Essay on Concussion Treatment

Most studies recommend rest and avoidance of exercise and symptom exacerbation until asymptomatic,4,7 causing, as a result, for prescribed rest to be one of the most frequently utilized concussion interventions.8 More recent studies, however, have instead advised a brief rest period in the acute phase (24- 48 hours) post-trauma after which patients are encouraged to become increasingly active while being sure to stay below the level of symptom exacerbation to facilitate recovery.8 Leddy et al. and others report that there is currently no conclusive research that states resting for more than 3 days is beneficial.4,9,10 Instead, the use of early exertional testing, including within the acute period of concussion recovery (aside from the initial 48 hours), has been demonstrated to provide a safe and effective biomarker for diagnosis and prognosis in concussion.11 The inclusion of sub-symptomatic exertion is especially beneficial in the event a patient’s symptoms are prolonged ( >10–14 days in adults and >4 weeks in children).8 In many instances, prolonged rest can be detrimental, rather than beneficial, to a patient's recovery, resulting in the onset of deconditioning, fatigue, and reactive depression.12,13,14

In general, exercise can improve brain function through the process of brain neuroplasticity.15 The inclusion of exercise into the rehabilitation process following a concussion has been reported to promote various beneficial physiologic processes. This is particularly useful in the event of a concussion which has been determined to involve a physiologic insult to the brain.16 Return-to-play determination solely dependent on elimination of concussion symptoms is unreliable as physiological recovery may last longer than symptom recovery alone.17 Rather, aerobic exercise, introduced in the proper time and amount, can address the physiologic dysfunction preventing a return-to-sport because of the ability of activity to increase parasympathetic activity, reduce sympathetic activation, and improve cerebral blood flow.18,19 The various enhancements exercise can make towards brain function could be translated to brain recovery following a concussion, or other forms of traumatic brain injuries.4

Save your time!
We can take care of your essay

• Proper editing and formatting
• Free revision, title page, and bibliography
• Flexible prices and money-back guarantee

Place an order

The ability of exercise to facilitate recovery alongside growing support for not solely resting until fully asymptomatic4,11 highlights the importance of the Buffalo Concussion Treadmill Test (BCTT) in ushering in a new means of post-concussion rehabilitation. The discovery of a physiological component of concussion symptoms as noted above20 highlights the importance of the creation of an evaluation of such measures during the clinical determination of readiness to return to activity. The BCTT fills that role as it involves the incorporation of closely monitored submaximal exercise while ensuring the patient remains below their cognitive and physical exacerbation threshold.13 Graded exercise testing with the BCTT provides a means of establishing a safe and effective aerobic rehabilitation plan that has been used as a means of speeding up recovery times in those with post-concussion syndrome as well as reliably diagnosing physiologic dysfunction in acute concussion.4,21 The passing of the BCTT has thus been established as a method by which athletes are deemed ready to undergo the return-to-play protocol without symptom exacerbation.11,21 While the BCTT was the first to utilize a standardized training program in concussion patients, the Gapski-Goodman Test (GGT) was created to serve as an alternative physical exertion test to provide a more effective means of returning patients to sport safely and quickly. The GGT constitutes a dynamic, anaerobic, multiplanar, high-risk assessment of an athlete, all elements lacking in the BCTT. Marshall et al.11 discovered that the GGT identified 14.6% of self-reported, asymptomatic individuals after concussion who appeared ready-to-play but needed the advanced activities of the GGT to trigger symptoms.

Though the BCTT is extremely useful in providing an initial screening of an individual’s sub-symptom aerobic capacity, as noted in the Marshall study,11 the BCTT is ineffective when used alone in determining return-to-play capabilities. While the GGT mimics the sporting environment better than the BCTT, it nevertheless may not be an appropriate test for those requiring lower levels of cardiovascular fitness in their activities of daily living and thus, an alternative testing procedure is necessary.11 Physical therapists at Burke Rehabilitation Hospital outpatient clinics recognized the usefulness of the BCTT and GGT, however these tests are insufficiently thorough and generalizable to the needs of their wide-ranging clientele. The Burke Rehabilitation Hospital Post-Concussion Exertion Protocol and Assessment was developed to more thoroughly and safely guide patients from their injury to return to their sport or activity.Most studies recommend rest and avoidance of exercise and symptom exacerbation until asymptomatic,4,7 causing, as a result, for prescribed rest to be one of the most frequently utilized concussion interventions.8 More recent studies, however, have instead advised a brief rest period in the acute phase (24- 48 hours) post-trauma after which patients are encouraged to become increasingly active while being sure to stay below the level of symptom exacerbation to facilitate recovery.8 Leddy et al. and others report that there is currently no conclusive research that states resting for more than 3 days is beneficial.4,9,10 Instead, the use of early exertional testing, including within the acute period of concussion recovery (aside from the initial 48 hours), has been demonstrated to provide a safe and effective biomarker for diagnosis and prognosis in concussion.11 The inclusion of sub-symptomatic exertion is especially beneficial in the event a patient’s symptoms are prolonged ( >10–14 days in adults and >4 weeks in children).8 In many instances, prolonged rest can be detrimental, rather than beneficial, to a patient's recovery, resulting in the onset of deconditioning, fatigue, and reactive depression.12,13,14

In general, exercise can improve brain function through the process of brain neuroplasticity.15 The inclusion of exercise into the rehabilitation process following a concussion has been reported to promote various beneficial physiologic processes. This is particularly useful in the event of a concussion which has been determined to involve a physiologic insult to the brain.16 Return-to-play determination solely dependent on elimination of concussion symptoms is unreliable as physiological recovery may last longer than symptom recovery alone.17 Rather, aerobic exercise, introduced in the proper time and amount, can address the physiologic dysfunction preventing a return-to-sport because of the ability of activity to increase parasympathetic activity, reduce sympathetic activation, and improve cerebral blood flow.18,19 The various enhancements exercise can make towards brain function could be translated to brain recovery following a concussion, or other forms of traumatic brain injuries.4

The ability of exercise to facilitate recovery alongside growing support for not solely resting until fully asymptomatic4,11 highlights the importance of the Buffalo Concussion Treadmill Test (BCTT) in ushering in a new means of post-concussion rehabilitation. The discovery of a physiological component of concussion symptoms as noted above20 highlights the importance of the creation of an evaluation of such measures during the clinical determination of readiness to return to activity. The BCTT fills that role as it involves the incorporation of closely monitored submaximal exercise while ensuring the patient remains below their cognitive and physical exacerbation threshold.13 Graded exercise testing with the BCTT provides a means of establishing a safe and effective aerobic rehabilitation plan that has been used as a means of speeding up recovery times in those with post-concussion syndrome as well as reliably diagnosing physiologic dysfunction in acute concussion.4,21 The passing of the BCTT has thus been established as a method by which athletes are deemed ready to undergo the return-to-play protocol without symptom exacerbation.11,21 While the BCTT was the first to utilize a standardized training program in concussion patients, the Gapski-Goodman Test (GGT) was created to serve as an alternative physical exertion test to provide a more effective means of returning patients to sport safely and quickly. The GGT constitutes a dynamic, anaerobic, multiplanar, high-risk assessment of an athlete, all elements lacking in the BCTT. Marshall et al.11 discovered that the GGT identified 14.6% of self-reported, asymptomatic individuals after concussion who appeared ready-to-play but needed the advanced activities of the GGT to trigger symptoms.

Though the BCTT is extremely useful in providing an initial screening of an individual’s sub-symptom aerobic capacity, as noted in the Marshall study,11 the BCTT is ineffective when used alone in determining return-to-play capabilities. While the GGT mimics the sporting environment better than the BCTT, it nevertheless may not be an appropriate test for those requiring lower levels of cardiovascular fitness in their activities of daily living and thus, an alternative testing procedure is necessary.11 Physical therapists at Burke Rehabilitation Hospital outpatient clinics recognized the usefulness of the BCTT and GGT, however these tests are insufficiently thorough and generalizable to the needs of their wide-ranging clientele. The Burke Rehabilitation Hospital Post-Concussion Exertion Protocol and Assessment was developed to more thoroughly and safely guide patients from their injury to return to their sport or activity.