Sporttherapeutische Behandlungsmethoden nach einer
                    Gehirnerschütterung

Michael Skibba; Jessica Reinhardt; Ingo Helmich

doi:10.1055/a-1909-5900

B&G Bewegungstherapie und Gesundheitssport, Table of Contents

B&G Bewegungstherapie und Gesundheitssport 2022; 38(05): 216-227
DOI: 10.1055/a-1909-5900

Wissenschaft

Sporttherapeutische Behandlungsmethoden nach einer Gehirnerschütterung

Sports Therapy Treatment Methods after a Concussion

Authors

Michael Skibba

¹Arbeitsgruppe Sportmotorik, Institut für Bewegungstherapie und bewegungsorientierte Prävention und Rehabilitation, Abteilung für Neurologie, Psychosomatik und Psychiatrie, Deutsche Sporthochschule Köln
Jessica Reinhardt

¹Arbeitsgruppe Sportmotorik, Institut für Bewegungstherapie und bewegungsorientierte Prävention und Rehabilitation, Abteilung für Neurologie, Psychosomatik und Psychiatrie, Deutsche Sporthochschule Köln
Ingo Helmich

¹Arbeitsgruppe Sportmotorik, Institut für Bewegungstherapie und bewegungsorientierte Prävention und Rehabilitation, Abteilung für Neurologie, Psychosomatik und Psychiatrie, Deutsche Sporthochschule Köln

²Abteilung für Neurologie, Psychosomatik und Psychiatrie, Deutsche Sporthochschule Köln

Abstract

Zusammenfassung

Einleitung Die Gehirnerschütterung (GE) ist eine häufig, insbesondere im Sport, auftretende Verletzung und kann zu langfristigen gesundheitlichen Einschränkungen führen. Studien deuten darauf hin, dass eine aktive statt passive Rehabilitation nach einer GE den Genesungsprozess unterstützen und längerfristige Auswirkungen reduzieren kann. Das Ziel dieser Arbeit ist es daher, mittels eines systematischen Reviews einen Überblick über spezifische sporttherapeutische Behandlungsmethoden und deren Einfluss auf die Genesung nach einer GE zu untersuchen.

Methoden systematische Literaturrecherche.

Ergebnisse Fünf von sechs randomisiert-kontrollierten Studien (RCT) zeigten, dass ein aerobes Training (AT) sowohl die Erholungszeit als auch die Gefahr langfristiger Symptome nach einer GE reduzieren kann. Drei RCTs zeigten, dass eine vestibuläre Rehabilitation (VR), die insbesondere Gleichgewichtstraining sowie visuelle und sensomotorische Übungen umfasst, und manuelle therapeutische Maßnahmen (MT) Symptome wie z. B. Schwindel, Nackenschmerzen und Kopfschmerzen reduzieren können. In keiner der neun Studien wurden negative Begleiterscheinungen bewegungstherapeutischer Maßnahmen nach einer GE beobachtet.

Fazit Sporttherapeutische Maßnahmen scheinen ein effektives Instrument für die Behandlung nach einer GE zu sein. Eine VR scheint sich positiv auf die Symptome Schwindel, Nackenschmerzen und/oder Kopfschmerzen auszuwirken. Ein AT kann hingegen unabhängig von der Art der Symptomatik eingesetzt werden und die Genesungszeit sowie mögliche langfristige Symptome nach einer GE reduzieren. Daher sind spezifische sporttherapeutische Maßnahmen nicht nur wirksam hinsichtlich der Genesung nach einer GE, sondern sollten bereits nach kurzer Ruhephase initiiert werden.

Summary

Introduction Concussion is a common injury, especially in sports, and can lead to long-term health impairments. Studies suggest that active rather than passive rehabilitation after concussion can support the recovery process and reduce long-term effects. Therefore, the objective of this article is to use a systematic review to provide an overview of specific sports therapy treatment methods and their influence on recovery after concussion.

Methods systematic literature research.

Results Five of the six randomized controlled trials (RCT) showed that aerobic exercise (AT) can reduce both recovery time and the risk of long-term symptoms after concussion. Three RCTs showed that vestibular rehabilitation (VR), which specifically includes balance, visual and sensorimotor exercises, and manual therapeutic measures (MT) can reduce symptoms such as dizziness, neck pain and headache. In none of the nine studies were negative side effects of exercise therapy measures observed after concussion.

Conclusion Sports therapy measures seem to be an effective tool for treatment after concussion. VR appears to have a positive effect on the symptoms of dizziness, neck pain and/or headaches. An AT, on the other hand, can be used regardless of the type of symptomatology to reduce recovery time and possible long-term symptoms after concussion. Therefore, specific sports therapy measures are not only effective with regard to recovery after a concussion, but should also be initiated after a short rest period.

Stichworte

Review - Gehirnerschütterung - Rehabilitation - Sporttherapie - Intervention.

Key words

review - concussion - rehabilitation - sports therapy - intervention.

Full Text

References

Literatur
1 Morris L, Gottshall K. Physical therapy management of the patient with vestibular dysfunction of head trauma. In: Susan J Herdman, Richard A Clendaniel, eds. Vestibular Rehabilitation. 4th Edition. Philadelphia: Davis Company; 2014
2 Helmich I. Game-specific characteristics of sport-related concussions. Journal of Sports Medicine and Physical Fitness 2018; 58: 172-179
3 Webbe F. The handbook of sport neuropsychology. Springer Publishing Company; 2011
4 Gardner RC, Yaffe K. Epidemiology of mild traumatic brain injury and neurodegenerative disease. Molecular and Cellular Neuroscience 2015; 66: 75-80
5 Helmich I, von Götz D, Emsermann C. et al. Not just contact sports: significant numbers of sports-related concussions in cycling. Journal of sports medicine and physical fitness 2019; 59: 496-501
6 Theadom A, Starkey NJ, Dowell T. et al. Sports-related brain injury in the general population: an epidemiological study. J Sci Med Sport 2014; 17: 591-596
7 Burt CW, Overpeck MD. Emergency visits for sports-related injuries. Ann Emerg Med 2001; 37: 301-308
8 Pearn ML, Niesman IR, Egawa J. et al. Pathophysiology Associated with Traumatic Brain Injury: Current Treatments and Potential Novel Therapeutics. Cellular and Molecular Neurobiology 2017; 37: 571-585
9 Gänsslen A, Schmehl I. et al. Leichtes Schädel-Hirn-Trauma im Sport Handlungsempfehlungen. Sportverlag Strauß. 1966
10 Guskiewicz KM, Marshall SW, Bailes J. et al. Recurrent concussion and risk of depression in retired professional football players. Medicine and Science in Sports and Exercise 2007; 39: 903-909
11 Guskiewicz KM, Marshall SW, Bailes J. et al. Association between Recurrent Concussion and Late-Life Cognitive Impairment in Retired Professional Football Players. Neurosurgery 2005; 57: 719-726
12 McCrory P, Meeuwisse W, Dvořák J. et al. Consensus statement on concussion in sport – the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine 2017; 51: 838-847
13 Murray DA, Meldrum D, Lennon O. Can vestibular rehabilitation exercises help patients with concussion? A systematic review of efficacy, prescription and progression patterns. British Journal of Sports Medicine 2017; 51: 442-451
14 Makdissi M, Schneider KJ, Feddermann-Demont N. et al. Approach to investigation and treatment of persistent symptoms following sport-related concussion: A systematic review. British Journal of Sports Medicine 2017; 51: 958-968
15 Quatman-Yates C, Cupp A, Gunsch C. et al. Physical Rehabilitation Interventions for Post-mTBI Symptoms Lasting Greater Than 2 Weeks: Systematic Review. 2016
16 McMahon P, Hricik A, Yue JK. et al. Symptomatology and functional outcome in mild traumatic brain injury: Results from the prospective TRACK-TBI study. Journal of Neurotrauma 2014; 31: 26-33
17 Leddy JJ, Baker JG, Willer B. Active Rehabilitation of Concussion and Post-concussion Syndrome. Physical Medicine and Rehabilitation Clinics of North America 2016; 27: 437-454
18 Choe MC. The Pathophysiology of Concussion. Current Pain and Headache Reports 2016; 20
19 Harmon KG, Drezner JA, Gammons M. et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med 2013; 47: 15-26
20 Feddermann-Demont N, Palla A, Ettlin T. et al. Diagnostik und Therapie bei Gehirnerschütterung im Sport. Forum Médical Suisse – Swiss Medical Forum 2020;
21 Ellis MJ, Leddy JJ, Willer B. Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: An evidence-based classification system with directions for treatment. Brain Injury 2015; 29: 238-248
22 Tan CO, Meehan WP, Iverson GL. et al. Cerebrovascular regulation, exercise, and mild traumatic brain injury. Neurology 2014; 83: 1665-1672
23 Whitney SL, Alghadir AH, Anwer S. Recent Evidence About the Effectiveness of Vestibular Rehabilitation. Current Treatment Options in Neurology 2016; 18: 1-15
24 Fetter M. Rehabilitation vestibulärer Störungen. In: NeuroRehabilitation. Springer; 2010: 383-398
25 Scheiber B, Schiefermeier-Mach N, Wiederin C. Wirksamkeit manualtherapeutischer Techniken in Kombination mit vestibulärer Rehabilitation nach sportbedingten Gehirnerschütterungen – Eine systematische Übersichtsarbeit randomisiert kontrollierter Studien. physioscience 2020; 16: 167-175
26 Brown L, Camarinos J. The Role of Physical Therapy in Concussion Rehabilitation. Seminars in Pediatric Neurology 2019; 30: 68-78
27 Schneider KJ, Leddy JJ, Guskiewicz KM. et al. Rest and treatment/rehabilitation following sport-related concussion: A systematic review. British Journal of Sports Medicine 2017; 51: 930-934
28 Leddy JJ, Wilber CG, Willer BS. Active recovery from concussion. Current Opinion in Neurology 2018; 31: 681-686
29 Thomas DG, Apps JN, Hoffmann RG. et al. Benefits of strict rest after acute concussion: A randomized controlled trial. Pediatrics 2015; 135: 213-223
30 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009; 62: e1-e34
31 Methley AM, Campbell S, Chew-Graham C. et al. PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Serv Res 2014; 14: 1-10
32 Elkins MR, Moseley AM, Sherrington C. et al. Growth in the Physiotherapy Evidence Database (PEDro) and use of the PEDro scale. British Journal of Sports Medicine 2013; 47: 188-189
33 Rzewuska M, Ferreira M, McLachlan AJ. et al. The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief: a systematic review with meta-analysis. European Spine Journal 2015; 24: 702-714
34 Leddy JJ, Haider MN, Ellis MJ. et al. Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatrics 2019; 173: 319-325
35 Leddy JJ, Master CL, Mannix R. et al. Early targeted heart rate aerobic exercise versus placebo stretching for sport-related concussion in adolescents: a randomised controlled trial. The Lancet Child & Adolescent Health 2021; 5: 792-799
36 Micay R, Richards D, Hutchison MG. Feasibility of a postacute structured aerobic exercise intervention following sport concussion in symptomatic adolescents: a randomised controlled study. BMJ Open Sport & Exercise Medicine 2018; 4: e000404
37 Reneker JC, Hassen A, Phillips RS. et al. Feasibility of early physical therapy for dizziness after a sports-related concussion: A randomized clinical trial. Scand J Med Sci Sports 2017; 27: 2009-2018
38 Bailey C, Meyer J, Briskin S. et al. Multidisciplinary concussion management: a model for outpatient concussion management in the acute and post-acute settings. The Journal of Head Trauma Rehabilitation 2019; 34: 375-384
39 Chan C, Iverson GL, Purtzki J. et al. Safety of active rehabilitation for persistent symptoms after pediatric sport-related concussion: a randomized controlled trial. Arch Phys Med Rehabil 2018; 99: 242-249
40 Kleffelgaard I, Soberg HL, Tamber AL. et al. The effects of vestibular rehabilitation on dizziness and balance problems in patients after traumatic brain injury: a randomized controlled trial. Clinical Rehabilitation 2019; 33: 74-84
41 Kurowski BG, Hugentobler J, Quatman-Yates C. et al. Aerobic exercise for adolescents with prolonged symptoms after mild traumatic brain injury: an exploratory randomized clinical trial. J Head Trauma Rehabil 2017; 32: 79
42 Schneider KJ, Meeuwisse WH, Nettel-Aguirre A. et al. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. Br J Sports Med 2014; 48: 1294-1298
43 Vikane E, Hellstrøm T, Røe C. et al. Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: a randomised controlled intervention study. Brain Inj 2017; 31: 475-484
44 McCrory P, Meeuwisse WH, Aubry M. et al. Consensus statement on concussion in sport: The 4th international conference on concussion in sport held in Zurich, znovember 2012. J Am Coll Surg 2013; 216
45 Howell DR, Hunt DL, Aaron SE. et al. Influence of aerobic exercise volume on postconcussion symptoms. The American Journal of Sports Medicine 2021; 49: 1912-1920
46 Leddy JJ, Haider MN, Ellis M. et al. Exercise is Medicine for Concussion. Current Sports Medicine Reports 2018; 17: 262-270
47 Lal A, Kolakowsky-Hayner SA, Ghajar J. et al. The Effect of Physical Exercise After a Concussion: A Systematic Review and Meta-analysis. American Journal of Sports Medicine 2018; 46: 743-752
48 Rooks CR, Thom NJ, McCully KK. et al. Effects of incremental exercise on cerebral oxygenation measured by near-infrared spectroscopy: A systematic review. Progress in Neurobiology 2010; 92: 134-150
49 Kaplan GB, Vasterling JJ, Vedak PC. Brain-derived neurotrophic factor in traumatic brain injury, post-traumatic stress disorder, and their comorbid conditions: Role in pathogenesis and treatment. Behavioural Pharmacology 2010; 21: 427-437
50 Binder DK, Scharfman HE. Brain-derived neurotrophic factor. Growth Factors 2004; 22: 123
51 Griffin ÉW, Mullally S, Foley C. et al. Aerobic exercise improves hippocampal function and increases BDNF in the serum of young adult males. Physiology and Behavior 2011; 104: 934-941
52 Erickson KI, Voss MW, Prakash RS. et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci U S A 2011; 108: 3017-3022
53 Harmon KG, Clugston JR, Dec K. et al. American Medical Society for Sports Medicine position statement on concussion in sport. British Journal of Sports Medicine 2019; 53: 213-225
54 Krøll LS, Hammarlund CS, Linde M. et al. The effects of aerobic exercise for persons with migraine and co-existing tension-type headache and neck pain. A randomized, controlled, clinical trial. Cephalalgia 2018; 38: 1805-1816
55 Alsalaheen BA, Whitney SL, Mucha A. et al. Exercise prescription patterns in patients treated with vestibular rehabilitation after concussion. Physiotherapy Research International 2013; 18: 100-108
56 Burzynski J, Sulway S, Rutka JA. Vestibular rehabilitation: review of indications, treatments, advances, and limitations. Current Otorhinolaryngology Reports 2017; 5: 160-166
57 Marouane E, el Mahmoudi N, Rastoldo G. et al. Sensorimotor rehabilitation promotes vestibular compensation in a rodent model of acute peripheral vestibulopathy by promoting microgliogenesis in the deafferented vestibular nuclei. Cells 2021; 10
58 Helmich I, Coenen J, Henckert S. et al. Reduced frontopolar brain activation characterizes concussed athletes with balance deficits. Neuroimage: clinical 2020; 25: 102164
59 Peeters W, van den Brande R, Polinder S. et al. Epidemiology of traumatic brain injury in Europe. Acta Neurochir (Wien) 2015; 157: 1683-1696
60 Taylor CA, Bell JM, Breiding MJ. et al. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths – United States, 2007 and 2013. MMWR Surveillance Summaries 2017; 66: 1
61 Stillman A, Alexander M, Mannix R. et al. Concussion: evaluation and management. Cleve Clin J Med 2017; 84: 623-630
62 Acabchuk RL, Brisson JM, Park CL. et al. Therapeutic Effects of Meditation, Yoga, and Mindfulness-Based Interventions for Chronic Symptoms of Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Applied Psychology: Health and Well-Being 2021; 13: 34-62
63 Len TK, Neary JP, Asmundson GJG. et al. Serial monitoring of CO2 reactivity following sport concussion using hypocapnia and hypercapnia. Brain Inj 2013; 27: 346-353
64 Mutch WAC, Ellis MJ, Ryner LN. et al. Patient-specific alterations in CO2 cerebrovascular responsiveness in acute and sub-acute sports-related concussion. Frontiers in Neurology 2018; 9: 23