Earlier initiation of clinical care after a concussion was associated with faster recovery in a new study.
Athletes who presented for evaluation within the first week after injury recovered faster than athletes who initially presented 2 to 3 weeks post injury.
"Our results show that following a concussion, patients should seek specialty care involving a comprehensive assessment and clinical exam that allows for more targeted treatments for specific symptoms and impairments as early as possible," lead author Anthony P. Kontos, PhD, told Medscape Medical News.
Kontos, who is research director of UPMC Sports Medicine Concussion Program, University of Pittsburgh, added: "Earlier care with a trained clinician allows patients to begin behavioral management strategies involving physical and cognitive activity, sleep, nutrition, hydration, and stress management, all of which can enhance the recovery process. Patients should not wait for a week or more to seek care to see if things improve on their own; rather, they should seek care as soon as they can to enhance their recovery process."
The study was published online January 6 in JAMA Neurology.
The researchers note that most athletes who experience a concussion do not receive care beyond an initial evaluation or diagnosis at or near the time of injury and that this may result in prolonged time to recovery.
There has been general reticence among clinicians who treat patients with concussion to engage in earlier active intervention because of perceptions that it may result in a prolonged recovery, but recent research suggests that provision of care in the first few days after a concussion, especially active interventions that target specific symptoms and impairments, may play a pivotal role in influencing recovery, the researchers say.
For the current retrospective, cross-sectional study, Kontos and colleagues analyzed data on 162 young people who experienced a concussion while playing organized or recreational sports and who received treatment at a sports medicine concussion clinic.
They compared time to recovery in the 98 patients seen within the first 7 days post injury (the early group) with 64 patients seen within 8 to 20 days post injury (the late group).
The early and late groups did not differ in age (mean, 15.3 years vs 15.4 years); number of female patients (early, 52.0%; late, 62.5%), or other demographic, medical history, or injury factors. The groups were also similar with respect to symptom severity, as well as cognitive, ocular, and vestibular outcomes at the first clinic visit.
Results from a logistical regression indicated that recovery time was increased for patients in the late-treatment group (adjusted odds ratio, 5.8). Having a score >2 on an assessment of visual motion sensitivity was also associated with increased recovery time (adjusted odds ratio, 4.5).
"We found that early access to clinical care was associated with an almost six times increased likelihood of a recovery within 30 days," Kontos said.
In the early group, 52% of patients recovered within 30 days, compared with 19% of those in the late group. Mean recovery time was 51 days in the early group vs 66 days in the late group.
Kontos pointedout that concussion treatment is not just a matter of prolonged rest. "Some patients may rest for 6 months and still have symptoms, but after 1 month of vestibular therapy they are better. The brain is like any other part of the body if it is damaged and you do nothing, it doesn't always repair itself. It needs the right therapy. We used an exposed recovery model which used active targeted treatments for individual symptoms of concussion.
"Earlier care involving a comprehensive assessment and clinical exam allows for more targeted treatments for specific symptoms and impairments," he commented.
"For example, a patient with vestibular impairment would be able to begin therapy earlier and potentially accelerate their recovery simply by coming in for specialty care sooner rather than waiting. In addition, earlier care with a trained clinician allows patients to begin behavioral management strategies involving physical and cognitive activity, sleep, nutrition, hydration, and stress management, all of which can enhance the recovery process."
The researchers note that the earlier initiation of active rehabilitation strategies, including exertion progression and the opportunity to start structured physical therapies (eg, on vestibular, visual, and cervical systems), is one reasonable explanation for the shorter recovery time in the earlier group in this study.
"Further, without clinical guidance and behavioral management recommendations postinjury, athletes may have been engaging in counterproductive recovery strategies, such as strict rest or excessive physical activity," they add.
They point out that this explanation is supported by the fact that athletes recovered in a similar amount of time after the first evaluation. "It appears that all athletes had similar impairments and similar recovery time after they had received initial clinical care, highlighting the importance of clinical care as soon as possible," they conclude.
"As a parent, I would prefer my child to recover quicker from concussion symptoms, and that means accessing care sooner," Kontos added.
Commenting on the study for Medscape Medical News, Sarah Benish, MD, associate professor of neurology at the University of Minnesota, in Minneapolis, said: "I think this article adds to the growing literature that suggest early and active intervention is most likely beneficial to concussion improvement."
However, Benish pointed out that the latter group appeared to have more females, more migraine sufferers, a high rate of loss of consciousness, and a higher rate of posttraumatic amnesia, which may have had a bearing on the results.
"In addition, I would be concerned that there is a selection bias and those who had milder concussion that would self-resolve have been eliminated for the later-care group, as they would not have been seen in the clinic. The only way to truly know would be to do a prospective study where concussion athletes are assigned to an early or late appointment," she added.
"I agree the study suggests patients might benefit from improving access to care for athletes to get help for concussion, but I am not sure this is the definitive study that is needed to convince health systems to invest more money into helping access issues in an area that is historically underserved. However, it is another step towards improving care for concussion patients," she concluded.
Kontos has received grants from the National Football League, personal fees from APA Books, and other compensation from the University of Pittsburgh outside the submitted work.
JAMA Neurology. Published online January 6, 2020. Abstract
For more Medscape Neurology news, join us on Facebook and Twitter.
Read the original here:
Earlier Intervention After Concussion Linked to Faster Recovery - Medscape
- Hyperbaric Chamber Therapy Brain Injury - May 7th, 2011 [May 7th, 2011]
- Treatment for Traumatic Brain Injury - May 9th, 2011 [May 9th, 2011]
- Atlanta Traumatic Brain Injury Treatment Emory - May 11th, 2011 [May 11th, 2011]
- Hyperbaric Oxygen Therapy Brain Injury Part 2 (Tbi) - May 20th, 2011 [May 20th, 2011]
- Mark, anoxi brain injury, physical therapy after stem cell treatment - May 21st, 2011 [May 21st, 2011]
- Hyperbaric Oxygen Therapy - May 21st, 2011 [May 21st, 2011]
- Bob Hahn Traumatic Brain Injury Recovery - May 23rd, 2011 [May 23rd, 2011]
- Mark, anoxi brain injury, after stem cell treatment at Tiantan Puhua Hospital Beijing - May 24th, 2011 [May 24th, 2011]
- New Beginnings community center for brain injury rehabilitation - May 30th, 2011 [May 30th, 2011]
- Traumatic Brain Injury - Part 1 - Dr. Robert Kohn, Neurologist - June 2nd, 2011 [June 2nd, 2011]
- Am I Brain Damaged? from traumatic brain injury - June 3rd, 2011 [June 3rd, 2011]
- SLI Wellness Center for Brain Injury Rehabilitation - June 11th, 2011 [June 11th, 2011]
- Update on Libya, Radiation in Japan, Tramatic Brain Injury treatment and more, 03/23/2011 - June 12th, 2011 [June 12th, 2011]
- Origami Brain Injury Rehabilitation Center - Finding Your Path - June 12th, 2011 [June 12th, 2011]
- Traumatic Brain Injury - Part 5 - Doctor Kohn, Chicago Neurologist - June 16th, 2011 [June 16th, 2011]
- The struggle to treat traumatic brain injury - June 17th, 2011 [June 17th, 2011]
- Traumatic Brain Injury Survivor Speaks about ProTECT trial at UC Health University Hospital - June 17th, 2011 [June 17th, 2011]
- Stem cell treatment for Brain Injury of Adrian - June 23rd, 2011 [June 23rd, 2011]
- Division of Vocational Rehabilitation Services for Traumatic Brain Injury (TBI) - June 24th, 2011 [June 24th, 2011]
- Hyperbaric Chamber Treatment Stroke and Traumatic Brain Injury TBI - July 4th, 2011 [July 4th, 2011]
- Traumatic Brain Injury - Part 2 - Dr. Robert Kohn, Neurologist - July 6th, 2011 [July 6th, 2011]
- Traumatic Brain Injury - Part 7 - Doctor Kohn, MD, Neurology, Neuropsychiatry - July 14th, 2011 [July 14th, 2011]
- Neurofeedback Training and Treatment at Healing Unleashed in Denver Colorado - July 15th, 2011 [July 15th, 2011]
- Alexis Verzal takes independent steps - July 18th, 2011 [July 18th, 2011]
- The New WalkAide System: Advanced Functional Electrical Stimulation (FES) for Treatment of Foot Drop - July 18th, 2011 [July 18th, 2011]
- Doctors Cool Newborn to Limit Brain Damage - July 19th, 2011 [July 19th, 2011]
- Traumatic Brain Injury - Part 6 - by Neurologist, Dr. Robert Kohn - July 24th, 2011 [July 24th, 2011]
- Brain injury and trauma treatment by homeopathy - July 31st, 2011 [July 31st, 2011]
- Traumatic Brain Injury - Part 4 - Dr. Kohn, Neuropsychiatrist / Neurologist - August 9th, 2011 [August 9th, 2011]
- Preserving Hope, Predicting Health - August 17th, 2011 [August 17th, 2011]
- Sask Brain Injury Association - August 19th, 2011 [August 19th, 2011]
- Cognition and Mild Head Injury by Dr. Muriel Lezak - August 21st, 2011 [August 21st, 2011]
- Brain injury_Shawna_ USA_before stem cell treatment 1.wmv - August 25th, 2011 [August 25th, 2011]
- Origami Brain Injury Rehabilitation Center - Recovery is a Journey - August 26th, 2011 [August 26th, 2011]
- Different types of Concussions by Dr. James Chesnutt.mov - August 30th, 2011 [August 30th, 2011]
- Brain injury_Shawna_ USA_after stem cell treatment 1.wmv - September 11th, 2011 [September 11th, 2011]
- With Brain Injuries, Soldiers Face A Battle For Care - September 23rd, 2011 [September 23rd, 2011]
- Tripler Medical Center Treats Traumatic Brain Injury (TBI) - September 24th, 2011 [September 24th, 2011]
- Sessions' Traumatic Brain Injury Amendment to DOD Appropriations - October 2nd, 2011 [October 2nd, 2011]
- Using Stem Cells for Treatment of TBI | Dr. Charles Cox | Research Trials - October 5th, 2011 [October 5th, 2011]
- Healing brain injuries - October 8th, 2011 [October 8th, 2011]
- Veterans Services at Origami Brain Injury Rehabilitation Center - - October 8th, 2011 [October 8th, 2011]
- Hope Beyond Trauma - October 9th, 2011 [October 9th, 2011]
- Traumatic Brain Injury - Part 3 - by Neurologist Dr. Robert Kohn - October 10th, 2011 [October 10th, 2011]
- Understanding and Improving Vocational Outcomes following Traumatic Brain Injury - Video - October 16th, 2011 [October 16th, 2011]
- LI facility dedicated to Terri Schiavo - Video - October 17th, 2011 [October 17th, 2011]
- Treating Traumatic Brain Injury with Neurotopia - featuring Holden McCray - October 18th, 2011 [October 18th, 2011]
- Brain Injury Survivors: Adriana Villar (Making a Difference: Story 1) - Video - October 21st, 2011 [October 21st, 2011]
- Fabio - brain injury - Video - October 23rd, 2011 [October 23rd, 2011]
- The Latest Developments in Traumatic Brain Injury Treatment - Video - October 25th, 2011 [October 25th, 2011]
- Stem Cell Treatments and Brain Damage Video of MRI of Brain Chambers WWW.STEMCELLREGENMED.COM - Video - October 29th, 2011 [October 29th, 2011]
- Military lags on promising treatment for brain-injured soldiers - Video - November 6th, 2011 [November 6th, 2011]
- Brian Moylan (TBI survivor) talking on treatment from the NHS - Video - November 10th, 2011 [November 10th, 2011]
- Brain Injury Experts at Madonna Rehabilitation Hospital - Video - November 12th, 2011 [November 12th, 2011]
- H200 Hand Rehabilitation System - Testimonials - Clinical Focus - Video - November 13th, 2011 [November 13th, 2011]
- Coping with Brain Injury: Robots and Rehabilitation - Video - November 16th, 2011 [November 16th, 2011]
- Traumatic Brain Injury Rehabilitation using MediTouch HandTutor - Video - November 18th, 2011 [November 18th, 2011]
- Brain Injury Treatment Success | College Station Chiropractor Dr. David Bailey - Video - November 30th, 2011 [November 30th, 2011]
- Hyperbaric Oxygen Therapy (HBOT) corrects brain-injury. - Video - December 7th, 2011 [December 7th, 2011]
- Story of a Traumatic Brain Injury Recovery with Hyperbaric Oxygen (Part1/4) - Video - December 8th, 2011 [December 8th, 2011]
- Hyperbaric Oxygen Therapy Brain Injury - Video - December 10th, 2011 [December 10th, 2011]
- Redwood Extended Care Facility - Brain Injury Services - Video - December 10th, 2011 [December 10th, 2011]
- What If... Brain Injury Rehabilitation - Video - December 17th, 2011 [December 17th, 2011]
- Dangers in Self Medication - Young Adults with Lyme Disease - Leo J. Shea, III, PhD - Video - December 18th, 2011 [December 18th, 2011]
- Reducing Severe Traumatic Brain Injury in the US - Video - December 19th, 2011 [December 19th, 2011]
- Traumatic Brain Injury - Part 8 - Dr. R. Kohn, MD, Neurology - December 21st, 2011 [December 21st, 2011]
- Brain injury rehabilitation using Wii recreational therapy - Video - December 24th, 2011 [December 24th, 2011]
- CNS President/CEO Dr. Mark Ashley discusses how research shapes brain injury rehabilitation - Video - December 29th, 2011 [December 29th, 2011]
- Albert James De Meillon-Traumatic Brain Injury-Part 1 - Video - January 1st, 2012 [January 1st, 2012]
- Hope Beyond Trauma_Janie Smith - Video - January 10th, 2012 [January 10th, 2012]
- Neurofeedback adhd - Video - January 11th, 2012 [January 11th, 2012]
- We are the World, We ARE The Children - Video - January 11th, 2012 [January 11th, 2012]
- New Hopes for Treating Traumatic Brain Injury - Video - January 11th, 2012 [January 11th, 2012]
- NeuroRestorative's Robin Ray Featured on ABC in Southern Illinois - Video - January 13th, 2012 [January 13th, 2012]
- Careers at Origami Brain Injury Rehabilitation Center - Video - January 26th, 2012 [January 26th, 2012]
- Chris Persel discusses what makes CNS a leader in brain injury rehabilitation - Video - January 27th, 2012 [January 27th, 2012]
- Care for catastrophic injuries, spinal cord and traumatic brain injury - Video - January 27th, 2012 [January 27th, 2012]
- Military Tests Pressurized Chamber to Treat TBI - Video - January 27th, 2012 [January 27th, 2012]
- Richmond Traumatic Brain Injury Attorneys Applaud White House Research Initiative Targeting Veterans’ Health Issues - January 28th, 2012 [January 28th, 2012]
- Protect Your Brain...Why? - Video - January 30th, 2012 [January 30th, 2012]