What are the treatments for neurological deficits after a concussion?

Treatment of Neurological Deficits After Concussion

A comprehensive approach to treating neurological deficits after concussion should include an initial period of brief rest followed by gradual, structured return to activity with specialized rehabilitation for persistent symptoms. 1, 2

Initial Management (First 24-48 Hours)

• Complete physical and cognitive rest is recommended for the first 24-48 hours after concussion to allow for initial recovery during the acute neurometabolic cascade 2, 3
• Avoid medications except acetaminophen as recommended by a physician, and avoid alcohol, illicit drugs, or other substances that might interfere with cognitive function and recovery 2
• Monitor for warning signs requiring immediate medical attention including repeated vomiting, worsening headache, confusion, focal neurologic deficits, abnormal behavior, increased sleepiness, loss of consciousness, or seizures 2, 3

Structured Return to Activity (After Initial Rest Period)

• After the initial 24-48 hour rest period, a gradual return to activity should be implemented rather than prolonged complete rest, which may actually worsen outcomes 1, 4
• Each step in the return-to-activity protocol should take a minimum of 24 hours, progressing from light aerobic exercise to sport-specific training to non-contact training drills to full contact practice and finally to return to normal activity 2
• Return to school protocols should be customized based on the severity of postconcussion symptoms, with gradual increases in duration and intensity of academic activities as tolerated 1

Management of Persistent Symptoms (Beyond 2-4 Weeks)

Physical Exercise Therapy

• Graded physical exercise should be implemented for patients with persistent symptoms, performed at least once weekly for a minimum of 4 weeks 2, 1
• Exercise should be performed below symptom exacerbation threshold and gradually increase in intensity and complexity over time 1, 5

Vestibular Rehabilitation

• Vestibular rehabilitation is recommended for patients with persistent vestibular dysfunction, including otolith manipulating procedures, habituation exercises, adaptation exercises, and balance training 2, 1
• These interventions should be administered at least once weekly for a period of 4 weeks 2

Manual Therapy

• Manual therapy for the neck and spine should be considered for persistent symptoms, especially when neck pain is present 2
• This may include mobilization and/or manipulation of the spine or other joints 2

Cognitive Support

• For students with prolonged symptoms affecting academic performance, educational supports should be implemented 1
• These may include shortened school days, reduced workloads, extended time for assignments and tests, and postponement of standardized testing 3
• For students with prolonged symptoms despite active treatment, referral to a specialist in pediatric mild traumatic brain injury is recommended 1

Monitoring and Follow-up

• Postconcussion symptoms and academic/functional progress should be monitored collaboratively by the patient, family, healthcare professionals, and school teams 1
• Educational supports should be adjusted on an ongoing basis until the student's academic performance returns to pre-injury levels 1
• If symptoms persist beyond 3 weeks, referral to a specialist in traumatic brain injury is recommended 2

Common Pitfalls to Avoid

• Returning to activity too soon before symptoms have resolved, which can worsen outcomes 2, 3
• Prolonged complete rest beyond 48 hours, which may actually prolong symptom duration and recovery 4, 6
• Ignoring symptoms or lack of proper medical evaluation 2
• Underestimating recovery time or relying solely on patient-reported symptoms without objective assessment 3

By following this structured approach to treating neurological deficits after concussion, healthcare providers can optimize recovery and minimize long-term complications for patients with concussion-related neurological deficits.