1.
A Physiologically Based Approach to Prescribing Exercise Following a Sport-Related Concussion.
Worts, PR, Burkhart, SO, Kim, JS
Sports medicine (Auckland, N.Z.). 2019;(5):683-706
Abstract
Clinical management of concussion has evolved over the last 20 years, and complete cognitive and physical rest remains a common clinical recommendation. The duration of rest may vary widely, from 24-48 h to several weeks or until the patient's symptoms have resolved or returned to near baseline levels. Following a period of rest, a stepwise progression of exercise is used for gradual return to play or to work. Previous research in healthy people suggested that prolonged periods of physical inactivity consistently induced deleterious physiological and psychological effects. A growing body of evidence indicates that initiating exercise earlier in the recovery process following a concussion may reduce symptom burden and lower the incidence of post-concussion syndrome. Preliminary findings appear promising, but data on the appropriate exercise prescription for patients who recently sustained a concussion are limited. We reviewed the literature in healthy individuals and patients with concussion and post-concussion syndrome to develop a physiologically based exercise prescription for the days following a concussion. Using this, practitioners may shorten the rest period and initiate controlled exercise earlier during the recovery process following a concussion.
2.
A review of the neuroprotective role of vitamin D in traumatic brain injury with implications for supplementation post-concussion.
Lawrence, DW, Sharma, B
Brain injury. 2016;(8):960-8
Abstract
BACKGROUND Nutritional interventions are promising treatment adjuncts in the management of concussion. Vitamin D (VDH) supplementation has demonstrated neuroprotective properties in multiple models of acquired brain injury. OBJECTIVE Review the neuroprotective role of VDH supplementation following traumatic brain injury (TBI). METHODS A Medline search was conducted to review manuscripts investigating the influence of VDH status or supplementation on TBI outcomes. RESULTS The search identified 165 studies, of which five were included. Four manuscripts studied a rodent model of TBI, while one studied a clinical sample. Vitamin D monotherapy independently reduced inflammation and neuronal injury following TBI, with a more robust effect observed in combination with progesterone (PROG). One study demonstrated VDH deficiency exacerbates post-TBI inflammatory response. One study in a clinical sample found combination therapy superior to PROG alone or placebo in improving outcomes after severe TBI. One study observed a more robust response to low-dose VDH compared to high-dose VDH when given in combination with PROG. CONCLUSION A protective role for VDH and a vitamin D sufficient status was identified for numerous outcomes following TBI. However, VDH supplementation cannot be recommended at this time to improve outcomes following TBI.
3.
Diagnostic approaches to predict persistent post-traumatic symptoms after mild traumatic brain injury - a literature review.
Studerus-Germann, AM, Thiran, JP, Daducci, A, Gautschi, OP
The International journal of neuroscience. 2016;(4):289-98
Abstract
Mild traumatic brain injury (mTBI) is one of the most frequently diagnosed neurological disorders in emergency departments. Although there are established recommendations for the diagnosis and treatment in the acute stage, there is an on-going debate in which diagnostic methods and risk factors predict unfavourable long-term outcome after mTBI. This literature review addresses the question, which diagnostic approaches may best predict persistent post-traumatic symptoms (pPTS). A literature search for experimental studies from January 2000 to September 2014 evaluating the following diagnostic approaches (1) susceptibility weighted imaging (SWI), (2) diffusion tensor imaging (DTI), (3) magnetic resonance spectroscopy (MRS), (4) functional magnetic resonance imaging (fMRI), as predictive factors of pPTS or unfavourable cognitive outcome in adult populations with mTBI was performed. DTI has been proved to be a valuable tool to identify diffuse axonal injury (DAI) after mTBI. Additionally, some studies showed associations between DAI and unfavourable cognitive outcome. SWI has shown to be a highly sensitive imaging method to identify microbleeds. The presence and quantity of microbleeds in this imaging technique can further provide aetiological evidence for pPTS. MRS provides information about local neurons metabolism and preliminary data show that creatine-phosphocreatine levels measured after mTBI are predictive of cognitive outcome and emotional distress. The results of one study have shown fMRI as a useful tool to differentiate mTBI patients with pPTS from controls and mTBI patients without pPTS in a resting-state condition. From the evaluated diagnostic approaches to predict pPTS after mTBI, DTI, SWI, MRS, and fMRI seem to have adequate sensitivity and specificity as predictive diagnostic tools for pPTS. Large longitudinal clinical trials are warranted to validate the prognostic applicability and practicability in daily clinical practice.