New recommendations for return to activity after concussion in military personnel

Expert guidance appears in annual military TBI issue of Journal of Head Trauma Rehabilitation

January 8, 2015 - Military service members with mild traumatic brain injury (mTBI), or concussion, should follow a six-step process of progressive activity, leading to return to active duty, according to new clinical recommendations by an expert panel. The guidance appears in the January-February issue of The Journal of Head Trauma Rehabilitation, official journal of the Brain Injury Association of America, an annual special issue devoted to new research on TBI in the military. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The new guidance includes specific recommendations for rest and activity, based on minimal or absent symptoms at each stage of the progression. The clinical recommendations were developed by a Progressive Activity Working Group established by the Defense and Veterans Brain Injury Center (DVBIC).

Specific Guidance for Return to Activity after Military mTBI

The Working Group consisted of Department of Defense representatives across all service branches and from the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, as well as other experts with experience assessing military patients with mTBI. The lead author was Karen L. McCulloch, PT, PhD, NCS, of University of North Carolina-Chapel Hill.

Based on current evidence and expert opinion, the recommendations seek to update previous guidelines, which were based largely on studies of sports-related concussions. "Although service members share similarities with athletes," Dr McCulloch and the Working Group write, "guidance for sports-related concussion is not always relevant to military contexts and does not incorporate the complexities of military demands, decision making under stressful conditions, and multitasking in extreme environments."

A 24-hour recovery period is mandated for all service members with mTBI following a first concussion, and longer recovery periods for second or third injuries. If a service member is free from symptoms at rest but develops symptoms after initial activity testing, the progressive return to activity guidance should be followed.

The recommendations describe a six-step process, progressing from rest, to light routine activity, to light occupation-oriented activity, to moderate, intensive, and unrestricted activity. Each stage lasts at least 24 hours, with specific types of activities prescribed.

Activity Increased Progressively--Depending on Symptoms

Patients cannot proceed to the next step in the progression if they develop symptoms: pain or other physical symptoms, affective (mood) symptoms, cognitive (thinking) symptoms, or balance/vestibular symptoms. If any of these occur, patients return to the previous stage of activity that they were able to tolerate without symptoms.

See original here:
New recommendations for return to activity after concussion in military personnel