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Concussions Demystified: Mechanisms, Symptoms, and Effective Treatment - Part 3

In Part 1, we explored the mechanism of injury (MOI) of concussions, focusing on how impacts to the head or body lead to brain movement inside the skull, triggering the neurometabolic cascade that affects brain function. In Part 2, we discussed the symptoms of concussions, which can vary widely, affecting physical, cognitive, emotional, and sleep functions. Recognizing these symptoms early is crucial for effective treatment and recovery, helping individuals return to normal activities safely.



Part 3: Effective Treatment and Recovery Strategies for Concussions

In Part 3, we shift our focus to the treatment of concussions, an essential aspect of managing this complex injury. Recovery from a concussion requires more than just rest; it involves a carefully structured approach to rehabilitation. We’ll explore evidence-based treatments, including physical therapy, visual and vestibular rehabilitation, and the importance of gradual return-to-activity protocols. By following these strategies, individuals can recover more effectively and reduce the risk of long-term complications like post-concussion syndrome.


Rest and Recovery

Initially, following a concussion, rest is essential. The brain requires time to heal, and excessive physical or cognitive activity can worsen symptoms and prolong recovery. The first 24 to 48 hours following the injury should be focused on physical and cognitive rest. This means avoiding strenuous physical activity, minimizing screen time, and limiting cognitive demands like reading and concentration (Complete Concussions, 2023). Rest during this early phase allows the brain to recover from the immediate biochemical disruptions caused by the concussion.


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The Role of Rehabilitation

Recent research emphasizes the importance of early intervention in concussion treatment. While rest is essential in the first couple of days, early rehabilitation has been shown to speed up recovery and reduce the risk of developing post-concussion syndrome (PCS). Active rehabilitation strategies can include exercise therapy, vestibular rehabilitation, and visual therapy (Schneider et al., 2014). These therapies aim to restore normal brain function, improve balance, and address visual disturbances that commonly follow a concussion.


Buffalo Concussion Treadmill Test (BCTT)

The Buffalo Concussion Treadmill Test (BCTT) is an important tool used in concussion rehabilitation. The test is designed to assess the individual’s tolerance to physical exertion, which is often impaired following a concussion. Gradual, controlled exercise is introduced to determine how well the brain responds to increased cardiovascular demand. The BCTT is particularly useful in individuals who experience prolonged symptoms or are at risk of developing PCS (Baker et al., 2012).


Multidisciplinary Approach

A multidisciplinary treatment approach is becoming the gold standard for concussion care. This approach includes working with healthcare providers from various disciplines, including physical therapists, neurologists, psychologists, and occupational therapists. Each provider contributes to a personalized treatment plan that addresses the specific symptoms and challenges the individual is facing. For instance, vestibular therapists work with patients to address dizziness and balance issues, while neuropsychologists help manage cognitive and emotional symptoms (Patricios et al., 2023).


Exercise Therapy and Rehabilitation

Physical activity has long been a contentious issue in concussion recovery, with the traditional belief that rest was paramount. However, modern research supports the idea that controlled, low-impact exercise, started as early as 5 to 7 days post-injury, can significantly improve recovery times and prevent long-term issues (Leddy et al., 2013). Exercise therapy enhances blood flow to the brain, which helps in the healing process and reduces the risk of developing PCS. Exercise must be carefully monitored, and the intensity must be kept below the symptom threshold to avoid exacerbating the injury.


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Visual and Vestibular Rehabilitation

Concussions frequently lead to visual disturbances and balance problems. Vestibular rehabilitation therapy (VRT) focuses on improving balance and reducing dizziness, while visual therapy addresses issues such as difficulty focusing or sensitivity to light (Reneker et al., 2017). These therapies are critical for restoring normal brain function and allowing the individual to return to everyday activities safely.


Psychological Support

Emotional disturbances, including anxiety, depression, and irritability, are common following a concussion. These symptoms can interfere with recovery and should not be overlooked. Psychological support, including cognitive behavioral therapy (CBT), can help individuals manage their emotional responses to the injury and reduce the impact of mental health symptoms on their recovery (Baker et al., 2012).


Step-by-Step Return-to-Activity Protocol

A crucial aspect of concussion treatment is a structured return-to-activity protocol. This protocol ensures that individuals gradually return to normal physical and cognitive activities without exacerbating their symptoms. The protocol typically starts with light aerobic activity, such as walking or stationary cycling, and progresses through various stages of physical exertion, sport-specific exercises, and non-contact drills (Complete Concussions, 2023). The protocol aims to prevent premature return to play or work, which can increase the risk of another concussion or more serious injury.


When to Seek Additional Treatment

In some cases, symptoms persist beyond the typical recovery window of 10 to 14 days. Individuals with persistent symptoms may require more intensive rehabilitation. Early referral to concussion rehabilitation specialists, who are trained in managing prolonged symptoms, is recommended to avoid long-term complications like PCS (Reneker et al., 2017). These specialists provide tailored treatment plans that can address neck pain, dizziness, visual disturbances, and cognitive deficits.


Conclusion

Concussion treatment has advanced significantly in recent years, with a greater focus on early intervention, personalized care, and active rehabilitation. While rest remains crucial in the early stages of recovery, modern research supports the inclusion of controlled exercise, vestibular rehabilitation, and visual therapy to promote faster and more complete recovery. By following evidence-based guidelines and employing a multidisciplinary approach, most individuals with concussions can recover fully and return to their normal activities without long-term effects.


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References

Baker, J. G., Freitas, M. S., Leddy, J. J., Kozlowski, K. F., & Willer, B. S. (2012). Return to full functioning after graded exercise assessment and progressive exercise treatment of postconcussion syndrome. Rehabilitation Research and Practice, 2012, 705309. https://doi.org/10.1155/2012/705309

Complete Concussions. (2023). What you need to know about concussions. Retrieved from https://completeconcussions.com

Leddy, J. J., Cox, J. L., Baker, J. G., Wack, D. S., Pendergast, D. R., Zivadinov, R., et al. (2013). Exercise treatment for postconcussion syndrome. Journal of Head Trauma Rehabilitation, 28(4), 241-249. https://doi.org/10.1097/HTR.0b013e31828a58c3

Reneker, J. C., Hassen, A., Phillips, R. S., Moughiman, M. C., Donaldson, M., Moughiman, J. (2017). Feasibility of early physical therapy for dizziness after a sports-related concussion: A randomized clinical trial. Scandinavian Journal of Medicine & Science in Sports, 26(3), 299-306. https://doi.org/10.1111/sms.12767

Schneider, K. J., Meeuwisse, W. H., Nettel-Aguirre, A., Barlow, K., Boyd, L., Kang, J., et al. (2014). Cervicovestibular rehabilitation in sport-related concussion: A randomized controlled trial. British Journal of Sports Medicine, 48(17), 1294-1298. https://doi.org/10.1136/bjsports-2013-093360

 
 
 

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