Introduction Assessment of functional recovery of service members following a concussion is central to their return to duty. Practical military-relevant performance-based tests are needed for identifying those who might need specialized rehabilitation, for evaluating the progress of recovery, and for making return-to-duty determinations. One such recently developed test is the ‘Portable Warrior Test of Tactical Agility’ (POWAR-TOTAL) assessment designed for use following concussion in an active duty population. This agility task involves maneuvers used in military training, such as rapid stand-to-prone and prone-to-stand transitions, combat rolls, and forward and backward running. The effect of concussion on the performance of such maneuvers has not been established. Materials and Methods The Institutional Review Board–approved study was conducted at Ft. Bragg, North Carolina, on 57 healthy control (HC) service members (SMs) and 42 well-matched SMs who were diagnosed with concussion and were referred for physical therapy with the intent to return to duty. Each study participant performed five consecutive trials of the POWAR-TOTAL task at full exertion while wearing inertial sensors, which were used to identify the constituent task maneuvers, or phases, and measure their durations. Statistical analyses were performed on durations of three main phases: (1) rising from prone and running, (2) lowering from vertical to prone, and (3) combat rolls. Results None of the three phases showed significant correlation with age (range 18-45 years) in either group. Gradual improvement in all three phase durations across five trials was observed in the HC group, but not in the concussed group. On average, control subjects performed significantly faster (P < .004 or less) than concussed subjects in all trials in the lowering and rolling phases, but less so in the rising/running phase. Membership in the concussed group had a strong effect on the lowering phase (Cohen’s d = 1.05), medium effect on the rolling phase (d = 0.72), and small effect on the rising/running phase (d = 0.49). Individuals in the HC group who had a history of prior concussions were intermediate between the concussed group and the never-concussed group in the lowering and rolling phases. Duration of transitional movements (lowering from standing to prone and combat rolls) was better at differentiating individuals’ performance by group (receiver operating characteristic area under the curve [AUC] = 0.83) than the duration of the entire POWAR-TOTAL task (AUC = 0.71). Conclusions Inertial sensor analysis reveals that rapid transitional movements (such as lowering from vertical to prone position and combat rolls) are particularly discriminative between SMs recovering from concussion and their concussion-free peers. This analysis supports the validity of POWAR-TOTAL as a useful tool for therapists who serve military SMs.

中文翻译：

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可穿戴传感器在便携式战士战术敏捷性测试中检测服役人员在 mTBI 后的运动差异

简介 对脑震荡后服役人员的功能恢复进行评估对于他们重返岗位至关重要。需要进行与军事相关的实用性能测试，以识别可能需要专门康复的人员、评估康复进度以及做出重返岗位的决定。最近开发的一项测试是“便携式战士战术敏捷性测试”（POWAR-TOTAL）评估，专为现役人群脑震荡后使用而设计。这项敏捷性任务涉及军事训练中使用的动作，例如快速从站立到俯卧和俯卧到站立的转换、战斗翻滚以及向前和向后奔跑。脑震荡对此类机动性能的影响尚未确定。材料和方法 机构审查委员会批准的研究是在英国《金融时报》进行的。北卡罗来纳州布拉格的 57 名健康控制 (HC) 服役人员 (SM) 和 42 名匹配良好的 SM 被诊断患有脑震荡，并被转介接受物理治疗，打算重返岗位。每位研究参与者在佩戴惯性传感器的情况下，连续进行五次 POWAR-TOTAL 任务试验，这些传感器用于识别任务的组成部分或阶段，并测量其持续时间。对三个主要阶段的持续时间进行了统计分析：（1）从俯卧和跑步中起身，（2）从垂直下降到俯卧，以及（3）战斗翻滚。结果 两组中，三个阶段均未显示与年龄（范围 18-45 岁）显着相关。在 HC 组中观察到五项试验的所有三个阶段持续时间逐渐改善，但在脑震荡组中则没有。平均而言，在所有试验中，对照受试者在下降和滚动阶段的表现明显快于脑震荡受试者（P < .004 或更低），但在上升/跑步阶段表现较差。震荡组的成员资格对下降阶段有很强的影响（Cohen's d = 1.05），对滚动阶段的影响中等（d = 0.72），对上升/跑步阶段的影响较小（d = 0.49）。HC 组中有脑震荡史的个体在下降和滚动阶段处于脑震荡组和从未脑震荡组之间。过渡运动的持续时间（从站立下降到俯卧和战斗翻滚）比整个 POWAR-TOTAL 任务的持续时间（AUC = 0.71）。结论 惯性传感器分析表明，快速过渡运动（例如从垂直位置降低到俯卧位置和战斗翻滚）对于从脑震荡中恢复的 SM 和未受脑震荡的同伴来说特别有区别。该分析支持 POWAR-TOTAL 作为军事 SM 治疗师的有用工具的有效性。