title: Challenges in Determining the Role of Rest and Exercise in the Management of Mild Traumatic Brain Injury.
abstract: Current consensus guidelines recommending physical and cognitive rest until a patient is asymptomatic after a sports concussion (ie, a mild traumatic brain injury) are being called into question, particularly for patients who are slower to recover and in light of preclinical and clinical research demonstrating that exercise aids neurorehabilitation. The pathophysiological response to mild traumatic brain injury includes a complex neurometabolic cascade of events resulting in a neurologic energy deficit. It has been proposed that this energy deficit leads to a period of vulnerability during which the brain is at risk for additional injury, explains why early postconcussive symptoms are exacerbated by cognitive and physical exertion, and is used to rationalize absolute rest until all symptoms have resolved. However, at some point, rest might no longer be beneficial and exercise might need to be introduced. At both extremes, excessive exertion and prolonged avoidance of exercise (physical and mental) have negative consequences. Individuals who have experienced a concussion need guidance for avoidance of triggers of severe symptoms and a plan for graduated exercise to promote recovery as well as optimal functioning (physical, educational, and social) during the postconcussion period.
authors: Department of Neurology, Children's National Medical Center, George Washington School of Medicine, Washington, DC, USA EWells@childrensnational.org.
authors: Elizabeth M
authors: EM
authors: Wells
authors: Departments of Neurology and Pediatrics, UVA Healthsystem, Charlottesville, VA, USA.
authors: Howard P
authors: HP
authors: Goodkin
authors: Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors: Grace S
authors: GS
authors: Griesbach
mesh_terms: D001930:Brain Injuries / Q000503:physiopathology* / Q000628:therapy*; D019468:Disease Management; D015444:Exercise / Q000502:physiology*; D006801:Humans; D012146:Rest
keywords: concussion; rest; subthreshold exercise