Prolonged Activity Restriction After Concussion

Abstract

The current treatment of concussion or mild traumatic brain injury (mTBI) is primarily based on expert consensus. Most clinical practice guidelines advise cognitive and physical rest after injury including withdrawal from normal life activities such as school attendance, sports participation, and technology use until symptoms resolve. Some individuals who sustain an mTBI experience persistent physical, cognitive, and mental health problems. Activity restriction itself may contribute to protracted recovery and other complications. Williamson's Activity Restriction Model of Depression, formulated more than 20 years ago, is central to this hypothesis. We review research evidence for potential harms of prolonged activity restriction and report an mTBI case as an example of how an "activity restriction cascade" can unfold. According to this model, psychological consequences of removal from validating life activities, combined with physical deconditioning, contribute to the development and persistence of postconcussive symptoms after mTBI in some youth. A modification to mTBI guidelines that emphasizes prompt reengagement in life activities as tolerated is encouraged.

Physical Activity and Intermittent Postconcussion Symptoms After a Period of Symptom-Limited Physical and Cognitive Rest

“…3 In these cases, the risks of prolonged rest are of great interest to treating clinicians. Patients who remain symptomatic with rest may have postconcussive disorder or postconcussion syndrome.…”

“…4 For these patients, prolonged rest may result in physical deconditioning, absence from normal life activities, and mental health degeneration. 3 These patients, who normally live an active lifestyle and are told to discontinue their usual activities for prolonged periods of time, can experience withdrawal, lethargy, and other symptoms of depression that closely mimic the symptoms of concussion. 3 They may actually benefit from light activity, which has been shown to improve patients with depression.…”

“…3 These patients, who normally live an active lifestyle and are told to discontinue their usual activities for prolonged periods of time, can experience withdrawal, lethargy, and other symptoms of depression that closely mimic the symptoms of concussion. 3 They may actually benefit from light activity, which has been shown to improve patients with depression. 3 Also, patients who have a mental illness before sustaining a concussion may experience longer-duration symptoms than patients who did not have a mental illness before the concussion.…”

“…3 They may actually benefit from light activity, which has been shown to improve patients with depression. 3 Also, patients who have a mental illness before sustaining a concussion may experience longer-duration symptoms than patients who did not have a mental illness before the concussion. 3 Because the symptoms of mental illness often closely resemble the symptoms of concussion, prolonged rest may not always be the most appropriate course of treatment for patients who do not follow the normal timeline in resolution of symptoms.…”

“…3 Also, patients who have a mental illness before sustaining a concussion may experience longer-duration symptoms than patients who did not have a mental illness before the concussion. 3 Because the symptoms of mental illness often closely resemble the symptoms of concussion, prolonged rest may not always be the most appropriate course of treatment for patients who do not follow the normal timeline in resolution of symptoms. For these reasons, the investigation of alternative interventions for patients with prolonged symptoms is important to give treating clinicians the tools to care for these patients.…”