From Rest to Rehabilitation: Are We Treating Concussions the Right Way?

Brain injuries are complex and often misunderstood. For decades, the medical approach to concussions was unchanged, and the typical treatment was simple: total rest until the symptoms disappeared. This approach stemmed from a rudimentary understanding of concussions, which are symptoms of traumatic brain injuries (TBI), as a “bruise to the brain”, instead of a complex neurological event that affects the brain’s functioning in profound and mysterious ways.

This stagnant approach persists even today, despite a growing body of research suggesting the brain recovers more effectively by being gradually and carefully reintegrated into the activities of life, rather than from total sensory deprivation and isolation.

The Role of Emerging Research

A report published in 2018 found that more than half of patients with concussions—millions a year in the United States, according to the Centers for Disease Control and Prevention (CDC)—leave the doctor’s office without evidence-based information or referrals to specialists. Instead, most are told to avoid all noise, sound, and activity possible for as long as symptoms persist. This could be for days, weeks, months. Some symptoms may never resolve completely.

Fortunately, the scientific community has begun to question the efficacy of this “total rest” approach. Studies have demonstrated that patients engaging in light physical exercise and cognitive activities soon after injury tend to recover faster than those who did not.  

The common perception of concussions as a “bruise to the brain” is not just outdated, but misleading. Instead, a concussion involves a cascade of changes to the signaling cells of the brain, called neurons. This can be visualized as shaking Jell-O in a mold: instead of sloshing like a liquid inside the skull, the movement causes the “Jell-O” to warp, stretching and fraying the neurons. This damages the neurons’ ability to transmit signals within the brain, and can lead to symptoms like confusion, memory loss, and disorientation.

Over time, however, the brain attempts to adapt by rerouting signals through different, undamaged neurons. This is not unlike redirecting traffic around a roadblock, instead of halting traffic completely. Though the process is often physically taxing, leading to exhaustion and headaches, total rest and sensory deprivation can actually hinder the process. Instead, a more active approach to recovery can encourage the recovery of the brain’s functions.

This “active rehabilitation” approach, advocated by the most recent Consensus Statement on Concussion in Sport, represents an important shift in medicine. It encourages patients to engage in controlled therapeutic activities, which stimulate the brain and promote recovery, and contrasts sharply with the older “cocooning” method, which actually may prolong symptoms by months. Additionally, a lack of mental stimulation may contribute to secondary issues, such as depression and general physical decline.

Frustrated by the lack of progress and the repetitive advice that failed to improve his condition, Conor Gormally, a victim of several severe sports-related concussions during childhood, founded the Concussion Alliance. This organization aims to bridge the gap between the latest scientific research and day-to-day clinical practices by providing resources and education to both patients and healthcare providers.

For example, the Alliance is working to improve medical training regarding concussions by offering continuing education courses, as many medical texts and healthcare providers continue to rely on outdated protocols. To address this misconception, the medical community urgently needs comprehensive educational programs such as this which can equip doctors and private individuals with the most up-to-date knowledge.

Here at the Herd Law Firm, we are proud to fight for drivers, motorcyclists, and seafarers in all types of personal injury claims, including fighting for those who sustain and suffer from traumatic brain injuries. As personal injury attorneys based in northwest Houston, we never waver in our commitment to help our clients and their families when they are injured or killed.

4/18/2024