After concussion, rest may not always be the best medicine, experts say

November 30, 2016

November 30, 2016 - Prescribed rest--both physical and mental--is the standard treatment for concussion. But a growing body of evidence suggests that a more active, targeted approach might provide better outcomes for some patients, reports a special article in the December issue of Neurosurgery, official journal of the Congress of Neurological Surgeons (CNS). The journal is published by Wolters Kluwer.

"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. While 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.

'Active and Targeted Treatments' May Enhance Recovery after Concussion

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. The "Targeted Evaluation and Active Management" (TEAM) panel met at a conference held in Pittsburgh in 2015, sponsored by the National Football League and University of Pittsburgh Medical Center.

Conference participants indicated their level of agreement with a series of statements regarding current and evolving treatment strategies for concussion. 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 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 characterized by diverse symptoms and impairments and evolving clinical profiles," Dr. Collins and colleagues write. "[R]ecovery 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."

The TEAM panel hopes their experience will help to increase awareness that all concussions are not the same and that, for some patients, treatment based on individual clinical profiles might be more effective than prescribed rest. They write, "Concussion symptoms and impairments are treatable, and active rehabilitations involving a multidisciplinary treatment team may enhance recovery."
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Click here to read "Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015."

Article "Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015" (doi: 10.1227/NEU.0000000000001447)

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