A more active, targeted approach might provide better outcomes rather than the standard treatment of rest for concussion reports a special article in the December issue of Neurosurgery, official journal of the Congress of Neurological Surgeons (CNS).
"Matching treatments to specific symptoms, impairments and clinical profiles may improve recovery after concussion," according to the statement by panel of medical and other experts.
‘Concussion symptoms and impairments are treatable and active rehabilitation involving mild physical activity, medication and rest may enhance recovery.’
AdvertisementWhile more research is needed, the panel cites emerging evidence that "multiple active rehabilitation strategies" might be more effective than simply recommending rest for every patient with concussion. Michael W. Collins, PhD, of University of Pittsburgh is lead author of the new report.
Dr. Collins and coauthors present 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 organizations.
Current approaches emphasize immediately removing the injured person from sports or other activity, followed by a prescribed period of physical and cognitive (mental) rest and gradual return to participation.
But 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 characterized by diverse symptoms and impairments and evolving clinical profiles," Dr. Collins and colleagues write. "Recovery varies on the basis of modifying factors, injury severity, and treatments."
The panel also weighed the emerging evidence on the "TEAM approach" as an alternative to prescribed rest. Preliminary research 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 individualized management to support them in returning to school or work. Others might receive medications to treat certain concussion-related symptoms and impairments.
Yet so far, there's little high-quality research to support specific treatments or medications for concussion management. The panel highlights severe key areas for further research--especially the need for multisite, prospective studies of specific treatments across various time points after concussion.
"No single treatment strategy will be effective for all patients after concussion because of the individualized natures of the injury and its clinical consequences," Dr. Collins and coauthors write. "Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments."