Rehabilitation of Concussion and Post-concussion Syndrome

Sports Health

Volumn 4, Issue 2, 2012, Pages 147-154

  Leddy, John J ^a   Sandhu, Harkeet ^a   Sodhi, Vikram ^a   Baker, John G ^a   Willer, Barry ^b  

^a Department of Orthopaedics and the Sports Medicine Institute ^*  (United States)

^b UNIVERSITY AT BUFFALO   (United States)

Author keywords

cognitive behavioral therapy; concussion; physiology; post concussion syndrome; rehabilitation

Indexed keywords

EID: 84857669716     PISSN: 19417381     EISSN: 19410921     Source Type: Journal    
DOI: 10.1177/1941738111433673     Document Type: Review

References (118)

1. Agrawal D,Gowda NK,Bal CS,Pant M,Mahapatra AK.Is medial temporal injury responsible for pediatric postconcussion syndrome? A prospective controlled study with single-photon emission computerized tomography.J Neurosurg. 2005;102 2:167-171.
2. Al Sayegh A,Sandford D,Carson AJ.Psychological approaches to treatment of postconcussion syndrome: a systematic review.J Neurol Neurosurg Psychiatry. 2010;81 (10): 1128-1134.
3. Alsalaheen BA,Mucha A,Morris LO, et al.Vestibular rehabilitation for dizziness and balance disorders after concussion.J Neurol Phys Ther. 2010;34 (2): 87-93.
4. Arciniegas DB,Topkoff JL.Applications of the P50 evoked response to the evaluation of cognitive impairments after traumatic brain injury.Phys Med Rehabil Clin N Am. 2004;15 (1): 177-203.
5. Baldwin SA,Fugaccia I,Brown DR,Brown LV,Scheff SW.Blood-brain barrier breach following cortical contusion in the rat.J Neurosurg. 1996;85 (3): 476-481.
6. Barde YA.Trophic factors and neuronal survival.Neuron. 1989;2 (6): 1525-1534.
7. Bazarian JJ,Atabaki S.Predicting postconcussion syndrome after minor traumatic brain injury.Acad Emerg Med. 2001;8 (8): 788-795.
8. Belanger HG,Vanderploeg RD.The neuropsychological impact of sports-related concussion: a meta-analysis.J Int Neuropsychol Soc. 2005;11 (4): 345-357.
9. Bergsneider M,Hovda DA,Lee SM, et al.Dissociation of cerebral glucose metabolism and level of consciousness during the period of metabolic depression following human traumatic brain injury.J Neurotrauma. 2000;17 (5): 389-401.
10. Bergsneider M,Hovda DA,Shalmon E, et al.Cerebral hyperglycolysis following severe traumatic brain injury in humans: a positron emission tomography study.J Neurosurg. 1997;86 (2): 241-251.
11. Berlin AA,Kop WJ,Deuster PA.Depressive mood symptoms and fatigue after exercise withdrawal: the potential role of decreased fitness.Psychosom Med. 2006;68 (2): 224-230.
12. Binder LM,Rohling ML,Larrabee GJ.A review of mild head trauma: part I Meta-analytic review of neuropsychological studies.J Clin Exp Neuropsychol. 1997;19 (3): 421-431.
13. Boake C,McCauley SR,Levin HS, et al.Diagnostic criteria for postconcussional syndrome after mild to moderate traumatic brain injury.J Neuropsychiatry Clin Neurosci. 2005;17 (3): 350-356.
14. Broglio SP,Ferrara MS,Macciocchi SN,Baumgartner TA,Elliott R.Test-retest reliability of computerized concussion assessment programs.J Athl Train. 2007;42 (4): 509-514.
15. Cantu RC.Second-impact syndrome.Clin Sports Med. 1998;17 (1): 37-44.
16. Carroll LJ,Cassidy JD,Peloso PM, et al.Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.J Rehabil Med. 2004;43 (suppl): 84-105.
17. Chamelian L,Feinstein A.The effect of major depression on subjective and objective cognitive deficits in mild to moderate traumatic brain injury.J Neuropsychiatry Clin Neurosci. 2006;18 (1): 33-38.
18. Chen JK,Johnston KM,Petrides M,Ptito A.Neural substrates of symptoms of depression following concussion in male athletes with persisting postconcussion symptoms.Arch Gen Psychiatry. 2008;65 (1): 81-89.
19. Cicerone KD.Remediation of "working attention" in mild traumatic brain injury.Brain Inj. 2002;16 (3): 185-195.
20. Del Percio C,Babiloni C,Marzano N, et al."Neural efficiency" of athletes' brain for upright standing: a high-resolution EEG study.Brain Res Bull. 2009;79 (3-4): 193-200.
21. Dimberg EL,Burns TM.Management of common neurologic conditions in sports.Clin Sports Med. 2005;24 (3): 637-662.
22. Dimeo F,Bauer M,Varahram I,Proest G,Halter U.Benefits from aerobic exercise in patients with major depression: a pilot study.Br J Sports Med. 2001;35 (2): 114-117.
23. Endo K,Ichimaru K,Komagata M,Yamamoto K.Cervical vertigo and dizziness after whiplash injury.Eur Spine J. 2006;15 (6): 886-890.
24. Enevoldsen EM,Jensen FT.Autoregulation and CO2 responses of cerebral blood flow in patients with acute severe head injury.J Neurosurg. 1978;48 (5): 689-703.
25. Fann JR,Uomoto JM,Katon WJ.Sertraline in the treatment of major depression following mild traumatic brain injury.J Neuropsychiatry Clin Neurosci. 2000;12 (2): 226-232.
26. Friedman JM.Post-traumatic vertigo.Med Health R I. 2004;87 (10): 296-300.
27. Gaetz M,Weinberg H.Electrophysiological indices of persistent post-concussion symptoms.Brain Inj. 2000;14 (9): 815-832.
28. Gagnon I,Galli C,Friedman D,Grilli L,Iverson GL.Active rehabilitation for children who are slow to recover following sport-related concussion.Brain Inj. 2009;23 (12): 956-964.
29. Gall B,Parkhouse W,Goodman D.Heart rate variability of recently concussed athletes at rest and exercise.Med Sci Sports Exerc. 2004;36 (8): 1269-1274.
30. Gall B,Parkhouse WS,Goodman D.Exercise following a sport induced concussion.Br J Sports Med. 2004;38 (6): 773-777.
31. Gebke KB.Mild traumatic brain injury.Curr Sports Med Rep. 2002;1 (1): 23-27.
32. Giza CC,Hovda DA.The neurometabolic cascade of concussion.J Athl Train. 2001;36 (3): 228-235.
33. Golding EM,Robertson CS,Bryan RM.The consequences of traumatic brain injury on cerebral blood flow and autoregulation: a review.Clin Exp Hypertens. 1999;21 (4): 299-332.
34. Golding EM,Steenberg ML,Contant CF,Krishnappa I,Robertson CS,Bryan RM.Cerebrovascular reactivity to CO(2) and hypotension after mild cortical impact injury.Am J Physiol. 1999;277 (4): H1457-H1466.
35. Goldstein B,Toweill D,Lai S,Sonnenthal K,Kimberly B.Uncoupling of the autonomic and cardiovascular systems in acute brain injury.Am J Physiol. 1998;275 (4): R1287-R1292.
36. Gray TS. Autonomic neuropeptide connections of the amygdala. In: Tahe Y, Morley JE, Brown MR, eds. Neuropeptides and Stress. Berlin, Germany: Springer-Verlag; 1989:92-105.
37. Griesbach GS,Gomez-Pinilla F,Hovda DA.The upregulation of plasticity-related proteins following TBI is disrupted with acute voluntary exercise.Brain Res. 2004;1016 (2): 154-162.
38. Griesbach GS,Hovda DA,Molteni R,Wu A,Gomez-Pinilla F.Voluntary exercise following traumatic brain injury: brain-derived neurotrophic factor upregulation and recovery of function.Neuroscience. 2004;125 (1): 129-139.
39. Griffin SL,van Reekum R,Masanic C.A review of cholinergic agents in the treatment of neurobehavioral deficits following traumatic brain injury.J Neuropsychiatry Clin Neurosci. 2003;15 (1): 17-26.
40. Guskiewicz KM.Assessment of postural stability following sport-related concussion.Curr Sports Med Rep. 2003;2 (1): 24-30.
41. Guskiewicz KM,Marshall SW,Bailes J, et al.Association between recurrent concussion and late-life cognitive impairment in retired professional football players.Neurosurgery. 2005;57 (4): 719-726.
42. Guskiewicz KM,Marshall SW,Bailes J, et al.Recurrent concussion and risk of depression in retired professional football players.Med Sci Sports Exerc. 2007;39 (6): 903-909.
43. Guskiewicz KM,McCrea M,Marshall SW, et al.Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study.JAMA. 2003;290 (19): 2549-2555.
44. Hamilton MT,Hamilton DG,Zderic TW.Exercise physiology versus inactivity physiology: an essential concept for understanding lipoprotein lipase regulation.Exerc Sport Sci Rev. 2004;32 (4): 161-166.
45. Hanna-Pladdy B,Berry ZM,Bennett T,Phillips HL,Gouvier WD.Stress as a diagnostic challenge for postconcussive symptoms: sequelae of mild traumatic brain injury or physiological stress response.Clin Neuropsychol. 2001;15 (3): 289-304.
46. Heitger MH,Jones RD,Macleod AD,Snell DL,Frampton CM,Anderson TJ.Impaired eye movements in post-concussion syndrome indicate suboptimal brain function beyond the influence of depression, malingering or intellectual ability.Brain. 2009;132 (pt 10): 2850-2870.
47. Helmick K.Cognitive rehabilitation for military personnel with mild traumatic brain injury and chronic post-concussional disorder: results of April 2009 consensus conference.NeuroRehabilitation. 2010;26 (3): 239-255.
48. Hicks RR,Smith DH,Lowenstein DH,Saint Marie R,McIntosh TK.Mild experimental brain injury in the rat induces cognitive deficits associated with regional neuronal loss in the hippocampus.J Neurotrauma. 1993;10 (4): 405-414.
49. Ho MR,Bennett TL.Efficacy of neuropsychological rehabilitation for mild-moderate traumatic brain injury.Arch Clin Neuropsychol. 1997;12 (1): 1-11.
50. Hovda DA,Lee SM,Smith ML, et al.The neurochemical and metabolic cascade following brain injury: moving from animal models to man.J Neurotrauma. 1995;12 (5): 903-906.
51. Hovda DA,Yoshino A,Kawamata T,Katayama Y,Becker DP.Diffuse prolonged depression of cerebral oxidative metabolism following concussive brain injury in the rat: a cytochrome oxidase histochemistry study.Brain Res. 1991;567 (1): 1-10.
52. Iverson GL.Misdiagnosis of the persistent postconcussion syndrome in patients with depression.Arch Clin Neuropsychol. 2006;21 (4): 303-310.
53. Iverson GL,Gaetz M,Lovell MR,Collins MW.Cumulative effects of concussion in amateur athletes.Brain Inj. 2004;18 (4): 1.
54. Iverson GL,Gaetz M,Lovell MR,Collins MW.Cumulative effects of concussion in amateur athletes.Brain Inj. 2004;18 (5): 433-443.
55. Johnston KM,McCrory P,Mohtadi NG,Meeuwisse W.Evidence-based review of sport-related concussion: clinical science.Clin J Sport Med. 2001;11 (3): 150-159.
56. Junger EC,Newell DW,Grant GA, et al.Cerebral autoregulation following minor head injury.J Neurosurg. 1997;86 (3): 425-432.
57. Katayama Y,Becker DP,Tamura T,Hovda DA.Massive increases in extracellular potassium and the indiscriminate release of glutamate following concussive brain injury.J Neurosurg. 1990;73 (6): 889-900.
58. Kawamata T,Katayama Y,Hovda DA,Yoshino A,Becker DP.Administration of excitatory amino acid antagonists via microdialysis attenuates the increase in glucose utilization seen following concussive brain injury.J Cereb Blood Flow Metab. 1992;12 (1): 12-24.
59. King ML,Lichtman SW,Seliger G,Ehert FA,Steinberg JS.Heart-rate variability in chronic traumatic brain injury.Brain Inj. 1997;11 (6): 445-453.
60. Korn A,Golan H,Melamed I,Pascual-Marqui R,Friedman A.Focal cortical dysfunction and blood-brain barrier disruption in patients with postconcussion syndrome.J Clin Neurophysiol. 2005;22 (1): 1-9.
61. Kristjansson E,Treleaven J.Sensorimotor function and dizziness in neck pain: implications for assessment and management.J Orthop Sports Phys Ther. 2009;39 (5): 364-377.
62. Kutcher JS,Eckner JT.At-risk populations in sports-related concussion.Curr Sports Med Rep. 2010;9 (1): 16-20.
63. Langlois JA,Rutland-Brown W,Wald MM.The epidemiology and impact of traumatic brain injury: a brief overview.J Head Trauma Rehabil. 2006;21 (5): 375-378.
64. Lau B,Lovell MR,Collins MW,Pardini J.Neurocognitive and symptom predictors of recovery in high school athletes.Clin J Sport Med. 2009;19 (3): 216-221.
65. Leddy JJ,Baker JG,Kozlowski K,Bisson L,Willer B.Reliability of a graded exercise test for assessing recovery from concussion.Clin J Sport Med. 2011;21 (2): 89-94.
66. Leddy JJ,Kozlowski K,Donnelly JP,Pendergast DR,Epstein LH,Willer B.A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome.Clin J Sport Med. 2010;20 (1): 21-27.
67. Leddy JJ,Kozlowski K,Fung M,Pendergast DR,Willer B.Regulatory and autoregulatory physiological dysfunction as a primary characteristic of post concussion syndrome: Implications for treatment.Neurorehabilitation. 2007;22 (3): 199-205.
68. Levin HS,Mattis S,Ruff RM, et al.Neurobehavioral outcome following minor head injury: a three-center study.J Neurosurg. 1987;66 (2): 234-243.
69. Levy M,Koeppen B,Stanton BBerne and Levy Principles of Physiology. Philadelphia, PA: Elsevier Mosby; 2006:.
70. Longhi L,Saatman KE,Fujimoto S, et al.Temporal window of vulnerability to repetitive experimental concussive brain injury.Neurosurgery. 2005;56 (2): 364-374.
71. Lovell MR,Collins MW,Iverson GL, et al.Recovery from mild concussion in high school athletes.J Neurosurgery. 2003;98 (2): 296-301.
72. Luis CA,Vanderploeg RD,Curtiss G.Predictors of postconcussion symptom complex in community dwelling male veterans.J Int Neuropsychol Soc. 2003;9 (7): 1001-1015.
73. Majerske CW,Mihalik JP,Ren D, et al.Concussion in sports: postconcussive activity levels, symptoms, and neurocognitive performance.J Athl Train. 2008;43 (3): 265-274.
74. McCauley SR,Boake C,Levin HS,Contant CF,Song JX.Postconcussional disorder following mild to moderate traumatic brain injury: anxiety, depression, and social support as risk factors and comorbidities.J Clin Exp Neuropsychol. 2001;23 (6): 792-808.
75. McCrea M,Guskiewicz KM,Marshall SW, et al.Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study.JAMA. 2003;290 (19): 2556-2563.
76. McCrory P.Does second impact syndrome exist?.Clin J Sport Med. 2001;11 (3): 144-149.
77. McCrory P, Johnston K, Meeuwisse W, et al. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Clin J Sport Med. 2005;15(2):48-55.
78. McCrory P,Johnston KM,Mohtadi NG,Meeuwisse W.Evidence-based review of sport-related concussion: basic science.Clin J Sport Med. 2001;11 (3): 160-165.
79. McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport: 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Clin J Sport Med. 2009;19(3):185-200.
80. Mittenberg W,Canyock EM,Condit D,Patton C.Treatment of post-concussion syndrome following mild head injury.J Clin Exp Neuropsychol. 2001;23 (6): 829-836.
81. Mittenberg W,Tremont G,Zielinski RE,Fichera S,Rayls KR.Cognitive-behavioral prevention of postconcussion syndrome.Arch Clin Neuropsychol. 1996;11 (2): 139-145.
82. Napadow V,Dhond R,Conti G,Makris N,Brown EN,Barbieri R.Brain correlates of autonomic modulation: combining heart rate variability with fMRI.Neuroimage. 2008;42 (1): 169-177.
83. Nilsson P,Hillered L,Ponten U,Ungerstedt U.Changes in cortical extracellular levels of energy-related metabolites and amino acids following concussive brain injury in rats.J Cereb Blood Flow Metab. 1990;10 (5): 631-637.
84. Ommaya AK,Gennarelli TA.Cerebral concussion and traumatic unconsciousness: correlation of experimental and clinical observations of blunt head injuries.Brain. 1974;97 (4): 633-654.
85. Oppenheimer DR.Microscopic lesions in the brain following head injury.J Neurol Neurosurg Psychiatry. 1968;31 (4): 299-306.
86. Palmese CA,Raskin SA.The rehabilitation of attention in individuals with mild traumatic brain injury, using the APT-II programme.Brain Inj. 2000;14 (6): 535-548.
87. Peterson CL,Ferrara MS,Mrazik M,Piland S,Elliott R.Evaluation of neuropsychological domain scores and postural stability following cerebral concussion in sports.Clin J Sport Med. 2003;13 (4): 230-237.
88. Pomeranz B,Macaulay RJ,Caudill MA, et al.Assessment of autonomic function in humans by heart rate spectral analysis.Am J Physiol. 1985;248 (1): H151-H153.
89. Ponsford J,Willmott C,Rothwell A, et al.Cognitive and behavioral outcome following mild traumatic head injury in children.J Head Trauma Rehabil. 1999;14 (4): 360-372.
90. Ponsford J,Willmott C,Rothwell A, et al.Factors influencing outcome following mild traumatic brain injury in adults.J Int Neuropsychol Soc. 2000;6 (5): 568-579.
91. Ponsford J,Willmott C,Rothwell A, et al.Impact of early intervention on outcome after mild traumatic brain injury in children.Pediatrics. 2001;108 (6): 1297-1303.
92. Ponsford J,Willmott C,Rothwell A, et al.Impact of early intervention on outcome following mild head injury in adults.J Neurol Neurosurg Psychiatry. 2002;73 (3): 330-332.
93. Preiss-Farzanegan SJ,Chapman B,Wong TM,Wu J,Bazarian JJ.The relationship between gender and postconcussion symptoms after sport-related mild traumatic brain injury.PM R. 2009;1 (3): 245-253.
94. Randolph C,McCrea M,Barr WB.Is neuropsychological testing useful in the management of sport-related concussion?.J Athl Train. 2005;40 (3): 139-152.
95. Rimel RW,Giordani B,Barth JT,Boll TJ,Jane JA.Disability caused by minor head injury.Neurosurgery. 1981;9 (3): 221-228.
96. Rohling ML,Faust ME,Beverly B,Demakis G.Effectiveness of cognitive rehabilitation following acquired brain injury: a meta-analytic re-examination of Cicerone et al's (2000, 2005) systematic reviews.Neuropsychology. 2009;23 (1): 20-39.
97. Saija A,Hayes RL,Lyeth BG,Dixon CE,Yamamoto T,Robinson SE.The effect of concussive head injury on central cholinergic neurons.Brain Res. 1988;452 (1-2): 303-311.
98. Sano K,Yoshioka M,Ogashiwa M, et al.Autonomic, somatomotor and electroencephalographic responses upon stimulation of the hypothalamus and the rostral brain stem in man.Confin Neurol. 1967;29 (2): 257-261.
99. Schneider HJ,Kreitschmann-Andermahr I,Ghigo E,Stalla GK,Agha A.Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review.JAMA. 2007;298 (12): 1429-1438.
100. Segalowitz SJ,Mahaney P,Santesso DL,MacGregor L,Dywan J,Willer B.Retest reliability in adolescents of a computerized neuropsychological battery used to assess recovery from concussion.NeuroRehabilitation. 2007;22 (3): 243-251.
101. Shetter AG,Demakas JJ.The pathophysiology of concussion: a review.Adv Neurol. 1979;22:5-14.
102. Stalnacke BM,Bjornstig U,Karlsson K,Sojka P.One-year follow-up of mild traumatic brain injury: post-concussion symptoms, disabilities and life satisfaction in relation to serum levels of S-100B and neurone-specific enolase in acute phase.J Rehabil Med. 2005;37 (5): 300-305.
103. Strebel S,Lam AM,Matta BF,Newell DW.Impaired cerebral autoregulation after mild brain injury.Surg Neurol. 1997;47 (2): 128-131.
104. Taylor AR.Post-concussional sequelae.Br Med J. 1967;3 (5557): 67-71.
105. Taylor AR,Bell TK.Slowing of cerebral circulation after concussional head injury: a controlled trial.Lancet. 1966;2 (7456): 178-180.
106. Teasdale TW,Engberg A.Duration of cognitive dysfunction after concussion, and cognitive dysfunction as a risk factor: a population study of young men.BMJ. 1997;315 (7108): 569-572.
107. Thomas M,Haas TS,Doerer JJ, et al.Epidemiology of sudden death in young, competitive athletes due to blunt trauma.Pediatrics. 2011;128 (1): e1-e8.
108. Tiersky LA,Anselmi V,Johnston MV, et al.A trial of neuropsychologic rehabilitation in mild-spectrum traumatic brain injury.Arch Phys Med Rehabil. 2005;86 (8): 1565-1574.
109. Treleaven J,Jull G,Sterling M.Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error.J Rehabil Med. 2003;35 (1): 36-43.
110. Tyler GS,McNeely HE,Dick ML.Treatment of post-traumatic headache with amitriptyline.Headache. 1980;20 (4): 213-216.
111. Vagnozzi R,Signoretti S,Cristofori L, et al.Assessment of metabolic brain damage and recovery following mild traumatic brain injury: a multicentre, proton magnetic resonance spectroscopic study in concussed patients.Brain. 2010;133 (11): 3232-3242.
112. Vagnozzi R,Signoretti S,Tavazzi B, et al.Temporal window of metabolic brain vulnerability to concussion: a pilot 1H-magnetic resonance spectroscopic study in concussed athletes. Part III.Neurosurgery. 2008;62 (6): 1286-1295.
113. van Ravenswaaij-Arts CM,Kollee LA,Hopman JC,Stoelinga GB,van Geijn HP.Heart rate variability.Ann Intern Med. 1993;118 (6): 436-447.
114. Wade DT,King NS,Wenden FJ,Crawford S,Caldwell FE.Routine follow up after head injury: a second randomised controlled trial.J Neurol Neurosurg Psychiatry. 1998;65 (2): 177-183.
115. Ward AA.The physiology of concussion.Clin Neurosurg. 1964;12:95-111.
116. Wilde EA,McCauley SR,Hunter JV, et al.Diffusion tensor imaging of acute mild traumatic brain injury in adolescents.Neurology. 2008;70 (12): 948-955.
117. Willer B,Leddy JJ.Management of concussion and post-concussion syndrome.Curr Treat Options Neurol. 2006;8 (5): 415-426.
118. Yamaki T,Murakami N,Iwamoto Y, et al.Cognitive dysfunction and histological findings in rats with chronic-stage contusion and diffuse axonal injury.Brain Res Brain Res Protoc. 1998;3 (1): 100-106.