What is the recommended treatment for a patient one week post-concussion (mild traumatic brain injury)?

Treatment for One Week Post-Concussion (Mild Traumatic Brain Injury)

At one week post-concussion, patients should resume a gradual schedule of activity that does not exacerbate symptoms, with close monitoring of symptom expression, followed by progressive reintroduction of noncontact aerobic activity. 1

Activity Progression Protocol

After the initial 24-48 hours of relative rest following a concussion, a structured approach to activity resumption is recommended:

Current Stage (1 week post-injury)

1. Gradual resumption of cognitive activities

   • Return to school/work with accommodations as needed
   • Monitor symptoms during cognitive tasks
   • Take breaks when symptoms worsen 1, 2

2. Progressive physical activity

   • Begin light aerobic exercise that doesn't trigger symptoms
   • Examples: Walking, stationary cycling at slow pace
   • Duration: 15-20 minutes per session
   • Frequency: 3-5 times per week 3
   • Avoid activities with risk of head impact 1

3. Symptom monitoring

   • Track number and severity of symptoms
   • Scale back activity if symptoms worsen
   • Progress to next level when current activities don't exacerbate symptoms 1, 2

Medication Management

• First-line for headaches: Acetaminophen (1000 mg) or ibuprofen (400 mg) 2
• Avoid: Opioids, excessive medication use (risk of dependency and rebound headaches) 2
• Warning: Monitor for analgesic overuse which can lead to rebound headaches 2

Return to Activity Framework

Follow this 5-stage protocol, with each stage lasting at least 24 hours 2:

1. ✓ Symptom-limited activity (completed in first 24-48 hours)
2. Current stage: Light aerobic exercise
3. Sport-specific exercise
4. Non-contact training drills
5. Full-contact practice (if applicable)

Only progress to the next stage if the current stage doesn't trigger symptoms 2.

Specific Interventions for Common Post-Concussion Issues

• Sleep disturbance: Address sleep hygiene; avoid sleep medications if possible 1, 2
• Vestibular symptoms: Consider referral for vestibular rehabilitation if dizziness persists 2
• Visual/ocular issues: Reduce screen time initially; consider vision therapy for persistent symptoms 2
• Mood/anxiety: Monitor for development of depression or anxiety; early intervention recommended 1, 2

Important Cautions

• Avoid complete inactivity: Prolonged rest beyond 3 days can be detrimental and may worsen outcomes 4, 5
• Avoid premature return to full activity: This increases risk of prolonged recovery and reinjury 1
• Monitor for warning signs: Worsening headache, repeated vomiting, increasing confusion require immediate medical attention 2

Evidence for Active Rehabilitation

Recent evidence strongly supports early, controlled reintroduction of activity. A meta-analysis found that prescribed exercise improved recovery time by approximately 4.6 days compared to strict rest 6. High-to-moderate intensity aerobic exercise, when introduced at the appropriate time (after initial rest period), has been shown to improve concussion-related symptoms 3.

The outdated approach of complete rest until all symptoms resolve is no longer supported by evidence and may actually prolong recovery 1, 7, 4.

Social Support and Education

Provide education to patient and family about:

• Expected course of recovery
• Warning signs requiring medical attention
• Importance of gradual return to activities
• Avoiding high-risk activities that could lead to reinjury 1, 2

By following this structured approach to post-concussion management at the one-week mark, patients can optimize their recovery while minimizing the risk of prolonged symptoms or complications.