Conventional wisdom has prescribed prolonged rest for concussions and traumatic brain injuries, but researchers now say such an approach might do more harm than good.
More than three dozen clinicians from multiple disciplines met in Pittsburgh last week to develop best practices and protocols for concussion treatment.
“There has been a hunger in the field for experts to stand shoulder to shoulder and make the statement that concussion is treatable,” said Dr. David Okonkwo, a neurosurgeon at UPMC, which hosted the conference. “That is in fact what has happened over the last 36 hours. We had full agreement from 37 of the best minds in the field that concussion is treatable.”
Researchers at the meeting, dubbed “Targeted Evaluation and Active Management,” or TEAM, agreed that there is no one-size-fits-all approach for concussion treatment, and instead advocated for the development of patient profiles based on specific symptoms.
“By matching … treatment with the different clinical profiles of the injury we’re all confident as a group that we can get kid better and get them back to school, sports, etc.,” said Michael Collins, executive director of UPMC Sports Medicine Concussion Program.
Dr. Javier Cardenas, director of the Barrow Concussion and Brain Injury Center at Barrow Neurological Institute in Phoenix, said once clinicians understand a patient’s specific symptoms, they can prescribe personalized treatments, including vision, occupational, speech and cognitive therapies.
He said the experts reviewed studies that showed prolonged rest mighty actually worsen concussion symptoms, and that light, controlled exercise overseen by a physician is a better approach.
“This is not a passive process, this is an active process,” Cardenas said. “Many times we see patients who are completely restricted from any physical activity, and as one of the major sources of this injury is sports and athletics, for those who are involved in athletics, this is actually a punishment and they become depressed. They become anxious.”
Dr. Jeff Bazarian, professor of emergency medicine at the University of Rochester Medical Center in Rochester, NY said this new active approach will hopefully encourage athletes to ask for help when they suffer concussions.
“I think for some athletes, they haven’t wanted to tell us that they’ve been injured because they’re thinking ‘This can’t be treated, so why bother telling someone?’” he said. “So the message is, yes it can be treated. Telling us … is the first step in getting you the treatment that gets you to recovery.”