UMEM Educational Pearls

Category: Orthopedics

Title: The Role of Active Rehabilitation in Concussion Management: A Systematic Review and Meta-analysis

Keywords: Concussion, active recovery, exercise (PubMed Search)

Posted: 10/5/2021 by Brian Corwell, MD (Emailed: 10/10/2021) (Updated: 10/22/2021)
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The Role of Active Rehabilitation in Concussion Management: A Systematic Review and Meta-analysis

 

Concussions make up 70% to 90% of all traumatic brain injuries

During the recovery process, prolonged rest has been shown to slow recovery and precipitate secondary symptoms of fatigue, reactive depression, anxiety and physical deconditioning.

As a result, a gradual increase in low-level activities has been encouraged after 24-48 h of rest.

23 articles for a total of 2547 concussed individuals, 49% female, both kids and adults. Included both sport related and non-sport related concussion.

None of the studies reported any adverse events in symptomatic participants after subthreshold exacerbation aerobic exercise.

Duration ranged from 15-20 minutes per session or until symptom exacerbation.

Subthreshold activity generally targeted 80% of max heart rate achieved during a graded symptom threshold test.

Every study showed improved concussion symptom scores with a physical activity intervention.

Most common treatment duration was 6 weeks (Range 1-12 wk)

Best outcomes if initiated with 2-3 weeks after injury but intervention beneficial in chronic phases of recovery as well.

The intervention of physical activity decreases post concussion symptom scores and the overall effect across studies was large and positive.

Optimal intensity, duration and time to initiation of exercise intervention needs further investigation.

Exercise effect is likely multifactorial including:

  1. Improvement in cerebral autoregulation
  2. Increases levels of brain-derived neurotrophic factor which promotes neuron growth and repair
  3. May reduce fear of exercise and perception of illness and injury
  4. Reintegration with social environments and support

One of the best effects I have seen in treating these patients is that active exercise allows a proactive approach to patient recovery. Patients become less focused on every minor symptom or irregularity.

 

References

Carter KM, et al. The Role of Active Rehabilitation in Concussion Management: A Systematic Review and Meta-analysis. Med Sci Sports Exerc. 2021 Sep 1;53(9):1835-1845.