Anthony P. Kontos
by Anthony P. Kontos, PhD
Patients often see a pediatrician or emergency department physician first after a concussion and are usually sent home with the following advice: take an immediate break from physical and cognitive activity (ie, rest completely) and/or gradually ease back into normal activity as symptoms tolerate and seek further care if symptoms persist or worsen.
Our recent findings suggest that this approach, which reflects current consensus, may need to also include advice to seek early care from a concussion specialty clinic. At the University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, we have spent the last 20 years developing and evolving an evidence-based model for concussion care. Our approach is predicated on a clinical profiles model based on a comprehensive assessment and clinical evaluation involving a multidisciplinary team and targeted, active treatments that provide precision care for each patient and each injury.
Immediate care is critical
We believe that people should seek specialty care from a licensed clinician who is trained to evaluate the injury and various domains of concussion symptoms and impairments (vestibular, ocular/vision, cognitive, anxiety/mood, migraine and other factors) as early as possible. Simple strategies like managing sleep and stress, proper hydration and nutrition, and physical activity can help accelerate the pathway to recovery for many patients. In addition, earlier appropriate therapies – such as vestibular or oculomotor therapy – that target specific symptoms and impairments can enhance a patient’s recovery from concussion.
My colleagues and I recently analyzed outcomes for 162 teen and young adult athletes (ages 12 to 22 years) who were diagnosed with a concussion and for whom we had documented full recovery. We found that athletes who sought care within the first week of injury recovered faster than those who sought care later (8 to 21 days) after the injury. Most of the difference between the early and late groups was due to the initial delay, not to injury severity, which was similar between the groups.
We also know that prescribed rest, which has been the predominant therapy for concussed patients, is not necessarily the best approach. In fact, the latest research has shown that patients who are active earlier in the recovery process actually recover sooner than those who rest for prolonged periods (Sufrinko et al., Leddy et al., Thomas et al.). Therefore, physical activity is one of the key components in our approach to treating patients.