Being told to do nothing can also lead patients to become hyper-focused on their symptoms, thereby delaying recovery. Anxiety – being told to stay home (often in the dark) and that any activity (cognitive or physical) can damage your brain can be quite alarming to patients.The potential harmful effects of cognitive rest are (from DiFazio et al., 2015): 2 11 Some evidence is beginning to suggest that too much rest may even be detrimental to recovery. Although it is still widely suggested, there is very limited evidence to support complete brain rest in the acute recovery phase of concussion. the traditional “complete brain rest” approach of the past. Similarly, the trend on the educational/vocational front is also beginning to favour early activation vs. Returning to school and work: New evidence for early activation Although the optimal time point to initiate a sub-symptom aerobic exercise rehabilitation program post-concussion has yet to be determined, the trend within the scientific literature is to initiate this earlier rather than later. Studies have since also demonstrated sub-symptom threshold aerobic exercise to be a safe and effective treatment strategy for pediatric populations 9 and also in more acute stages of recovery 10 something that was once contraindicated. Using a unique protocol in a controlled environment, patients have since demonstrated recovery in numerous trials utilizing sub-symptom threshold exercise. The theory was that ongoing symptoms may be due to autonomic dysregulation, cerebral blood flow abnormalities, and other systemic physiologic dysfunction which may be amenable to aerobic exercise. Researchers at the University of Buffalo (UB) began studying exercise as a potential treatment intervention for individuals with persistent symptoms in the early 2000’s. 3,4 It is for this reason we believe that restriction of “high-risk” activities should still be included in concussion management practices A second concussion, suffered prior to full recovery of the first, can lead to additive/compounding effects resulting in more severe brain injury and, in rare cases, death. Activity restriction helps to prevent a secondary concussion injury (Second Impact Syndrome).Early studies examining animals showed that exercise too soon after concussion resulted in a down-regulation of brain-healing modulators (i.e., Brain-Derived Neurotropic Factor (BDNF) 2 thereby potentially delaying recovery.1 Theoretically, anything that burns energy (cognitive or physical activity) can potentially prolong recovery. Concussion creates an energy deficit within the brain (i.e., the neurometabolic cascade).Rest fulfils a few important criteria for concussion management: Based on the pathophysiology of concussion, an initial period of rest may be beneficial, however we are beginning to understand that prolonging this initial rest period may also be detrimental. There are very few conditions or injuries in which rest is an effective treatment. Unfortunately, these recommendations have not been based on scientific study, but rather “expert opinion”. Patients are typically advised to rest until their symptoms go away and when that doesn’t work, they are told to rest some more. Historically, the cornerstone of concussion treatment has been rest.
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