Publikationen von Dr. Ingo Helmich
I. Helmich, J. Coenen, S. Henckert, E. Pardalis, S. Schupp, H. Lausberg. Reduced frontopolar brain activation characterizes concussed athletes with balance deficits. NeuroImage: Clinical 25 (2020) 102164
Athletes with sport-related concussions (SRC) often demonstrate deficits in postural stability. Lower cerebral blood flow in frontal cortices has been documented in athletes with symptoms after SRC, however, it is unclear if functional brain oxygenation during postural control tasks is reduced in symptomatic athletes after SRC in the same manner. We therefore compared brain oxygenation patterns in frontal cortices of symptomatic and asymptomatic athletes with SRC during postural control tasks with the hypothesis that symptomatic athletes are characterized by reduced functional brain oxygenation during postural control.
62 concussed athletes (n = 31 symptomatic, n = 31 asymptomatic) were investigated during four postural control tasks with eyes closed versus eyes opened conditions and stable vs. unstable surface conditions. Brain oxygenation was assessed using functional NearInfraRed Spectroscopy (fNIRS) on frontopolar cortices of each hemisphere. Postural sway was measured by the analysis of ground reaction forces.
Symptomatic athletes showed greater postural sway when compared to asymptomatic athletes during postural control, particularly during closed eyes and/or unstable surface conditions. Changes of oxygenated hemoglobin (∆HbO2) within the left hemispheric frontopolar cortex were significantly reduced in symptomatic athletes when compared to asymptomatic athletes during the eyes closed condition. A stepwise linear regression analysis revealed that self-reported post-concussion symptoms such as headaches and sadness predict decreased brain oxygenation during postural control with closed eyes.
Symptomatic athletes with increased postural sway are characterized by decreased frontopolar brain oxygenation during postural control tasks, particularly during conditions with closed eyes. Because the frontopolar cortex showed to be involved in redistributing executive functions to novel task situations, we conclude that athletes with post-concussion symptoms suffer from a deficit in coordinating postural adjustments to balance control tasks with reduced sensory input.
I. Helmich, K.C.H. Reinecke, K. Meuter, N. Simalla, N. Ollinger, R. Junge, H. Lausberg. Symptoms after sport-related concussions alter gestural functions. Journal of Science and Medicine in Sport 23 (2020) 437–441
Symptoms after sport-related concussions (SRC) are common. Because post-concussion symptoms are often not clearly visible, speech-accompanying gestures may help clinicians to gain additional information about the patient’s history and symptoms during medical consultation. We hypothesized that athletes with SRC and who suffered from persisting symptoms would display more gestures during concussion assessment protocols when compared to non-concussed athletes because of the athletes’ previous motor-sensory experiences made during the concussive event.
A retrospective cross-sectional study.
Three matched groups of 40 (active) athletes were investigated in the context of concussion assessment (/and baseline) protocols: 14 symptomatic and 14 asymptomatic athletes with a SRC, and 12 non-concussed athletes. Certified raters using a standard analysis system for nonverbal behaviour analysed videotaped hand movements and gestures during a standardized concussion assessment protocol.
Symptomatic athletes spent significantly more time with in space hand movements, i.e., movements that act in the body-external free space without touching anything and specifically, motion quality presentation gestures than non-concussed athletes.
Increased in space movements, which are functionally gestures, and specifically, motion quality presentation gestures in symptomatic athletes indicate that the more vivid sensory motor experience of the head trauma is reflected in more gestural expressions. Thus, hand movements and gestures differentiate athletes who suffer from post-concussion symptoms from non-concussed athletes indicating the athletes’ motor-sensory experiences of the event and its aftereffects. The present study highlights the fact that gestures can be employed as behavioural markers of symptoms after sport-related concussions.
Observations of hyperactive (/restless, agitated) behaviour as a consequence of mild traumatic brain injuries (mTBI) in sports are inconclusive as reduced or slowed movement behaviour is also commonly described post-concussion. This might be grounded in the fact that the movement behaviour of athletes has not been systematically investigated during standardized settings and with objective methods of nonverbal movement analysis. Thus, we investigate whether symptoms after mTBI in sports are characterized by a hyper- or hypoactive movement behaviour experimentally.
Three matched groups of 40 athletes were investigated: 14 symptomatic and 14 asymptomatic athletes with a mTBI; and 12 non-concussed athletes. Four certified raters analysed with a standard analysis system for nonverbal behaviour each athlete’s hand movement activity, hand movement contacts, and resting positions that were displayed during a videotaped standardized anamnesis protocol.
Symptomatic athletes spend significantly more time with act apart hand movements and less time with closed rest positions when compared to non-concussed athletes. Post-concussion symptom (PCS) scores positively correlate with act apart hand movements. A linear regression analysis revealed that act apart hand movements significantly predict the PCS score.
Athletes with increased symptoms after mTBI move their hands in a hyperactive and restless manner. Increased act apart hand movements, i.e., when both hands move simultaneously without touching each other, indicate a motoric destabilization in symptomatic athletes’ behaviour that might be related to impaired inhibitory motor control systems. Future diagnoses should concern the systematic analysis of the nonverbal movement behaviour as a potential behavioural marker of symptoms after mTBI.
Ingo Helmich, Hedda Lausberg. Nonverbal Hand Movement Durations Indicate Post-Concussion Symptoms of Athletes. J Neurotrauma. 2019 Oct 15;36(20):2913-2921. doi: 10.1089/neu.2019.6385. Epub 2019 Jun 26.
Methods of post-concussion diagnosis are still under debate with regard to sensitivity, objectivity, reliability, and costs. Spontaneous displays of nonverbal hand movement behavior during interaction are indicative of psychopathology and are relatively simple to record and analyze. Increased continuous (irregular) body-focused hand movement activity in particular indicates psychopathologies that overlap in symptomatology with those of sport-related concussions (SRCs). We therefore hypothesized that the duration of "irregular," "on body," and "act on each other" hand movements is increased in athletes with SRC who suffer from post-concussion symptoms. Three matched groups of 40 athletes were investigated: 14 symptomatic athletes with a concussion, 14 asymptomatic athletes with a concussion, and 12 non-concussed athletes. Using the Neuropsychological Gesture (NEUROGES)-Elan analysis system, four certified raters analyzed all nonverbal hand movements that were displayed during a videotaped standardized anamnesis about concussion history, incidence, course of action, and post-concussion symptoms. The duration of irregular Structure units among symptomatic athletes was significantly longer compared with asymptomatic athletes. Irregular, on body, and act on each other hand movement durations correlated with post-concussion symptoms. Whereas the duration of irregular units significantly predicted the post-concussion symptom score, working memory performances showed only marginal effects. Increased duration of irregular hand movement units indicates post-concussion symptoms in athletes with SRC. Because the recording of spontaneous displays of nonverbal hand movement behavior is relatively simple and cost efficient, we suggest using the neuropsychological analysis of hand movement behavior as a future diagnostic parameter of concussion management protocols.
Ingo Helmich, Daniel von Götz, Carina Emsermann, Fu Xuanjin, Anne Griese, Ilka Lauterbach, Hedda Lausberg. Not just contact sports: significant numbers of sports-related concussions in cycling. J Sports Med Phys Fitness. 2019 Mar;59(3):496-501. doi: 10.23736/S0022-4707.18.08329-9. Epub 2018 Apr 4.
Background: Although sports-related concussions (SRCs)/mild traumatic brain injuries in contact sports have recently received much attention, investigation of SRCs in cycling - a sport yielding some of the highest percentages of SRC - remains strikingly limited. In particular, rates of incidence, cycling-specific causes, and potential long-term effects of SRC have not been examined in this sport. Here, a retrospective online survey was used to investigate the incidence and potential long-term effects of SRCs among cyclists.
Methods: A cycling-specific questionnaire was developed and administered to 2792 cyclists via an online survey. First, participants were asked about their acute symptomatology, and secondly, cycling-specific items and concussion history were addressed.
Results: Of the 999 cyclists whom completed the questionnaire, 23.8% had experienced a concussion. Incidence of concussion was significantly higher in cyclists who were club members, who cycled more than 200 kilometers per week, and who wore a helmet. Cyclists with a history of concussion complained significantly more often about headaches, pressure in the head, sensitivity to light, confusion, and irritability.
Conclusions: Concussions in cycling are a serious injury with a high incidence relative to other sports. Although wearing a helmet reduces the risk of severe brain injury, interesting, the present results show a relation between helmet use, participation in cycling clubs, and increased concussion incidence. These data are in line with the growing number of findings showing that athletes with a history of concussion report more symptoms.
BACKGROUND: Concussions are common incidences in sports. However, game-specific characteristics such as tactics, field positions, etc. might positively/negatively contribute to the occurrence of mild traumatic brain injuries (mTBI) in various sports such as soccer, volleyball, handball, or basketball. Thus, the intention of this study was to analyze game-specific characteristics of concussive incidents in active players from the perspective of different sportive disciplines.
METHODS: Four sport-specific questionnaires for soccer, handball, volleyball and basketball were established using an online survey tool.
RESULTS: A total of 3001 participants completed the questionnaires. 18% of the participants answered that they had experienced a concussion which significantly differed depending on the sport practiced (χ2(3)=56.868, P<0.001; soccer 25%, handball 24%, volleyball 13%, basketball 15%). Whereas handball and soccer players experienced most concussions on the amateur level, volleyball players experienced most on the professional level and basketball players during leisure play (χ2(9)=112.667, P<0.001). Soccer players experienced most concussions by a collision with another player, volleyball players instead experienced most concussions by hits from the ball (χ2(6)=211.260, P<0.001). In soccer, goalkeepers and defensive midfield players showed most concussive incidences (χ2(7)=19.638, P<0.01); in volleyball, the libero position and outside positions showed to be significantly affected from sport-related concussions (χ2(6)=13.617, P<0.05).
CONCLUSIONS: The present results showed that factors critically contributing to the occurrence of concussions are sport-specific and particularly concern amateurs. This indicates that most concussions in ball games appear in situations, where medical care units are not necessarily present. Preventive measures should therefore especially address amateurs in ball sports.
Postural instability has been shown to characterize individuals who suffered from long-term symptoms after mild traumatic brain injury. However, recordings of neural processes during postural control are difficult to realize with standard neuroimaging techniques. Thus, we used functional nearinfrared spectroscopy to investigate brain oxygenation of individuals with persistent postconcussion symptoms (pPCS) during postural control in altered environments.
We compared brain oxygenation and postural sway during balance control in three groups: individuals suffering from pPCS, individuals with a history of mild traumatic brain injury but without pPCS, and healthy controls. Individuals were investigated during postural control tasks with six different conditions: i) eyes opened, ii) eyes closed, and iii) blurred visual input, each while standing a) on a stable and b) an unstable surface.
In all groups, during the eyes closed/unstable surface condition as compared with the other conditions, the postural sway increased as well as the brain oxygenation in frontal brain cortices. In the most difficult balance condition, as compared with the other two groups, subjects with pPCS applied more force over time to keep balance as measured by the force plate system with a significantly greater activation in frontopolar/orbitofrontal areas of the right hemisphere.
As subjects with pPCS applied more force over time to control balance, we propose that with regard to cognitive processes, the increase of cerebral activation in these individuals indicates an increase of attention-demanding processes during postural control in altered environments.
Helmich I, Saluja RS, Lausberg H, Kempe M, Furley P, Berger A, Chen JK & Ptito A. 2015. Persistent Postconcussive Symptoms Are Accompanied by Decreased Functional Brain Oxygenation. J Neuropsychiatry Clin Neurosci. 2015 Fall;27(4):287-98
Diagnostic methods are considered a major concern in the determination of mild traumatic brain injury. The authors examined brain oxygenation patterns in subjects with severe and minor persistent postconcussive difficulties and a healthy control group during working memory tasks in prefrontal brain regions using functional near-infrared spectroscopy. The results demonstrated decreased working memory performances among concussed subjects with severe postconcussive symptoms that were accompanied by decreased brain oxygenation patterns. An association appears to exist between decreased brain oxygenation, poor performance of working memory tasks, and increased symptom severity scores in subjects suffering from persistent postconcussive symptoms.