Title: The Role of Active Rehabilitation in Concussion Management: A Systematic Review and Meta-analysis<br/>Author: Brian Corwell<br/><a href='http://umem.org/profiles/faculty/294/'>[Click to email author]</a><hr/><p> The Role of Active Rehabilitation in Concussion Management: A Systematic Review and Meta-analysis</p> <p> </p> <p> Concussions make up 70% to 90% of all traumatic brain injuries</p> <p> During the recovery process, prolonged rest has been shown to slow recovery and precipitate secondary symptoms of fatigue, reactive depression, anxiety and physical deconditioning.</p> <p> As a result, a gradual increase in low-level activities has been encouraged after 24-48 h of rest.</p> <p> 23 articles for a total of 2547 concussed individuals, 49% female, both kids and adults. Included both sport related and non-sport related concussion.</p> <p> None of the studies reported any adverse events in symptomatic participants after subthreshold exacerbation aerobic exercise.</p> <p> Duration ranged from 15-20 minutes per session or until symptom exacerbation.</p> <p> Subthreshold activity generally targeted 80% of max heart rate achieved during a graded symptom threshold test.</p> <p> Every study showed improved concussion symptom scores with a physical activity intervention.</p> <p> Most common treatment duration was 6 weeks (Range 1-12 wk)</p> <p> Best outcomes if initiated with 2-3 weeks after injury but intervention beneficial in chronic phases of recovery as well.</p> <p> The intervention of physical activity decreases post concussion symptom scores and the overall effect across studies was large and positive.</p> <p> Optimal intensity, duration and time to initiation of exercise intervention needs further investigation.</p> <p> Exercise effect is likely multifactorial including:</p> <ol> <li> Improvement in cerebral autoregulation</li> <li> Increases levels of brain-derived neurotrophic factor which promotes neuron growth and repair</li> <li> May reduce fear of exercise and perception of illness and injury</li> <li> Reintegration with social environments and support</li> </ol> <p> 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.</p> <p> </p> <fieldset><legend>References</legend>
<p> <span style="color: rgb(33, 33, 33); font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;">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. </span></p> </fieldset>