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Active rehabilitation may help some concussion patients

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Conventional management for concussion involves prescribed rest — both physical and mental — and a progressive return to activity. But a growing body of evidence suggests that a more active, targeted approach may be effective for some patients.

This topic is discussed by a panel of medical and other experts in the December issue of Neurosurgery, the official journal of the Congress of Neurological Surgeons.

“Matching treatments to specific symptoms, impairments, and clinical profiles may…improve recovery after concussion,” the report states. Although more research is needed, the experts cite emerging evidence that “multiple active rehabilitation strategies” might be more effective than simply recommending rest for every patient with concussion.

Dr Michael W. Collins of the University of Pittsburgh is lead author of the new report, which features a series of “statements of agreement” by a team of concussion experts from various healthcare disciplines as well as from sport, military and public health organisations.

The panel agreed that there is “limited empirical evidence” to support the effectiveness of prescribed rest — and that rest may not be the best approach for all patients. “Concussions are characterised by diverse symptoms and impairments and evolving clinical profiles,” Dr Collins and colleagues wrote. Patient recovery varies depending on a range of factors, they said.

Weighing up the emerging evidence on the “Targeted Evaluation and Active Management” (TEAM) approach, the panel highlighted preliminary research which suggests that active treatment can be started early after concussion, and that matching targeted and active treatments to the patient’s clinical profile may improve recovery.

For example, some patients might receive individualised management to support them in returning to school or work. Others might receive medications to treat certain concussion-related symptoms and impairments.

However, so far there has been little high-quality research to support specific treatments or medications for concussion management.

“No single treatment strategy will be effective for all patients after concussion because of the individualised natures of the injury and its clinical consequences,” Dr Collins and coauthors wrote. “Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments.”

The authors concluded: “Concussion symptoms and impairments are treatable, and active rehabilitations involving a multidisciplinary treatment team may enhance recovery.”