title: Rehabilitation of Concussion and Post-concussion Syndrome.
abstract: BACKGROUND
  Prolonged symptoms after concussion are called post-concussion syndrome (PCS), which is a controversial disorder with a wide differential diagnosis.
  
  
  METHODS
  MEDLINE and PubMed searches were conducted for the years 1966 to 2011 using the search terms brain concussion/complications OR brain concussion/diagnosis OR brain concussion/therapy AND sports OR athletic injuries. Secondary search terms included post-concussion syndrome, trauma, symptoms, metabolic, sports medicine, cognitive behavioral therapy, treatment and rehabilitation. Additional articles were identified from the bibliographies of recent reviews.
  
  
  RESULTS
  Of 564 studies that fulfilled preliminary search criteria, 119 focused on the diagnosis, pathophysiology, and treatment/rehabilitation of concussion and PCS and formed the basis of this review. Rest is the primary treatment for the acute symptoms of concussion. Ongoing symptoms are either a prolonged version of the concussion pathophysiology or a manifestation of other processes, such as cervical injury, migraine headaches, depression, chronic pain, vestibular dysfunction, visual dysfunction, or some combination of conditions. The pathophysiology of ongoing symptoms from the original concussion injury may reflect multiple causes: anatomic, neurometabolic, and physiologic.
  
  
  CONCLUSIONS
  Treatment approaches depend on the clinician's ability to differentiate among the various conditions associated with PCS. Early education, cognitive behavioral therapy, and aerobic exercise therapy have shown efficacy in certain patients but have limitations of study design. An algorithm is presented to aid clinicians in the evaluation and treatment of concussion and PCS and in the return-to-activity decision.
authors.affiliation: Department of Orthopaedics and the Sports Medicine Institute, Buffalo, New York.
authors.forename: John J
authors.initials: JJ
authors.lastname: Leddy
authors.forename: Harkeet
authors.initials: H
authors.lastname: Sandhu
authors.forename: Vikram
authors.initials: V
authors.lastname: Sodhi
authors.forename: John G
authors.initials: JG
authors.lastname: Baker
authors.forename: Barry
authors.initials: B
authors.lastname: Willer