Symptom Exacerbation and Adverse Events During a Randomized Trial of Early-Stage Rehabilitation After Sport-Related Concussion: Safety Outcomes From the Active Rehab Study

The state of the science for potential contributors to musculoskeletal injury following concussion: Mechanisms, gaps, and clinical considerations

Concussion is a common mild traumatic brain injury affecting athletic, military, and general populations. While unrestricted medical clearance often occurs within 1-month, emerging evidence indicates prolonged sensorimotor control deficiencies and greater musculoskeletal injury risk after a concussion. Various theoretical frameworks and original studies indicate potential neurophysiological alterations affecting sensory input, sensorimotor integration, and neuromotor output, though the exact mechanisms remain unclear. This commentary aims to briefly review the literature on contributors to sensory and neuromotor deficiencies potentially related to musculoskeletal injury risk, recommend future research avenues to better understand these factors, and highlight current and future clinical applications.

Concussion and the Autonomic, Immune, and Endocrine Systems: An Introduction to the Field and a Treatment Framework for Persisting Symptoms

A significant proportion of patients who sustain a concussion/mild traumatic brain injury endorse persisting, lingering symptoms. The symptoms associated with concussion are nonspecific, and many other medical conditions present with similar symptoms. Medical conditions that overlap symptomatically with concussion include anxiety, depression, insomnia, chronic pain, chronic fatigue, fibromyalgia, and cervical strain injuries. One of the factors that may account for these similarities is that these conditions all present with disturbances in the optimal functioning of the autonomic nervous system and its intricate interactions with the endocrine system and immune system-the three primary regulatory systems in the body. When clinicians are working with patients presenting with persisting symptoms after concussion, evidence-based treatment options drawn from the literature are limited. We present a framework for the assessment and treatment of persisting symptoms following concussion based on the available evidence (treatment trials), neuroanatomical principles (research into the physiology of concussion), and clinical judgment. We review the research supporting the premise that behavioral interventions designed to stabilize and optimize regulatory systems in the body following injury have the potential to reduce symptoms and improve functioning in patients. Foundational concussion rehabilitation strategies in the areas of sleep stabilization, fatigue management, physical exercise, nutrition, relaxation protocols, and behavioral activation are outlined along with practical strategies for implementing intervention modules with patients.