Progress in Concussion Rehabilitation

Knowledge around concussion and brain injury recovery and rehabilitation is making promising progress; however, challenges remain in driving progress and innovation in clinical practice.

Every field of clinical practice faces the challenges of keeping up to date with the latest clinical evidence and implementation of a change in practice usually takes a frustratingly long time! Concussion research and practice is also further challenged by the complex nature of brain impairments that involve many clinical specialities from the areas of neurology, neuropsychology, sport, and vestibular clinical practice, just to name a few. If rehabilitation is to progress, these clinical specialities will need to communicate and collaborate effectively. That is no easy task, with differences in terminology, experience, locations, and expertise making collaborative work very challenging.

A new review article ‘Concussion Rehabilitation and the Application of Ten Movement Training Principles’ has been recently published and was written by our Co-Director, Associate Professor James McLoughlin. It encourages a common language that can help categorise and review progress in relation to key rehabilitation principles. This article will keep you well up to date in the latest development in concussion rehabilitation and hopefully support future collaborations and innovations for rapid progress. This fits with our motto at Your Brain Health

“Better information leads to better decision making and ultimately better outcomes.”

Movement training principle Factors to consider in concussion rehabilitation
Actual and predicted bodily state Body schema. Spatial cognition. Cervical joint position sense errors
Feedback Visual and vestibular feedback dependence. Sensory reweighting.
Integration and perceptual dysfunction. Overemphasis on symptom reporting
Error-based learning Gaze stability and balance training. Vision training
Reward-based learning Behavioural changes. Motivations and pressures. Managing expectations
Cognitive selection and planning Memory and concentration changes. Executive dysfunction. Cognitive adaptations, loads, and fatigue. Slowed processing speed. Difficulty with increasing complexity
Practice and variability Time for learning and adaptation. Frequency, intensity, and duration of practice to be effective. Variability and integration of different domains into rehabilitation. Autonomic and cardiovascular limitations. Prescribed rests/breaks
Biomechanics Forces for brain damage and cervical whiplash injury. Prevention via protective gear. Prevention via motor skill training. Motor control and muscle compensations. Post-traumatic benign paroxysmal positional vertigo (BPPV)
Physical capacity Detrimental rest. Autonomic dysfunction and postural orthostatic tachycardia syndrome (POTS). Deconditioning. Neck strength and stability
Attentional focus Dual-task challenges. Attention-deficit/hyperactivity disorder (ADHD) and concussion testing. Functional overlay, external focus, and distraction techniques. Overemphasis on symptoms and hypervigilance illness behaviours
Beliefs and self-efficacy Anxiety. Depression. Post-traumatic stress disorder (PTSD).
Psychological flexibility. Negative beliefs and nocebo effects. Community misinformation and messaging