Activity Level and Type During Post-acute Stages of Concussion May Play an Important Role in Improving Symptoms Among an Active Duty Military Population

Abstract

Background: Previous research demonstrates that early rest and gradual increases in activity after concussion can improve symptoms; however, little is known about the intensity and type of activity during post-acute time periods—specifically months post-injury—that may promote optimal recovery in an active duty service member (SM) population. Objective: The objectives of this study were to investigate how activity level and type at the post-acute stages of concussion (at 1 and 3 month[s] post-injury) impact subsequent symptoms among SMs, and how this relationship might differ by the level of symptoms at the time of injury. Methods: Participants included 39 SMs ages 19–44 years from 3 military installations who were enrolled within 72 h after sustaining a concussion. Linear regression was used to evaluate whether the association between activity level at 1 or 3 month(s) post-injury (as measured by a multi-domain Activity Questionnaire) and subsequent symptoms at 3 and/or 6 months (as measured by the Neurobehavioral Symptom Inventory) varied by the level of symptoms at acute stages of concussion. Partial correlation was used to evaluate relationships that did not differ by acute symptom level. Symptoms at the time of activity assessment (1 or 3 month[s]) were accounted for in all models, as well as activity level at acute stages of concussion. Results: Greater physical and vestibular/balance activity at 1 month were significantly correlated with lower symptoms at 3 months, but not at 6 months post-injury. There were no significant associations found between activity (total or by type) at 3 months and symptoms at 6 months. The association between activity level at either 1 or 3 months and subsequent symptoms at 3 and/or 6 months did not differ by the level of acute symptoms. Conclusion: The intensity and type of activities in which SMs engage at post-acute stages of concussion may impact symptom recovery. Although low levels of activity have been previously shown to be beneficial during the acute stage of injury, higher levels of activity may provide benefit at later stages. These findings provide support for the importance of monitoring and managing activity level beyond the acute stage of concussion.

Best Practices for Progressive Return to Activity after Concussion: Lessons Learned from a Prospective Study of U.S. Military Service Members

“…34,35 Results from the DVBIC PRA study provided additional support for these findings, as SMs who engaged in higher levels of physical or vestibular activity during the sub-acute stage (1 month post-injury) reported lower levels of symptoms in the chronic stage (3 months post-injury). 36 This apparent reversal in the effects of activity over time highlights the importance of matching concussion patients' activity levels to their stage of recovery, with a graded increase in activity level as symptoms subside. 10,33,[37][38][39][40][41][42] Although implementing PRA may require additional monitoring and management throughout the acute and sub-acute stages, these extra efforts are likely to translate into faster recovery and lower rates of chronic issues-particularly for patients who were highly symptomatic during the acute stage.…”

“…26 Fortunately, evidence supports the value of vestibular rehabilitation for those experiencing these symptoms, [43][44][45] and within the DVBIC PRA study, engagement in vestibular activities later (in the sub-acute phase) was associated with faster recovery. 36 Although only a small subset of patients with concussion are likely to receive targeted rehabilitation services, the guidance and structure of a graded return to activity provided by front-line medical personnel may be valuable. This includes discouraging premature return to activity during the acute stage to prevent acute symptoms from becoming chronic, and in treating patients whose symptoms have begun to linger by encouraging resumption of appropriate activities during post-acute phases of recovery.…”

An active approach in the treatment of post-concussion syndrome - Evidence-based practice in a collective case study

“…Early initiation of aerobic exercise has been associated with a faster recovery 95 ; however, overexertion at different stages post-mTBI can be detrimental 15,[96][97][98] and some evidence suggests that the appropriate intensity is timing-based. 99 It is therefore recommended that practitioners monitor progress under controlled conditions and with the proper testing tools. A high quality and specifically developed method for testing this is the Buffalo Concussion Treadmill Test, 100 but other testing methods with comparable protocols could be similarly applied.…”

An active approach in the treatment of post-concussion syndrome - Evidence-based practice in a collective case study

“…Early initiation of aerobic exercise has been associated with a faster recovery 95 ; however, overexertion at different stages post-mTBI can be detrimental 15,[96][97][98] and some evidence suggests that the appropriate intensity is timing-based. 99 It is therefore recommended that practitioners monitor progress under controlled conditions and with the proper testing tools. A high quality and specifically developed method for testing this is the Buffalo Concussion Treadmill Test, 100 but other testing methods with comparable protocols could be similarly applied.…”