CONCUSSION REHABILITATION INTERVENTIONS A LITERATURE REVIEW
Main Article Content
Abstract
Sports-related concussions (SRC) are a common injury among athletes. Despite our growing understanding of concussion pathophysiology, comprehensive rehabilitation programs remain a clinical challenge. The accepted view of SRC rehabilitation emphasizes physical and cognitive rest. However, some conflicting studies report rest may facilitate prolonged symptoms. In this review article, we report on alternative SRC rehabilitation strategies to address the complex symptom variations, including physical activity, neuro-visual training, vestibular training, music therapy, speech-language therapy, and hyperbaric oxygen chamber therapy. The mass of published works supports the utility of these alternative therapies to aid recovery, but more research is vital to clarifying these relationships. In this review, we explore the relationships between symptoms and therapies. As there is a growing body of evidence to support these alternative therapies, many questions remain when concerning the role these alternative methods play in the bigger picture of standardizing a thorough SRC rehabilitation program.
Downloads
Article Details
References
McCrory, P., Meeuwisse, W., Vos, P. E., et al. Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2016;51(11):838-847. https://doi.org/10.1136/bjsports-2017-097699
Frieden TR, Houry D, & Baldwin G. Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. Centers for Disease Control and Prevention: National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. 2015.
Harmon KG, Clugston JR, Roberts WO, et al. American Medical Society for Sports Medicine Position Statement on Concussion in Sport. Clin J Sport Med 2019;29(2):87-100. https://doi.org/10.1097/jsm.0000000000000720
Dematteo CA, Hanna SE, Xu L, et al. My child doesn’t have a brain injury, he only has a concussion. Pediatrics 2010;125(2):327-334. https://doi.org/10.1542/peds.2008-2720
Sharp DJ, & Jenkins, PO. Concussion is confusing us all. Pract Neurol 2015, 15(3); 172–186. https://doi.org/10.1136/practneurol-2015-001087
McCrory P, Feddermann-Demont N, Tarnutzer AA, et al. What is the definition of sports-related concussion: a systematic review. Br J Sports Med 2017;51(11):877-887. https://doi.org/10.1136/bjsports-2016-097393
Baldwin GT, Breiding MJ, Dawn Comstock R. Epidemiology of sports concussion in the United States. Handb Clin Neurol 2018;158;63-74. https://doi.org/10.1016/b978-0-444-63954-7.00007-0
Kerr ZY, Roos KG, Dompier TP, et al. Epidemiologic Measures for Quantifying the Incidence of Concussion in National Collegiate Athletic Association Sports. J Athl Train 2017;52(3):167-174. https://doi.org/10.4085/1062-6050-51.6.05
Bryan MA, Rowhani-Rahbar A, et al. Sports and Recreation-Related Concussions in US Youth. Pediatrics 2016;138(1):e20154635. https://doi.org/10.1542/peds.2015-4635
McCrea M, Hammeke Guskiewicz K, et al. Unreported concussion in high school football players: implications for prevention. Clin J Sport Med 2014;14(1):13-17. https://doi.org/10.1097/00042752-200401000-00003
Gardner AJ, Quarrie KL, & Iverson GL. The Epidemiology of Sport-Related Concussion: What the Rehabilitation Clinician Needs to Know. J Orthopaed Sports Phys Ther 2019;49(11):768-778. https://doi.org/10.2519/jospt.2019.9105
Pierpoint LA and Collins C. Epidemiology of Sport-Related Concussion. Clin Sports Med 2019;40(1):1-18. https://doi.org/10.1016/j.csm.2020.08.013
McKea DB and Kutcher JS. Concussion consensus: raising the bar and filling in the gaps. Clin J Sport Med 2009;19(5):343-346. https://doi.org/10.1097/JSM.0b013e3181b2c114
Bazarian JJ. Diagnosing mild traumatic brain injury after a concussion. J Head Trauma Rehabil 2010;25(4):225-227. https://doi.org/10.1097/HTR.0b013e3181e7f784
Barkhoudarian G, Hovda DA, and Giza CC. The Molecular Pathophysiology of Concussive Brain Injury - an Update. Phys Med Rehabil Clin N Am 2016;27(2):373-393. https://doi.org/10.1016/j.pmr.2016.01.003
Giza C and Hovda DA. The new neurometabolic cascade of concussion. Neurosurgery 2014;75 Suppl 4:S24-33. https://doi.org/10.1227/NEU.0000000000000505
Romeu-Mejia R, Giza CC, & Goldman JT. Concussion Pathophysiology and Injury Biomechanics. Curr Rev Musculoskelet Med 2019;12(2):105-116. https://doi.org/10.1007/s12178-019-09536-8
Bodnar C, Watson Bachstetter AD, et al. Inflammatory Regulation of CNS Barriers After Traumatic Brain Injury: A Tale Directed by Interleukin-1. Front Immunol 2021;12:688254. https://doi.org/10.3389/fimmu.2021.688254
Giza C, Greco T and Prins ML. Concussion: pathophysiology and clinical translation. Handb Clin Neurol 2018;158:51-61. https://doi.org/10.1016/b978-0-444-63954-7.00006-9
Leddy J, Baker JG, Willer B, et al. A Physiological Approach to Prolonged Recovery From Sport-Related Concussion. J Athl Train 2017;52(3):299-308. https://doi.org/10.4085/1062-6050-51.11.08
Manley G, Gardner AJ, Iverson GL, et al. A systematic review of potential long-term effects of sport-related concussion. Br J Sports Med 2017;51(12):969-977. https://doi.org/10.1136/bjsports-2017-097791
Scorza KA, & Cole W. Current Concepts in Concussion: Initial Evaluation and Management. Am Fam Physician 2019;99(7):426-434.
Feddermann-Demont N, Echemendia RJ, Tarnutzer AA. What domains of clinical function should be assessed after sport-related concussion? A systematic review. Br J Sports Med 2017;51(11):903-918. https://doi.org/10.1136/bjsports-2016-097403
Dwyer B, & Katz DI. Post-concussion syndrome. Handb Clin Neurol 2018;158:163-178. https://doi.org/10.1016/b978-0-444-63954-7.00017-3
Sohlberg MM, & Ledbetter AK. Management of Persistent Cognitive Symptoms After Sport-Related Concussion. Am J Speech Lang Pathol 2016;25(2):138-149. https://doi.org/10.1044/2015_AJSLP-14-0128
Broglio SP, Collins MW, Kontos AP, et al. Current and Emerging Rehabilitation for Concussion: A Review of the Evidence. Clin Sports Med 2015;34(2):213-231. https://doi.org/10.1016/j.csm.2014.12.005
Willer BS, Haider MN, Leddy JJ, et al. Comparison of Rest to Aerobic Exercise and Placebo-like Treatment of Acute Sport-Related Concussion in Male and Female Adolescents. Arch Phys Med Rehabil 2019;100(12):2267-2275. https://doi.org/10.1016/j.apmr.2019.07.003
Strelzik J and Langdon R. The Role of Active Recovery and “Rest” After Concussion. Pediatr Ann 2017;46(4):e139-e144. https://doi.org/10.3928/19382359-20170320-02
Schneider KJ, Iverson GL, & Meeuwisse WH, et al. The effects of rest and treatment following sport-related concussion: a systematic review of the literature. Br J Sports Med 2010;47(5):304-307. https://doi.org/10.1136/bjsports-2013-092190
Schneider KJ, Leddy JJ, Makdissi M, et al. Rest and treatment/rehabilitation following sport-related concussion: a systematic review. Br J Sports Med 2017;51(12):930-934. https://doi.org/10.1136/bjsports-2016-097475
Sufrinko AM, Kontos AP, Thomas DG, et al. The Effectiveness of Prescribed Rest Depends on Initial Presentation After Concussion. J Pediatr 2017;185:167-172. https://doi.org/10.1016/j.jpeds.2017.02.072
Thomas DG, Apps JN, Hammeke T, et al. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics 2015;135(2):213-223. https://doi.org/10.1542/peds.2014-0966
Grady MF, Master CL, & Gioia GA. Concussion Pathophysiology: Rationale for Physical and Cognitive Rest. Pediatric Annals 2012;41(9):377-382. https://doi.org/doi:10.3928/00904481-20120827-12
Brown NJ, Mannix RC, Meehan WP, et al. Effect of cognitive activity level on duration of post-concussion symptoms. Pediatrics 2014;133(2):e299-304. https://doi.org/10.1542/peds.2013-2125
Haider MN, Bezherano I, Leddy JJ, et al. Exercise for Sport-Related Concussion and Persistent Post-concussive Symptoms. Sports Health 2021;13(2):154-160. https://doi.org/10.1177/1941738120946015
Leddy JJ, Baker JG, & Willer B. Active Rehabilitation of Concussion and Post-concussion Syndrome. Phys Med Rehabil Clin N Am 2016;27(2):437-454. https://doi.org/10.1016/j.pmr.2015.12.003
Grool AM, Aglipay M, et al. Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Post-concussive Symptoms in Children and Adolescents. JAMA 2016;316(23):2504-2514. https://doi.org/10.1001/jama.2016.17396
Del Rossi G, Anania T, and Lopez RM. Early Aerobic Exercise for the Treatment of Acute Pediatric Concussions. J Athletic Train 2020;55(7):649-657. https://doi.org/10.4085/1062-6050-404-19
Clark JF, Caudell-Stamper DN, Divine JG, et al. Can a transient exertion-related carotid (TERC) murmur heard during a symptom-limited exercise test be used as a means for managing sports concussion? Med Hypotheses 2016;93:11-15. https://doi.org/10.1016/j.mehy.2016.05.003
Perrey S. Promoting motor function by exercising the brain. Brain Sci 2013;3(1):101-122. https://doi.org/10.3390/brainsci3010101
Armstrong RA. Visual problems associated with traumatic brain injury. Clin Exp Optom 2018;101(6):716-726. https://doi.org/10.1111/cxo.12670
Clark JF, Ellis JK, Divine JG, et al. Analysis of Central and Peripheral Vision Reaction Times in Patients With Post-concussion Visual Dysfunction. Clin J Sport Med 2017;27(5):457-461. https://doi.org/10.1097/jsm.0000000000000381
Scheiman M, Wick, B. Clinical Management of Binocular Vision: Heterophoric, Accommodative, and Eye Movement Disorders. Philadelphia, PA: Lippincott Williams & Wilkins; 2013.
Damari DA. Vision Therapy for Non-Strabismic Binocular Vision Disorders An Evidence-Based Approach. OptoWest 2013.
Abernethy, B. Training the visual-perceptual skills of athletes. Insights from the Study of Motor Expertise. Am J Sports Med 1996;24(6 Suppl):S89-92.
Barton JJS, & Ranalli PJ. Vision Therapy: Ocular Motor Training in Mild Traumatic Brain Injury. Ann Neurol 2020;88(3):453-461. https://doi.org/10.1002/ana.25820
Clark JF, Vincent J. Three Pillars of NeuroVisual Training. Friends of NeuroVisual Training 2020;1(1).
Clark JF, Middendorf A, Divine J, et al. Aggressive Rehabilitation Pathway Targeting Concussion Symptoms: Illustration with a Case Study. Brain Disord Ther 2014;3:1000131. https://doi.org/10.4172/2168-975X.1000131
Clark JF, Graman P, Myer G, et al. An exploratory study of the potential effects of vision training on concussion incidence in football. Optomet Vis Perform 2015;3.
Clark JF, Colosimo A, Divine J, et al. Vision training methods for sports concussion mitigation and management. J Vis Exp 2015;(99):e52648. https://doi.org/10.3791/52648
Clark JF, Hasselfeld K, Divine J, et al. Colored Glasses to Mitigate Photophobia Symptoms Post-traumatic Brain Injury. J Athl Train 2017;52(8):725-729. https://doi.org/10.4085/1062-6050-52.4.04
Clark JF, Ellis JK, Graman P, et al. High performance vision training improves batting statistics for University of Cincinnati baseball players. PLoS ONE 2012;7(1):e29109.
Clark JF, Selmanovic E, Vincent J. Survey of Prevention and Intervention Strategies Reducing Return to Play Post-Concussion in Division 1 Football. NeuroSports 2020;1:5. https://nsuworks.nova.edu/neurosports/vol1/iss1/5
Debski EA. Fixing my gaze: A scientist’s journey into seeing in three dimensions. In J Clin Invest 2009;119:3188. https://doi.org/10.1172/jci41156
Simpson-Jones ME & Hunt AW. Vision rehabilitation interventions following mild traumatic brain injury: a scoping review. Disabil Rehabil 2019;41(18):2206-2222. https://doi.org/10.1080/09638288.2018.1460407
Herdman SJ. Advances in the treatment of vestibular disorders. Phys Ther 1997;77(6):602-618. https://doi.org/10.1093/ptj/77.6.602
Han BI, Song HS, & Kim JS. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises. J Clin Neurol 2011;7(4):184-196. https://doi.org/10.3988/jcn.2011.7.4.184
Halmagyi GM, Weber KP, and Curthoys IS. Vestibular function after acute vestibular neuritis. Restor Neurol Neurosci 2010;28(1):37-46. https://doi.org/10.3233/RNN-2010-0533
Herdman SJ, Schubert MC, Tusa RJ. Recovery of dynamic visual acuity in unilateral vestibular hypofunction. Arch Otolaryngol Head Neck Surg 2003;129(8);819-824. https://doi.org/10.1001/archotol.129.8.819
Grossman GE and Leigh RJ. Instability of gaze during locomotion in patients with deficient vestibular function. Ann Neurol 1990;27(5);528-532. https://doi.org/10.1002/ana.410270512
Herdman SJ. Role of vestibular adaptation in vestibular rehabilitation. Otolaryngol Head Neck Surg 1998;119(1):49-54. https://doi.org/10.1016/S0194-5998(98)70195-0
Schubert MC and Zee DS. Saccade and vestibular ocular motor adaptation. Restor Neurol Neurosci 2010;28(1):9-18. https://doi.org/10.3233/RNN-2010-0523
Lewis RF. Advances in the diagnosis and treatment of vestibular disorders: psychophysics and prosthetics. J Neurosci 2015;35(13):5089-5096. https://doi.org/10.1523/JNEUROSCI.3922-14.2015
Herdman SJ, Clendaniel RA, Niparko JK. Vestibular adaptation exercises and recovery: acute stage after acoustic neuroma resection. Otolaryngol Head Neck Surg 1996;113(1):77-87. https://doi.org/10.1016/s0194-5998(95)70148-6
Schneider KJ, Meeuwisse WH, Emery CA. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. Br J Sports Med 2014;48(17);1294-1298. https://doi.org/10.1136/bjsports-2013-093267
Storey EP, Wiebe DJ, Master CL. Vestibular Rehabilitation Is Associated With Visuovestibular Improvement in Pediatric Concussion. J Neurologic Phys Ther 2018;42(3):134-141. https://doi.org/10.1097/npt.0000000000000228
Murray DA, Meldrum D, and Lennon O. Can vestibular rehabilitation exercises help patients with concussion? A systematic review of efficacy, prescription and progression patterns. Br J Sports Med 2017;51(5):442-451. https://doi.org/10.1136/bjsports-2016-096081
Mollica A, Thaut M, and Burke MJ. Proposing Music-based Interventions for the Treatment of Traumatic Brain Injury Symptoms: Current Evidence and Future Directions. Can J Psychiatry 2021;66(8):707-709. https://doi.org/10.1177/07067437211007811
Bronson H, Vaudreuil R, and Bradt J. Music Therapy Treatment of Active-Duty Military: An Overview of Intensive Outpatient and Longitudinal Care Programs. Music Therapy Perspectives 2018;36(2):195-206. https://doi.org/10.1093/mtp/miy006
Vik BMD. Music-supported Systematic Treatment Strategies for People with Executive Dysfunction Following Traumatic Brain Injury: Similarities and Divergencies in 7 Case Reports. Music Med 2019;11(3):166-175.
Thompson S, Hays K, Kowalski RG, et al. Rhythmic Auditory Stimulation and Gait Training in Traumatic Brain Injury: A Pilot Study. J Music Ther 2020;58(1):70-94. https://doi.org/10.1093/jmt/thaa016
Gooding LF and Langston DG. Music Therapy with Military Populations: A Scoping Review. J Music Ther 2019;56(4):315-347. https://doi.org/10.1093/jmt/thz010
Martínez-Molina N, Siponkoski S.-T, and Särkämö T, et al. Resting-State Network Plasticity Induced by Music Therapy after Traumatic Brain Injury. Neural Plasticity 2021;6682471. https://doi.org/10.1155/2021/6682471
Vik BMD, Skeie GO, and Specht K. Neuroplastic Effects in Patients with Traumatic Brain Injury After Music-Supported Therapy. Frontier Human Neurosci 2021;13(177). https://doi.org/10.3389/fnhum.2019.00177
Li K, Weng L, and Wang X. The State of Music Therapy Studies in the Past 20 Years: A Bibliometric Analysis. Frontier Psychol 2021;12(2168); https://doi.org/10.3389/fpsyg.2021.697726
Ketcham C, Bowie M, and Hall E., et al. The Value of Speech-Language Pathologists in Concussion Management. Current Research: Concussion 2019;4:e8-e13. https://doi.org/10.1055/s-0037-1603645
Vander Werff KR, and Rieger B. Impaired auditory processing and neural representation of speech in noise among symptomatic post-concussion adults. Brain Injury 2019;33(10):1320-1331. https://doi.org/10.1080/02699052.2019.1641624
Sohlberg MM, and Ledbetter AK. Management of Persistent Cognitive Symptoms After Sport-Related Concussion. Am J Speech Lang Pathol 2016;25(2):138-149. https://doi.org/10.1044/2015_AJSLP-14-0128
Bronson H, Vaudreuil R, and Bradt J. Music Therapy Treatment of Active-Duty Military: An Overview of Intensive Outpatient and Longitudinal Care Programs. Music Ther Perspect 2018;36(2):195-206. https://doi.org/10.1093/mtp/miy006
O’Brien KH. Overcoming Knowledge Barriers for Inclusion of School-Based Speech-Language Pathologists in the Management of Students with Mild Traumatic Brain Injury. Semin Speech Lang 2020;41(2):195-208. https://doi.org/10.1055/s-0040-1701687
Dachtyl SA, and Morales P. A Collaborative Model for Return to Academics After Concussion: Athletic Training and Speech-Language Pathology. Am J Speech Lang Pathol 2017;26(3):716-728. https://doi.org/10.1044/2017_AJSLP-16-0138
Williams-Butler M and Cantu RC. Concussion Practice Patterns among Speech-Language Pathologists. Health 2019;11:880-895. https://doi.org/10.4236/health.2019.117071
Duff MC, and Stuck S. Paediatric concussion: Knowledge and practices of school speech-language pathologists. Brain Injury 2015;29(1);64-77. https://doi.org/10.3109/02699052.2014.965747
Lundine JP, Ciccia AH, and Brown J. The Speech-Language Pathologists’ Role in Mild Traumatic Brain Injury for Early Childhood-, Preschool-, and Elementary School-Age Children: Viewpoints on Guidelines From the Centers for Disease Control and Prevention. Am J Speech Lang Pathol 2019;28(3):1371-1376. https://doi.org/10.1044/2019_AJSLP-18-0295
Kane AW, Diaz DS, and Moore C. Physical Therapy Management of Adults with Mild Traumatic Brain Injury. Semin Speech Lang 2019;40(01):036-047.
Thom SR. Hyperbaric oxygen: its mechanisms and efficacy. Plast Reconstr Surg 2011;127(1):131S-141S. https://doi.org/10.1097/PRS.0b013e3181fbe2bf
Fife CE and Hopf H. Hyperbaric oxygen: its mechanisms and efficacy. Plast Reconstr Surg 2011;127(1):142S-143S. https://doi.org/10.1097/PRS.0b013e3181fb5443
Miller RS, Weaver LK, and Brenner LA, et al. Effects of hyperbaric oxygen on symptoms and quality of life among service members with persistent post-concussion symptoms: a randomized clinical trial. JAMA Intern Med 2015;175(1):43-52. https://doi.org/10.1001/jamainternmed.2014.5479
Boussi-Gross R, Golan H, and Efrati S, et al. Hyperbaric oxygen therapy can improve post-concussion syndrome years after mild traumatic brain injury - randomized prospective trial. PLoS One 2013;8(11):e79995. https://doi.org/10.1371/journal.pone.0079995
Palzur E, Vlodavsky E, and Soustiel JF, et al. Hyperbaric oxygen therapy for reduction of secondary brain damage in head injury: an animal model of brain contusion. J Neurotrauma 2004;21(1):41-48. https://doi.org/10.1089/089771504772695931
Palzur E, Zaaroor M, and Soustiel JF, et al. Neuroprotective effect of hyperbaric oxygen therapy in brain injury is mediated by preservation of mitochondrial membrane properties. Brain Res 2008;1221:126-133. https://doi.org/10.1016/j.brainres.2008.04.078
Vlodavsky E, Palzur E, and Soustiel, J. F. Hyperbaric oxygen therapy reduces neuroinflammation and expression of matrix metalloproteinase-9 in the rat model of traumatic brain injury. Neuropathol Appl Neurobiol 2006;32(1):40-50. https://doi.org/10.1111/j.1365-2990.2005.00698.x
Dong Y, Hu X, and Wang T, et al. Effect of hyperbaric oxygenation therapy on post-concussion syndrome. Exp Ther Med 2018;16(3):2193-2202. https://doi.org/10.3892/etm.2018.6463