Appropriate Activities

While restricting activity during the acute phase, particularly for servicemembers with significant post-concussive symptoms, showed benefit in the first study, the second study indicated that increasing the same activities during the post-acute stage could also improve recovery.

The study included 39 servicemembers. Overall, total, cognitive and vestibular symptoms declined significantly between one and three months post-concussion and continued through the sixth month. Symptoms experienced at three and six months did not correlate to the level of symptoms within the first 72 hours, but did vary by activity level one month after injury, “suggesting that the effects of post-acute activity levels on later symptom outcomes were not simply due to pre-existing differences in trajectory of recovery,” the authors wrote.

Physical and vestibular/balance activities had the strongest impact on reducing cognitive and vestibular symptoms at three months. Vestibular/balance activities at one month also correlated to lower total symptoms at three months.

“These findings provide support for the importance of monitoring and managing activity level beyond the acute stage of concussion,” said the authors.

Most people will have returned to pre-injury activity levels at one or three months post-injury, noted Gregory, but the researchers determined that 26.8% of servicemembers still experience significant levels of post-concussive symptoms at three months.

For those who have not returned to full activity, “the kinds of vestibular/balance activities recommended in the post-acute stage of concussion would depend on the stage of recovery of the servicemember,” Gregory said. “Activities can be very limited. such as limiting positions where your head is below your heart (Stage 1) and can proceed in a stepwise manner to taking the stairs (Stage 2) to light walking on uneven terrain or in a narrow hallway (Stage 3) to taking part in agility drills with cutting and quick direction changes (Stage 4) to being able to change positions rapidly (Stage 5) and then eventually being able to engage in unrestricted activities (Stage 6).”

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