The Right Balance
The DVBIC is in the process of updating its progressive return to activities, or PRA, guidelines based on the new research and clinician feedback, Gregory noted.
The center offers training to providers and a third study by the group found “a more gradual increase in activity among those with PRA-CR-trained providers, along with a greater decrease in symptoms, within one week post-injury. Further, patients with atypical symptoms at the acute stage of concussion whose providers had the PRA-CR had their symptoms normalized by one week post-concussion compared to patients whose providers did not have the PRA-CR training,” she said.
Overall, “it’s important that appropriate rest is emphasized during the acute stages of concussion and equally important that gradual increase in activity level be introduced as soon as symptoms allow,” Gregory said. “Further, providers, along with patients themselves, have a key role in being able to monitor and prescribe the progression of activity level, but also the type of activity (with physical and vestibular/balance activities being the focus) as concentrating on total activities in general may overlook the impact of focusing rehabilitation efforts on these specific types of activities.”
- Remigio-Baker RA, Bailie JM, Gregory E, Cole WR, McCulloch KL, Cecchini A, Stuessi K, Andrews TR, Mullins L, Ettenhofer ML. Activity Level During Acute Concussion May Predict Symptom Recovery Within an Active Duty Military Population. J Head Trauma Rehabil. 2019 Jun 25. [Epub ahead of print].
- Remigio-Baker RA, Bailie JM, Gregory E, et al. Activity Level and Type During Post-acute Stages of Concussion May Play an Important Role in Improving Symptoms Among an Active Duty Military Population. Front Neurol. 2019;10:602. Published 2019 Jun 19.
- Bazarian, JJ, McClung, J, Shah, MN, Cheng, YT, Flesher, W, Kraus, J. Mild traumatic brain injury in the United States, 1998-2000. Brain Injury. 2005. 19(2):85-91.