Active rehabilitation after a concussion
Rest was once thought to be the most important factor in recovery from concussion, and post-concussion syndrome. However, a recent literature review looks at the role of activity, and how this can impact recovery. The authors discuss that 80-90% of all sport-related concussions resolve within a span of 1-2 weeks. Nevertheless, Post-Concussion Syndrome (PCS), persisting symptoms for an extended period of time following injury, can result in a clustering of symptoms due to a multi-physiological reaction. Thus advice to simply 'rest' may not be targeted enough for the management of the several symptoms resulting from PCS.
It is discussed that the Zurich Concensus Guidelines note that no single symptom specific to concussion, but rather the clustering of symptoms together pose several post-injury impairments. When managing PCS, a wider approach with treatment may be found superior to simply rest alone. Rest is a valuable approach for the first 24-48 hours following injury, and functional MRIs have been used to identify that the brain may be using compensatory strategies for activity and high-concentration tasks following injury. However, prolonged rest can have a counter-productive effect with physical and cognitive tolerance and resolution of symptoms.
Therefore, it is proposed that a gradual exposure to activity can be as beneficial with returning to activy as rest alone. Activity that is held at the sub-symptom level can have positive effects. However, the specific parameters of activity will vary on the individual - keeping in mind that sub-symptomatic activity with both cognitive and physical tasks is the aim. Other therapies that are discussed such as psychological input and cognitive therapy are beneficial for mood support and cognitive training. Additionally, physiotherapy and vestibular therapies are also critical in addressing additional physical symptoms associated with concussion.
While rest plays a critical role in the intial recovery of concussion, recent literature supports the use of a sub-symptomatic approach to therapy. Gradual exposure back to activity can help in a timely recovery and return to activities of daily living rather than rest alone.
> From: Leddy et al., Phys Med Rehabil Clin N Am 27 (2017) 437-454. All rights reserved to Elsiever Inc. Click here for the online summary.