Return to full functioning after graded exercise assessment and progressive exercise treatment of postconcussion syndrome (original) (raw)
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Use of Graded Exercise Testing in Concussion and Return-to-Activity Management
Current Sports Medicine Reports, 2013
Concussion is a physiologic brain injury that produces systemic and cognitive symptoms. The metabolic and physiologic changes of concussion result in altered autonomic function and control of cerebral blood flow. Evaluation and treatment approaches based upon the physiology of concussion may therefore add a new dimension to concussion care. In this article, we discuss the use of a standard treadmill test, the Buffalo Concussion Treadmill Test (BCTT), in acute concussion and in postconcussion syndrome (PCS). The BCTT has been shown to diagnose physiologic dysfunction in concussion safely and reliably, differentiate it from other diagnoses (e.g., cervical injury), and quantify the clinical severity and exercise capacity of concussed patients. It is used in PCS to establish a safe aerobic exercise treatment program to help speed recovery and return to activity. The use of a provocative exercise test is consistent with world expert consensus opinion on establishing physiologic recovery from concussion.
Exercise for Sport-Related Concussion and Persistent Postconcussive Symptoms
Sports Health: A Multidisciplinary Approach, 2020
Context: Emerging research supports the use of mild to moderate aerobic exercise for treating sport-related concussion (SRC) and persistent postconcussive symptoms (PPCS), yet the current standard of care remains to be strict rest. The purpose of this review is to summarize the existing literature on physical activity and prescribed exercise for SRC and PPCS. Evidence Acquisition: PubMed and Embase were searched in April of 2019 for studies assessing rest or prescribed exercise for SRC and PPCS. No specific search syntax was used. Study Design: Clinical review. Level of Evidence: Level 4. Results: A majority of studies show that spontaneous physical activity is safe after SRC and that subsymptom threshold aerobic exercise safely speeds up recovery after SRC and reduces symptoms in those with PPCS. Exercise tolerance can safely be assessed using graded exertion test protocols within days of injury, and the degree of early exercise tolerance has diagnostic and prognostic value. Conclu...
Effects of Aerobic Exercise on Post-Concussion Syndrome Geneviève Fulton PSP 5388: Kinesiology
Several studies have looked at the effects of aerobic exercise on post-concussion syndrome (PCS). While the jury is still out on a causal relationship between an aerobic exercise program for survivors of a traumatic brain injury (TBI) and symptom reduction or relief, this literature review points to hope regarding help for such a debilitating syndrome as long as certain conditions are met. This literature review shows that PCS symptom severity can decrease, and specific symptoms can go away with a controlled, individualized, graded aerobic exercise program.
Utility of Exercise in the Management of a Concussion
Current recommendations advocating rest in the acute phase of concussion lack evidence that avoiding symptom exacerbation while allowing natural healing mechanisms to occur benefits recovery. Subsymptom threshold graded aerobic exercise as treatment for patients with impairments persisting beyond the typical recovery timeline is well supported by the literature. Disruptions to the physiological homeostasis in the brain as a result of concussion offer some explanation for the dysfunctions observed in the autonomic nervous system. Clinical manifestations of these dysfunctions diminish with time in concussed individuals, with recent evidence revealing accelerated recovery when exercise treatment is introduced. Studies evaluating the temporal relationship of voluntary exercise on physiological markers of recovery in animals suggest that initiating exercise as soon as one day after injury improves the rate and extent of recovery from concussion. This idea is further supported in human studies, suggesting that a moderate amount of physical activity during the acute phase reduces symptom duration and risk for post-concussion disorder (PCD). Based on the limited evidence supporting this concept, critical analysis is warranted of whether or not a concussed patient may benefit from voluntary subsymptom threshold graded aerobic activity for treatment as symptoms become stable.
Exercise and Concussion, Part 2: Exercise as a Therapeutic Intervention
International Journal of Athletic Therapy & Training, 2014
Exercise provides systemic benefits that may facilitate recovery of normal function following concussion. Some studies have demonstrated therapeutic benefits from exercise following concussion. Postconcussion exercise needs to be structured and carefully monitored.
Exercise is Medicine for Concussion
Current sports medicine reports, 2018
Sport-related concussion (SRC) is a physiological brain injury that produces cerebral and systemic effects, including exercise intolerance. Exercise intolerance after concussion is believed to be the result of autonomic nervous system (ANS) dysfunction. Ventilation is inappropriately low for the level of exercise intensity, raising arterial carbon dioxide (PaCO2) levels. Elevated PaCO2 increases cerebral blood flow (CBF) out of proportion to exercise intensity, which is associated with symptoms that limit exercise performance. Thus, elevated exercise PaCO2 may signal incomplete recovery from SRC. This article reviews recent observational and experimental data and presents the evidence that subthreshold aerobic exercise normalizes the cerebrovascular physiological dysfunction and is "medicine" for patients with concussion and persistent postconcussive symptoms (PPCS). It discusses the systematic evaluation of exercise tolerance after concussion using the Buffalo Concussion ...
Exercise Treatment for Postconcussion Syndrome
Journal of Head Trauma Rehabilitation, 2013
To compare functional magnetic resonance imaging (fMRI) activation patterns during a cognitive task, exercise capacity, and symptoms in postconcussion syndrome (PCS) patients who received exercise treatment (n = 4) with a PCS placebo stretching group (n = 4) and a healthy control group (n = 4). Methods: Subjects completed a math processing task during fMRI and an exercise treadmill test before (time 1) and after approximately 12 weeks (time 2). Exercise subjects performed aerobic exercise at 80% of the heart rate (HR) attained on the treadmill test, 20 minutes per day with an HR monitor at home, 6 days per week. The program was modified as the HR for symptom exacerbation increased. Results: At time 1, there was no difference in fMRI activation between the 2 PCS groups but healthy controls had significantly greater activation in the posterior cingulate gyrus, lingual gyrus, and cerebellum versus all PCS subjects (P < .05, corrected for multiple comparisons). At time 2, exercise PCS did not differ from healthy controls whereas placebo stretching PCS had significantly less activity in the cerebellum (P < .05 corrected) and in the anterior cingulate gyrus and thalamus (P < .001, uncorrected) versus healthy controls. At time 2, exercise PCS achieved a significantly greater exercise HR (P < .001) and had fewer symptoms (P < .0004) than placebo stretching PCS. Cognitive performance did not differ by group or time. Conclusions: Controlled aerobic exercise rehabilitation may help restore normal cerebral blood flow regulation, as indicated by fMRI activation, in PCS patients. The PCS symptoms may be related to abnormal cerebral blood flow regulation.
Rehabilitation of Concussion and Post-concussion Syndrome
Sports Health: A Multidisciplinary Approach, 2012
Context: Prolonged symptoms after concussion are called post-concussion syndrome (PCS), which is a controversial disorder with a wide differential diagnosis. Evidence Acquisition: MEDLINE and PubMed searches were conducted for the years 1966 to 2011 using the search terms brain concussion/ complications OR brain concussion/ diagnosis OR brain concussion/ therapy AND sports OR athletic injuries. Secondary search terms included post-concussion syndrome, trauma, symptoms, metabolic, sports medicine, cognitive behavioral therapy, treatment and rehabilitation. Additional articles were identified from the bibliographies of recent reviews. Results: Of 564 studies that fulfilled preliminary search criteria, 119 focused on the diagnosis, pathophysiology, and treatment/rehabilitation of concussion and PCS and formed the basis of this review. Rest is the primary treatment for the acute symptoms of concussion. Ongoing symptoms are either a prolonged version of the concussion pathophysiology or ...
Orthopaedic Journal of Sports Medicine, 2021
Background: Current recommendations for sport-related concussion uniformly emphasize the importance of physical activity. However, specifics of this recommendation remain vague and do not account for an exercise dosage or compliance. Purposes: First, we examined if an 8-week individualized sub-symptom threshold aerobic exercise prescription, initiated within the first two weeks of concussion, alleviates symptom severity or affects the amount of exercise performed during the study. Second, we examined whether prescription adherence, rather than randomized group assignment, reflects the actual impact of aerobic exercise in post-concussion recovery. Methods: For this single-site prospective randomized clinical trial, participants completed an aerobic exercise test within 14 days of injury, and were randomized to an individualized aerobic exercise program or standard-of-care, and returned for assessments 1 month and 2 months after the initial visit (Table 1). The aerobic exercise group ...