On le savait déjà mais cet article vient appuyer le fait que la région cervicale doit impérativement être évaluée chez les patients qui ont eu une commotion cérébrale. En effet, il s’avère que les patients avec commotion cérébrale et symptômes persistants ont significativement plus de dysfonctions cervicales que ceux qui récupèrent rapidement [1]. Fait intéressant, les sujets post-commotion avec récupération favorable ont tout de même plus de dysfonctions que les sujets contrôles. Globalement, c’est au moins 50% de sujets post-commotion cérébrale qui présentent des dysfonctions articulaires cervicales, sans même considérer les dysfonctions musculaires et autres. Il est ainsi conseillé que tous les sujets post-commotion, symptomatiques ou non, devraient être évaluée en profondeur.
Abstract
Background. Clinically relevant scores of neck disability have been observed in adults post mild traumatic brain injury (mTBI), even in those who initially report to be recovered. Potentially cervical musculoskeletal and/or cervical sensorimotor impairments may underlie these persistent symptoms post mTBI. Objective. To determine whether cervical impairments exist beyond expected recovery times following concussion compared to healthy controls (HC). Study design. Observational cohort study. Methods. Participants aged 18–60 years consisting of 39 HC, and 72 individuals, 4 weeks to 6 months post mTBI of which 35 considered themselves asymptomatic (Asymp), and 37 symptomatic (Symp). Cervical outcome measures included range and velocity of motion, flexor muscle endurance, presence of at least one dysfunctional cervical joint, joint position error -neutral and torsion, movement accuracy, smooth pursuit neck torsion test (SPNT) and balance. Results. Individuals in the Symp mTBI group demonstrated significantly reduced: flexion and rotation range, rotation velocity, flexor endurance and movement accuracy as well as increased postural sway and a higher percentage had positive cervical joint dysfunction (p < 0.01]. The mTBI group who considered themselves recovered (Asymp)demonstrated significantly lower rotation range, flexor endurance, and a higher percentage had positive cervical joint dysfunction and positive SPNT (p < 0.05) compared to HCs. Conclusion. Individuals reporting symptoms post mTBI demonstrated cervical spine musculoskeletal and sensorimotor impairments beyond expected recovery times. Those not reporting symptoms had fewer but some cervical impairments. The need for a comprehensive neck assessment should be considered, perhaps even in those not reporting symptoms.
Références
[1] Galea O, O’Leary S, Treleaven J. Cervical musculoskeletal and sensorimotor impairments 4 weeks to 6 months following mild traumatic brain injury: An observational cohort study. Musculoskel Sci Pract 2022;57:102490.