运动相关脑震荡后的原始反射 profiling：一个以运动员为中心的候选行为状态标志物测试框架

文献信息

中文摘要

直接前瞻性证据表明运动相关脑震荡（SRC）后原始反射表达发生变化，目前非常有限。因此，本 Perspective 提出一个刻意限定的使用情境：将标准化原始反射 profiling 作为实验性、低成本的候选行为状态标志物，在运动员恢复过程中进行测试，而非作为已确立的诊断生物标志物或重返运动标准。该框架所依据的标准化 18 反射方案在报告的 565 名参与者验证样本中显示出极好的评定者间（κ = 0.912-1.000）和评定者内（κ = 0.912-0.983）可重复性；然而，运动员特异性信度、对 SRC 的反应性、结构效度、预后效用和治疗敏感性仍未确立。我们区分了三种可测试的候选机制——额叶-皮层下停止网络功能障碍、感觉运动/传入门控改变以及前庭-网状脊髓调节异常——并具体说明了支持或削弱每种解释的发现。分阶段研究计划首先进行运动特异性信度和可行性研究，然后进行前瞻性运动员内变化超出测量误差的评估，之后才评估机制汇聚、增量预后价值和干预敏感性。完整的 18 反射谱（30 项双侧或非偏侧化测量）应保持为主要分析层面。总和原始反射负担仅作为描述性总结保留，不得替代反射特异性分析。掌抓握和 Babkin 相关反应提供了一个聚焦、可证伪的测试案例，用于在力匹配抓握期间将偏侧化反射表达与运动前区和辅助运动区血流动力学联系起来。阶段之间的推进需要预先设定的成功标准、独立重复和明确的停止规则。在这些条件满足之前，原始反射 profiling 应保持为嵌入指南一致性脑震荡护理中的实验性结局。

英文摘要

Direct prospective evidence that primitive-reflex expression changes after sport-related concussion (SRC) is currently very limited. This Perspective therefore proposes a deliberately restricted context of use: standardized primitive-reflex profiling as an experimental, low-cost candidate behavioral state marker to be tested within athletes across recovery, not as an established diagnostic biomarker or a return-to-sport criterion. The standardized 18-reflex protocol underlying this framework demonstrated excellent inter-rater (κ = 0.912-1.000) and intra-rater (κ = 0.912-0.983) reproducibility in the reported 565-participant validation sample; however, athlete-specific reliability, responsiveness to SRC, construct validity, prognostic utility, and treatment sensitivity remain unestablished. We distinguish three testable candidate mechanisms-fronto-subcortical stopping-network dysfunction, altered sensorimotor/afferent gating, and vestibular-reticulospinal dysregulation-and specify findings that would support or weaken each account. A staged research program begins with sport-specific reliability and feasibility, proceeds to prospective within-athlete change beyond measurement error, and only then evaluates mechanistic convergence, incremental prognostic value, and intervention sensitivity. The full 18-reflex profile (30 bilateral or non-lateralized measurements) should remain the primary level of analysis. A summed primitive-reflex burden is retained only as a descriptive summary and must not substitute for reflex-specific analysis. Palmar grasp and Babkin-related responses provide a focused, falsifiable test case for relating lateralized reflex expression to premotor and supplementary motor hemodynamics during force-matched grasping. Progression between stages requires prespecified success criteria, independent replication, and explicit stopping rules. Until those conditions are met, primitive-reflex profiling should remain an experimental outcome embedded within guideline-concordant concussion care.