From the Guidelines
Treatment for a concussion involves a gradual return to activity, with an initial period of rest followed by a stepwise increase in physical and cognitive exertion.
Key Components of Treatment
- Initial Rest: Patients should be counseled to rest and avoid activities that exacerbate symptoms, especially in the first few days after injury 1, 2.
- Gradual Return to Activity: Once asymptomatic at rest, patients can progress through a graded return-to-play protocol, with each step taking at least 24 hours, and a minimum of 5 days to resume full activity 3.
- Cognitive Rest: Patients may also require cognitive rest, including temporary leave from school, reduced workloads, and avoidance of activities that worsen symptoms, such as reading or taking tests 4.
- Subsymptom Threshold Exercise: For patients with persistent symptoms, subsymptom threshold exercise training, which involves short durations of light cardiovascular activity without inducing symptoms, may be beneficial 2, 5.
Important Considerations
- Monitoring for Symptoms: Patients should be monitored for return of symptoms, and if symptoms recur, they should return to a previous step in the protocol 3.
- Individualized Approach: Treatment should be individualized, taking into account the patient's specific symptoms, needs, and circumstances 1, 5.
- Communication with Healthcare Providers: Patients, parents, and healthcare providers should communicate effectively to ensure a safe and effective return to activity 4.
From the Research
Treatment Approaches for Concussion
The treatment for concussion is a multifaceted approach that has evolved over the years. Recent studies have challenged the traditional method of prolonged rest, instead suggesting that active recovery and sub-symptom threshold exercise may be beneficial [(6, 7, 8)].
- Active Recovery: Emerging data suggests that aerobic exercise training can improve autonomic nervous system (ANS) function, which is often dysfunctional in individuals with concussion 6.
- Sub-symptom Threshold Exercise: This approach involves prescribing a progressive, individualized exercise program that is below the threshold of symptoms, allowing patients to return to sport and work safely [(6, 9)].
- Cognitive and Physical Rest: While rest is still considered a mainstay of treatment, particularly in the acute phase, it is no longer recommended as the sole treatment approach 10.
- Multidisciplinary Treatment: Treatment options may also include cervical physical therapy, vestibular therapy, vision therapy, cognitive rehabilitation, cognitive behavioral therapy, and pharmacological management, depending on the underlying symptom generators 9.
Key Considerations
When managing concussion, it is essential to identify the underlying symptom generators and develop a personalized treatment plan 9. The treatment approach may need to be tailored to address specific symptoms, such as persistent post-concussive symptoms (PPCS) 9.
- Early Education and Intervention: Early education and intervention, including cognitive behavioral therapy and aerobic exercise therapy, have shown efficacy in certain patients 8.
- Return-to-Activity Decision: Clinicians must carefully evaluate patients and make informed decisions about return to activity, using algorithms and guidelines to support this process 8.