Active Rehabilitation of Concussion and Post-concussion Syndrome

Leddy, John J.; Baker, J. G.; Willer, Barry

doi:10.1016/j.pmr.2015.12.003

Cited by 120 publications

(108 citation statements)

References 102 publications

(130 reference statements)

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“…EPIC treatment addresses these two characteristics, largely through aerobic exercise. The work of Leddy et al [24,[89][90][91]93,[99][100][101][102][103] provide support to our proposed theory concerning CVR restoration and ANS re-regulation. Concerning local blood flow regulation, NVC dysregulation significantly contributes to PCS pathology.…”

Section: Resultssupporting

confidence: 80%

“…Upon identification of neural regions of interest showing deficits in NVC, EPIC treatment integrates three fundamental neurocognitive rehabilitation components: Prepare, activate and rest. Therapeutic activities used in each of these three phases are the result of research, clinical experience, screening and empirical testing [88][89][90][91][92][93]. The preparatory stage includes aerobic exercise and neuromuscular therapy, titrated to patients exercise tolerance and lasts 50 min.…”

Section: Enhanced Performance In Cognition (Epic) Treatmentmentioning

confidence: 99%

“…Leddy et al have played a major role in investigating exercise in patients with PCS [24,25,[89][90][91]93,[99][100][101][102][103]. They demonstrated the safety and efficacy of a graduated treadmill exercise test in patients with PCS.…”

Section: Re-regulation Of Ans and CDmentioning

confidence: 99%

“…As previously mentioned, Leddy et al [24,25,[89][90][91]93,[99][100][101][102][103] have played major roles in investigating aerobic exercise in patients with PCS. One study investigated the use of sub-symptomatic threshold aerobic exercise in normalizing some of the physiologic disturbances seen in PCS, particularly BP, minute ventilation (VE), PETCO 2 and CBF velocity (CBFV) measured by transcranial Doppler [101].…”

Section: Restoration Of Cvrmentioning

confidence: 99%

“…Much of our understanding of ANS/CA re-regulation and restoration of CVR through aerobic exercise has been due to the work performed by Leddy et al [24,[89][90][91]93,[99][100][101][102][103]. EPIC treatment seeks to maximize the benefits of aerobic exercise to re-regulate ANS/CA and to restore CVR.…”

Section: Nvc Re-regulationmentioning

confidence: 99%

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Neurovascular Coupling: A Unifying Theory for Post-Concussion Syndrome Treatment and Functional Neuroimaging

Ct¹,

Allen²

2017

J Neurol Neurophysiol

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Post-concussion syndrome (PCS) occurs in a significant percentage of concussion patients and is defined as having a history of traumatic brain injury with persistence of three or more symptoms. Standard structural clinical neuroimaging studies show no abnormal findings for the majority of PCS patients as opposed to functional MRI, which often reveals irregularities in the blood-oxygen level dependent (BOLD) signal. This suggests that dysregulation of neurovascular coupling, which causes abnormal BOLD signals, plays a significant role in PCS pathology. However, compared to the pathophysiologic mechanisms occurring in acute concussion, the underlying neuropathophysiology of chronic concussive sequelaeor PCS is less understood, though becoming clearer with emerging research. We present a treatment approach grounded in the physiological theory presented here called Enhanced Performance in Cognition (EPIC), which has shown strong clinical success. Dysregulation of neurovascular coupling (NVC), along with disruptions in cerebrovascular reactivity (CVR) and autonomic nervous system (ANS) dysregulation are the targets of EPIC treatment. Success of the approach itself tentatively supports the hypothesis that these three features figure prominently in the neuropathophysiology of PCS. The aim of this report is to provide a theory of the underlying mechanisms of PCS pathology and its treatment that is in accord with the current corpus of research and explains the recent therapeutic success seen in PCS patient using the EPIC treatment. We propose a novel theory concerning the mechanisms by which NVC dysregulation is normalized. This includes focused, intense and repetitive neurocognitive challenges during post-exercise cognitive boost and the avoidance of intracerebral steal in the setting of restored and re-regulated CVR and ANS. It is intended that both the theory and treatment approach are presented explicitly enough to generate empirical studies with clear hypothetical predictions from the theory as well as clinical innovations with significant relevance to improve current practices.

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Section: Resultssupporting

confidence: 80%

Section: Enhanced Performance In Cognition (Epic) Treatmentmentioning

confidence: 99%

Section: Re-regulation Of Ans and CDmentioning

confidence: 99%

Section: Restoration Of Cvrmentioning

confidence: 99%

Section: Nvc Re-regulationmentioning

confidence: 99%

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Neurovascular Coupling: A Unifying Theory for Post-Concussion Syndrome Treatment and Functional Neuroimaging

Ct¹,

Allen²

2017

J Neurol Neurophysiol

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Nutritional interventions to improve neurophysiological impairments following traumatic brain injury: A systematic review

McGeown

Hume

Theadom

et al. 2020

J of Neuroscience Research

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Traumatic brain injury (TBI) accounts for significant global health burden. Effects of TBI can become chronic even following mild injury. There is a need to develop effective therapies to attenuate the damaging effects of TBI and improve recovery outcomes. This literature review using a priori criteria (PROSPERO; CRD42018100623) summarized 43 studies between January 1998 and July 2019 that investigated nutritional interventions (NUT) delivered with the objective of altering neurophysiological (NP) outcomes following TBI. Risk of bias was assessed for included studies, and NP outcomes recorded. The systematic search resulted in 43 of 3,748 identified studies met inclusion criteria. No studies evaluated the effect of a NUT on NP outcomes of TBI in humans. Biomarkers of morphological changes and apoptosis, oxidative stress, and plasticity, neurogenesis, and neurotransmission were the most evaluated NP outcomes across the 43 studies that used 2,897 animals. The risk of bias was unclear in all reviewed studies due to poorly detailed methodology sections. Taking these limitations into account, anti-oxidants, branched chain amino acids, and ω-3 polyunsaturated fatty acids have shown the most promising pre-clinical results for altering NP outcomes following TBI. Refinement of pre-clinical methodologies used to evaluate effects of interventions on secondary damage of TBI would improve the likelihood of translation to clinical populations.

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The impact of the COVID‐19 pandemic on the well‐being of individuals with persistent postconcussive symptoms: A qualitative study

Machan

Jahraus

Debert

et al. 2022

PM&R

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Background In response to the COVID‐19 pandemic, public health measures were implemented that closed essential businesses, mandated social distancing, and imposed substantial changes to the routine care experienced by patients with mild traumatic brain injury (mTBI) and persistent postconcussive symptoms (PPCS). Patients with PPCS often rely on a comprehensive care team, requiring in‐person treatments and consistent care. Little information exists regarding how access to these services have been affected by public health measures and what outcome the measures have had on the recovery of patients with PPCS. Objective To explore the impact of the restriction of in‐person treatments, shifts to virtual care, and global public health measures on the recovery and psychological well‐being of patients with PPCS. Design Qualitative interviews were recorded, transcribed, and analyzed using a reflexive thematic analysis approach to identify the main impacts of the public health measures on participants with PPCS. Setting Participant interviews were completed remotely via telephone or video‐calling software during province‐wide shutdowns. Participants 20 individuals with PPCS who attended the institution's Brain Injury Program consented to participate. Interventions Not applicable. Results The impacts of the public health measures emerged most prominently in three main categories: (1) day‐to‐day lived experiences, (2) personal health status, and (3) health service experiences and barriers. Conclusions This in‐depth investigation of the lived experiences of patients with PPCS outlines how the COVID‐19 public health measures negatively affected their care and well‐being. The analysis identified that through increasing social support systems, providing better access to standard or remote treatment, and developing more effective telehealth strategies, this population could be better supported in the event of future public health measures.

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Active Rehabilitation of Concussion and Post-concussion Syndrome

Cited by 120 publications

References 102 publications

Neurovascular Coupling: A Unifying Theory for Post-Concussion Syndrome Treatment and Functional Neuroimaging

Neurovascular Coupling: A Unifying Theory for Post-Concussion Syndrome Treatment and Functional Neuroimaging

Nutritional interventions to improve neurophysiological impairments following traumatic brain injury: A systematic review

The impact of the COVID‐19 pandemic on the well‐being of individuals with persistent postconcussive symptoms: A qualitative study

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