的重复循环来组织。拟议框架：神经周期化支持有氧、颈部、前庭-眼、神经运动、认知-运动和运动专项能力的同步但受控的发展。进展仍从属于医学许可、临床发现、症状反应和运动专项风险。结论：神经周期化应被视为概念性临床框架，而非经过验证的康复方案或替代性重返运动许可路径。它整合了阿姆斯特丹共识建议、循证外推和作者提出的要素，需要针对特定人群进行调整并进行前瞻性评估。

英文摘要

Background/Objectives: Contemporary sport-related concussion management has shifted from prolonged rest toward early, symptom-limited activity and a staged return-to-sport strategy. The Amsterdam framework provides an essential safety hierarchy but does not fully operationalize how clinicians should manipulate exercise dose, task complexity, recovery, and interacting rehabilitation domains within each stage. This Perspective proposes neuroperiodization as a constrained, criterion-based load-prescription framework nested within the Amsterdam strategy. Framework Development: The framework distinguishes prescribed external load from internal response, including symptom change and duration, heart rate, rating of perceived exertion, task quality, confidence, and delayed recovery. Clinical decision-making is organized through a repeated cycle of assessment, prescription, monitoring, adaptation, and reassessment. Proposed Framework: Neuroperiodization supports the concurrent but controlled development of aerobic, cervical, vestibular-ocular, neuromotor, cognitive-motor, and sport-specific capacities. Progression remains subordinate to medical clearance, clinical findings, symptom response, and sport-specific risk. Conclusions: Neuroperiodization should be regarded as a conceptual clinical framework rather than a validated rehabilitation protocol or an alternative return-to-sport clearance pathway. It integrates Amsterdam consensus recommendations, evidence-informed extrapolations, and author-proposed elements and requires population-specific adaptation and prospective evaluation.