The majority of youth athletes with a sport-related concussion will spontaneously recover quickly following a period of cognitive and physical rest, most within 7 to 10 days [1], in some cases symptoms persist for weeks, months and years beyond the initial injury. [15] If your child is suffering from post-concussion syndrome [2]), then additional therapies may need to be considered.
Although no medicine has been shown in double-blind randomized control trials to effectively speed the recovery from concussive brain injury, many of the symptoms can be treated medically, new therapies are being tested, and some non-traditional therapies have been shown to help some suffering from post-concussion syndrome.
Whatever therapies parents consider for a child with post-concussion syndrome, they need to weigh the potential risks and adverse effects against the likelihood of benefit, and whether they are tailored to address the athlete's most bothersome symptoms, says William P. Meehan, III, MomsTeam's concussion expert emeritus and former Director of the Sports Concussion Clinic in the Division of Sports Medicine at Boston Children's Hospital. In addition, says Dr. Meehan, athletes engaging in these potential therapies should be closely monitored by a clinician experienced in the assessment and management of sport-related concussions or concussive brain injuries in general.
The foundation of postconcussion syndrome management is time. Recovery from PCS can be a long and slow process that is often frustrating for patients and removes them their normal activities, including school and sports. [15] Management is ideally done by a multi-disciplinary team of concussion specialists. [15,16]
Reassurance, discussion of expected recovery time, and compensatory strategies to address difficulties with aspects of cognition, such as attention, memory, and executive functioning can improve symptoms of PCS, according to a recent meta-analysis of the literature. [10] While psychological intervention was found in one study to reduce PCS symptoms at 3 to 6 months after injury, [11] a recent systematic review of psychological intervention for PCS concluded that there was limited evidence of benefit. [10,12] An information booklet on strategies for dealing with posttraumatic symptoms in children resulted in fewer symptoms and less behavioral changes in children 3 months after injury. [10,13]
Noting studies showing the successful use of modified forms of cognitive behavioral therapy in adults with chronic symptoms and problems following mTBI, and a "large and mature literature" showing the effectiveness of psychological treatments in reducing symptoms and improving functioning in adults with depression and generalized anxiety disorder, and the use of behavioral and psychological treatments in improving sleep and reducing psychological distress in people with insomnia, a 2013 study [9] found it "plausible that psychological treatment for athletes who are slow to recover may be of benefit and should be studied more systematically."
Interventions to improve cognition have improved performance on selected neuropsychological test scores and cognitive function following neurocognitive rehabilitation in patients with mild- or mild-to-moderate-TBI. Neurocognitive rehabilitation uses cognitive tasks to improve cognitive processes, or it may involve developing compensatory strategies to address difficulties with aspects of cognition, such as attention, memory, and executive functioning.[10 (citing studies)]
While cognitive and physical rest [3] is often prescribed for concussed athletes in the period immediately after injury, the conventional wisdom among clinicians has been that such rest is of limited use for patients with post-concussion syndrome.
That belief, however, has been brought into question. In a study of concussed high school students reported in the Journal of Pediatricsr [1] researchers, led by MomsTeam concussion expert neuropsychologist Rosemarie Scolaro Moser, Ph D, [4] found that not only did concussed athletes score significantly better on neurocognitive test [5]s and report statistically significant decreases in the number and severity of post- [6]concussion symptoms [6] after a week of strict cognitive and physical rest, but that the beneficial effects of such rest were seen whether such rest came soon after a concussion or weeks to months later.
Indeed, more than a quarter of the sample which continued to experience concussion symptoms past the 31-day mark (defined by some as the point at which post-concussion syndrome is diagnosed) still demonstrated improvements with prescribed rest which were comparable to those experienced by concussed athletes in the study who were still in the early stages of concussion.
"Our results represent the first data documenting the efficacy of prescribed rest for the treatment of post-concussion symptoms and cognitive dysfunction, whether the rest is applied in the early or prolonged stages of recovery," Dr. Moser notes. The idea that cognitive and physical rest may help improve the condition of patients with post-concussion syndrome [2] is [also] noteworthy," she writes, because "there may be a perception among clinicians that once the 7- to 10-day time period in which the neurometabolic "cascade" [2] has passed, and a patient continues to experience concussive symptoms, cognitive and physical rest is of limited use."
That recent research suggests that blood flow to the brain was still reduced [7] in more than a third of 11- to 15-year-olds even at 1 month or more post-concussion, Dr. Moser argues, not only "supports an even longer recovery period than typically thought but is consistent with the notion that a period of rest may be therapeutic" in treating post-concussion syndrome.
It is significant to note that Dr. Moser's study involved 1 week of rest. Prolonged rest, especially in athletes, however, can lead to physical deconditioning, metabolic disturbances, anxiety and stress, irritability, fatigue and mild depression. [9,10] There is no scientific evidence that prolonged rest for more than several weeks in concussed patients is beneficial. [10] In the absence of good scientific evidence, doctors must decide when to transition an athlete from activity restrictions and watchful waiting to more active treatment and rehabilitation, including exercise (see below). [9]
There is very little research evaluating pharmacological treatment following sport-related concussion. [9] There is no scientific evidence that medication speeds recovery from concussion in humans. [10] A wide variety of medications, sush as non-steroidal anti-inflammatories, sleep agents, methylphenidate, antidepressants and anticonvulsants, have been used for persistent headache, sleep problems and other symptoms following mTBI in civilian and military personnel. [9]
In a first-of-its-kind study [3], researchers at the University of Pittsburgh Medical Center recently found that Amantadine - a drug originally developed as a medication to treat or prevent illness caused by the flu virus, and later shown to improve symptoms of Parkinson's disease and cognitive function in patients with serious brain, spinal cord, or nerve-related illnesses and injuries - may be useful in treating adolescents who have not spontaneously recovered from concussion following a period of cognitive and physical rest. [9]
Given 100 mg of amantadine twice daily at breakfast and lunch, a small treatment group of 25 student-athletes (ranging in age from 13 to 19 and with an average age of 15.54 years) who were experiencing persistent neurcognitive deficits and concussion symptoms at 3 to 4 weeks post-injury, reported a significant decrease in reported symptoms and performed better on verbal memory and reaction time on neurocognitive tests compared to a control group of concussed student-athletes with post-concussion syndrome treated conservatively (i.e., rest) and without medication.
The findings "provides tentative support for the efficacy of amantadine as pharmacological treatment for patients who fall outside of the normal recovery trajectory (i.e., more than 3 weeks) following concussion," writes lead author, Cara Camilio Reddy, MD, Director, Brain Injury Program, Department of Physical Medicine and Rehabilitation and Medical Advisor to the Sports Concussion Program in the Department of Orthopedic Surgery at the University of Pittsburgh Medical Center.
"These results highlight one possible treatment for patients with prolonged recovery from concussion," Reddy says, although it "may not be the treatment of choice for all patients with post-concussive symptoms" because "individualized concussion management requires [an] in-depth interview to evaluate the symptoms and to tailor a management plan based upon each individual's symptom profile."
Due to limitations in the study (small sample size, retrospective nature, a non-randomized design resulting in both subjects and clinicians being aware the drug was being used which could have resulted in placebo and experimenter bias), the study authors said the results "should be viewed cautiously" until double-blind randomized control trials of the efficacy of amantadine following concussion in a sufficiently large sample could be conducted to collaborate the study's findings. In addition, as the authors of a recent meta-analysis on the effects of rest and treatment following sport-related concussion [9] note, the individuals in the treatment group were at a lower baseline at the start of the study for verbal memory and visual memory, and they reported more symptoms.
As with all medications, Amantadine has side effects, but is generally well tolerated and is so safe that the current FDA approval for the drug is for use by healthy children during an influenza outbreak, in order to prevent them from getting the flu. It use cannot be stopped abruptly because of the risk of developing malignant hyperthermia, a medical condition that causes painful rigidity of the muscles and high fevers.
Because of a concern for the potential for birth defects in the children of women who are pregnant or who become pregnant while taking Amantadine, careful thought should be given to the potential risks and benefits of taking the drug when deciding whether it should be used to treat concussion.
For an article by a New Jersey mother describing her teenage daughter's successful experience with Amantadine in recovering from post-concussion syndrome, click here [8].
Chiropractic, now considered a branch of mainstream medicine, is best known, of course, for the adjustments DCs do of the vertebra of the neck and back to correct misalignments (subluxation) which irritate the spinal nerves, reducing muscle strength and setting off spasms, or other painful symptoms.
Chiropractic neurology was developed by Dr. Ted Carrick and is a much more recent sub-specialty focusing specifically on brain function. The CN view of concussion suggests that, following the injury, symptoms linger due to the swelling of neurons in the damaged area of the brain, causing dysfunction of those neurons and possibly the death of connections. The goal of CN is to identify the damaged areas using simple, yet sophisticated, diagnostic techniques which explore brain function. Its aim is to restore normal brain function by locating the injured (target) area in the brain via non-invasive, stimulative techniques - such as very simple, non-strenuous, visual exercises, the use of specific colors and pattern of target lights - which reveal sensory or musculoskelatal responses indicating either normalcy or dysfunction, and then perform therapy according to the observed responses to the targeted environmental stimuli.
The CN view of concussion suggests that symptoms linger due to the swelling of the neurons in the damaged area of the brain. One specific brain area which may be damaged in a concussion is the vestibular system, which may cause dizziness and/or dysfunction of the brain's vascular (blood flow) system, among other symptoms. CN is designed to promote the formation of new connections in damaged areas of the brain (neuroplasticity), the consequence of which is to improve brain function. Among the therapies a CN may suggest in the treatment of PCS is warm baths with Epsom salts.
Craniosacral therapy (CST) is a 20th century offshoot of cranial osteopathic medicine, a philosophy and system of healing first proposed by Dr. A. T. Still in 1874. The goal of CST is to improve cranial flexibility and restore normal brain function. It is fundamentally an approach that encourages the body to heal itself, but it is not a quick fix. Just like every other aspect of concussion, the body and brain need time to do the work of healing in response to CST.
Although CST is considered somewhat outside the mainstream, some leading sports physicians treating concussion (and the various symptoms of concussion such as vertigo, headache, musculoskeletal pain, vision and hearing changes to name a few) now refer patients to CST, sometimes with impressive results.
Vetibular dysfunction (e.g. dizziness) is commonly associated with concussion and other traumatic brain injury. [5,9] A recent study [9] [4] suggests that the degree of dizziness right after a concussion may be indicative of the eventual length of recovery, with extreme dizziness suggesting a longer recuperation, i.e. post-concussion syndrome. The authors also urged follow-up vestibular assessments to further delineate the cause of dizziness and inform subsequent therapy and treatment. Citing a 2010 study finding that patients who had at least 2 rehabilitation visits for persistent dizziness after a concussion showed improvement on tests for dizziness, [5] the study said that on-field identification of dizziness could lead to earlier implementation of vestibular rehabilitation and other modalities to treat dizziness, which may expedite recovery from concussion.
A 2015 study [10] [24] by Canadian researchers found that nearly two-thirds (62.5%) of young athletes diagnosed with PCS had vestibular-ocular dysfunction or VOD (e.g. they complained of intermittent blurred or double vision, visual disturbance, gaze instability or difficulty focusing, dizziness, difficulty reading, or motion sensitivity and were found on clinical examination to have more than one abnormality in eye movements or vestibulo-ocular reflexes [11]).
The findings led the study authors to conclude that the presence of VOD may be predictive of a prolonged recovery from sports-related concussion. Writing in the Journal of Neurosurgery: Pediatrics, lead author Michael Ellis of the Canada North Concussion Network in Manitoba, said that, "Future research is needed to confirm the findings of this study, identify clinical predictors of vestibulo-ocular dysfunction, and evaluate the effects of targeted vestibular and oculomotor rehabilitation on the objective findings responsible for persistent concussion symptoms."
Vestibular rehabilitation therapy [12] (VRT) has been demonstrated to be a highly effective treatment for most individuals with vestibular or central balance system disorders. [5,22] In a number of studies, customized vestibular rehabilitation programs have been reported to be significantly more effective in resolving symptoms than generic exercises, and especially medications, and has been found to reduce dizziness and improve gait and balance in children and adults after concussion. [9,14]
In one small randomized controlled trial [23], a combination of cervical and vestibular physiotherapy was found to decrease time to medical clearance to return to sport in youth and young adults with persistent symptoms of dizziness, neck pain and/or headaches following a sport-related concussion.
Both the control and intervention groups received weekly sessions with a physiotherapist for 8 weeks or until the time of medical clearance, and received postural education, range of motion exercises and cognitive and physical rest [13] until asymptomatic followed by a protocol of graded exertion [14]. The intervention group also received cervical spine and vestibular rehabilitation. In the treatment group, 73% (11/15) of the participants were medically cleared within 8 weeks of initiation of treatment, compared with only 7% (1/14) in the control group. Put another way, individuals in the treatment group were almost 4 times more likely to be medically cleared by 8 weeks.
A second retrospective study[5], including patients with persistent symptoms of dizziness after concussion, found that treatment with vestibular therapy only reported significant decreases in symptoms.
In a third retrospective study, [26] researchers, reviewing the charts of 53 pediatric patients who had completed a course of VRT after concussion, found improved tolerance of eye tracking and balance, and that all tolerated the therapy without significant exacerbation of symptoms. The results led the paper's authors to conclude that VRT may be helpful in treating persisting dizziness and balance problems after concussion in children and teens, but that further study was neeed to determine if VRT may improve prolonged symptoms of dizziness and balance disturbance in children with concussion.
The basis for the success of a vestibular rehabilitation program is the use of already existing neural mechanisms for adaptation, plasticity, and compensation in the human brain. Compensation and adaptation have been demonstrated to be closely related to the direction, duration, frequency, and magnitude of the stimulus. Specifically designed VRT exercise protocols take advantage of this plasticity of the brain to increase sensitivity and restore symmetry, which results in an improvement in vestibular-ocular control, an increase in the gain of the vestibuloocular reflex (VOR), better postural strategies, and increased levels of motor control for movement.
When an athlete is unable to transition back into an active lifestyle, they are at risk for secondary problems such as physical deconditioning, anxiety and stress, mild depression, and irrritability. Over time, the strength of the relation between the original injury and ongoing symptoms very likely diminishes, and the pre-existing, current and contextual factors increasingly contribute to causing, maintaining, or exacerbating symptoms. [9]
The accepted wisdom that PCS should be treated with rest, reassurance and anti-depressants, and that physical activity [3] should be avoided, however, is now being questioned, with the authors of a 2013 systematic review of the literature on the effects of rest and treatment following sport-related concussion [9] noting that "[c]onverging lines of diverse, albeit indirect, medical and scientific evidence [now] support the use of exercise as a core component of treatment for children, adolescents, and young adults who are slow to recover from concussion."
In a landmark 2012 study published in the Clinical Journal of Sports Medicine, [6] researchers at the State University of New York at Buffalo (SUNY-Buffalo) reported that a program of progressive exercise developed individually for each participant and performed at levels just below the onset of symptoms was safe and relieved nearly all PCS symptoms.
The SUNY-Buffalo regimen is based on the hypothesis that the regulatory system responsible for maintaining cerebral blood flow, which may be dysfunctional in people with concussion, [7] can be restored to normal by controlled, graded, symptom-free exercise. A 2013 pilot study by the same researchers provided preliminary evidence to support that hypothesis.
"Perhaps the most exciting aspect of this study is that all of the subjects that participated, both athletes and non-athletes, got better eventually, although the athletes certainly improved the fastest," said Barry Willer, PhD, UB professor of psychiatry and rehabilitation sciences and senior author on the study, in a January 2010 SUNY-Buffalo press release. [8]
"It also was reassuring to discover that the use of exercise was safe and did not prolong symptoms, a worry expressed by other practitioners."
Physicians in UB's Sports Medicine Concussion Clinic initially used their approach only with athletes from UB teams, but word spread, and they now have assessed and treated many professional athletes, especially those from the National Hockey League.
"One of the advantages we offer to professional teams is a more precise test of post-concussion syndrome," says John J. Leddy, MD, associate professor of orthopaedics and co-director of UB's Sports Medicine Institute. "If the patient does not develop symptoms during the exercise test, then the cause of their difficulties is likely to be another source. Most commonly it is neck strain, which tends to cause headaches that mimic post-concussion headache."
"The data suggest that some PCS symptoms are related to disturbed cerebral autoregulation, and that after this treatment, the brain was able to regulate blood flow when the blood pressure rose during exercise," says Leddy. "We think progressive stepwise aerobic training may improve cerebral autoregulation by conditioning the brain to gradually adapt to repetitive mild elevations of systolic blood pressure."
"Although each concussion should be considered a 'unique injury,' a randomized trial that included a PCS control group should be conducted to address the possibility that PCS symptoms would have resolved spontaneously without intervention, said study co-author Karl Kozlowski, PhD, UB clinical instructor of exercise and nutrition sciences, who developed the exercise protocol.
"All of our subjects had been symptomatic for months before treatment and were not getting better on their own," says Kozlowski, "so we are pretty convinced that the regulated exercise program did the trick."
Most recently, researchers presenting at the American of Academy of Pediatrics National Conference and Exhibition in Washington, D.C. in October 2015, [25] reported that aerobic therapy may lessen the symptoms experienced by children and adolescents suffering from post-concussion syndrome and allow them to return to baseline.
Researchers, led by William R. Johnson of the Perelman School of Medicine at the University of Pennsylvania, reviewed the charts of 57 pediatric patients with post-concussion syndrome presenting to a specialty sports medicine concussion program at a large children's hospital from 2011-2013 who were referred to physical therapy (PT) for post-concussion symptoms.
Extracting data from each PT visit with AT, along with the number of symptoms, symptom severity, exercise time, completed exercise, and symptoms with exercise, they found that the percentage of patients who reported concussion symptoms dropped from 93% at their first PT visit to 42% at discharge from physical therapy.
Two-thirds of the patients were able to complete AT during their initial PT session, with exercise inducing post-concusive symptoms in slightly more than half (54%). At their final PT session, nine out of ten were able to complete the exercise, with exercise inducing post-concussion symptoms in only 9%.
While conceding that further study was needed to prospectively compare outcomes in post-concussion syndrome patients treated with and without AT, the authors concluded that exersise appeared to be both tolerated by pediatric patients with post-concussion syndrome and to result in a reduction of symptoms.
There is anecdotal evidence [15] to suggest that good old fashioned Epsom salts (magnesium sulfate), either as part of a bath therapy or as a foot soak, is a simple, yet remarkably helpful, therapy in relieving the symptoms of post-concussion syndrome.
It appears Epsom salts help in concussion recovery for several reasons. According to a groundbreaking 2001 study by researchers at UCLA, [2] the biology of concussion involves a cascade of damaging calcium ion releases, which the magnesium in the Epsom salts likely helps counteract (although fundamental research on mineral supplements is typically old, and no pharmaceutical company or biochemistry department is likely going to spend big bucks promoting the use of magnesium sulfate any time soon).
Magnesium is also a known treatment for migraine and helps to promote sound sleep, and sulfates are necessary for proper brain function with respect to behavior, mood and function. Reduced sulfation has been shown in a study by researchers at the University of Birmingham (UK) to play a role in brain dysfunction, such as Parkinson's Disease.
While more research is needed specific to concussion, the use of Epsom salts may be a sensible, non-invasive, inexpensive home remedy which may help the concussed athlete with little, if any, downside risks. At the very least, floating in a bathtub reduces the strain on the brain in counter-acting the pull of gravity.
One potential therapy that has gained recent attention is Hyerbaric Oxygen Therapy (HBO2), which involves breathing high levels of oxygen, usually 100%, at an increased pressure of at least 1.4 times greater than atmospheric pressure at sea level. The intent of HBO2 therapy is to increase the oxygenation of the blood and tissues of the patient to supraphysiological levels, based on the still unproven theory that it can return neurons in the brain adjacent to severely damaged or dead neurons to normal or near normal function through exposure to hyperbaric oxygen.[18].
A 2011 study [17] of fifteen military personnel (all previously diagnosed with traumatic brain injury) treated with forty hyperbaric oxygen treatments reported that the patients made significant improvements in injury symptoms, physical exam results, cognitive measurements, and most importantly, quality of life ratings.
A subsequent, first-of-its-kind double-blind, randomized, prospective study [18] of 50 military personnel with at least one combat-related mild traumatic brain injury treated with 30 sessions of 2.4 atmospheres absolute hyperbaric oxygen, found no significant effect on post-concussion symptoms or neurocognitive test scores.
"Given that HBO2 ... demonstrates no therapeutic value, requires long treatment series, is expensive, exposes patients to potential side effects, and has limited availability, clinical usage is not warranted for the management of symptoms of chronic mTBI at ... treatment pressure [of 2.4 atmospheres]," the study concludes.
The authors, however, in recognition of the possibility that the dose was "excessive" (noting that most anecdotal chronic mTBI case reports and series used 1.3 atmospheres), recommended that larger, multicenter, randomized, controlled, double-blinded clinical trials be conducted at lower total oxygen doses."
Most recently, a single center, double-blind, randomized, sham-controlled, prospective 2014 study[19] of military service members with at least one combat-related mild traumatic brain injury suffering from PCS who underwent 40, once-daily hyperbaric chamber compressions at 2.0 atmospheres found no significant improvement in concussion symptoms that could be attributed to the HBO2, findings which paralleled the results of the 2012 study.
The study's authors viewed their findings as "particularly important" because they used the more typical treatment pressures advocated by hyperbaric clinicians.
There are no diet supplements that have been scientifically proven to treat or cure concussions, although that has not kept companies from trying. As a result, the U.S. Food and Drug Administration (FDA) was forced in December 2013 to issue a consumer health advisory [16] [20] warning consumers to avoid purported dietary supplements marketed with claims to prevent, treat, or cure concussions and other TBIs "because the claims are not backed with scientific evidence that the products are safe and effective for such purposes." The advisory warns that "even if such supplement contains no harmful ingredients, "that claim alone can be dangerous," says Gary Coody, FDA's National Health Fraud Coordinator.
"We are very concerned that false assurances of faster recovery will convince athletes of all ages, coaches, and even parents that someone suffering from a concussion is ready to resume activities before they are really ready," says Coody, who says parents need to be "watch for claims that these products can ... lessen the severity of concussions or TBIs."
"Typically," says the FDA advisory, "products promising relief from TBIs tout the benefits of ingredients such as turmeric and high levels of omega-3 fatty acids derived from fish oil." It noted that it has been forced to send warning letters to at least two companies ikn 2012 that their products were not generally recognized as safe and effective for treating TBIs, and that unless the violations were promptly corrected, legal action could result without further notice. Both companies changed their websites and labelling.
Most recently, the FDA issued a warning letter to Star Scientific, Inc. for marketing its product Anatabloc with claims to treat TBI.
Note: this article describes just some of the potential therapies for treating PCS, and it is not intended to be exhaustive, nor is it intended to provide medical advice. If your child has PCS, please consult with their treating physician.
1. Moser RS, Glatts C, Schatz P. Efficacy of Immediate and Delayed Cognitive and Physical Rest for Treatment of Sport-Related Concussion. J Pediatrics DOI: 10.1016/j.jpeds.2012.04.012 (in press).
2.Giza CC, Hovda DA, The Neurometabolic Cascade of Concussion. J Ath Train 2001;36(3):228-235.
3. Reddy CC, Collins M, Lovell M, Kontos A. Efficacy of Amantadine Treatment on Symptoms and Neurocognitive Performance Among Adolescents Following Sport-Related Concussion. J Head Trauma Rehab 2012: DOI: 10.1097/HTR.0b013e318257fbc6 (published online ahead of print)(accessed December 13, 2012).
4. Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which On-Field Signs/Symptoms Predict Protracted Recovery From Sport-Related Concussion Among High School Football Players? Am J. Sports Med 2011;20(10) DOI:10.1177/0363546511410655 (published June 28, 2011 online ahead of print)(accessed November 5, 2011).
5. 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.
6. Leddy J, et. al. A Preliminary Study of Subsymptom Threshold Exercise Training for Refractory Post-Concussion Syndrome, Clinical J of Sport Med 2010; 20(1):21-27 (doi: 10.1097/JSM.0b013e3181c6c22c).
7. Neary J. et. al. Cerebrovascular Reactivity Impairment after Sport-Induced Concussion, Med & Sci in Sports & Exercise 2011;43(12): 2241-2248.
8. SUNY-Buffalo, UB Specialized Exercise Regimen Shown to Relieve Prolonged Concussion Symptoms. http://www.buffalo.edu/news/10848 (accessed December 10, 2011).
9. Schneider K, Iverson G, Emery C, McCrory P, Herring S, Meeuwisse W. The effects of rest and treatment following sport-related concussion: a systematic review of the literature. Br J Sp Med. 2013;47:304-307.
10. Leddy J, Sandhu H, Sodi V, Baker J, Willer B. Rehabilitation of Concussion and Post-concussion syndrome. Sports Health: A Multidisciplinary Approach 2013;4(2):147-154,
11. Mittenberg W, Tremont G, Zielinski R, Fichera S, Rayls K. Cognitive-behavioral prevention of postconcussion syndrome. Arch Clin Neuropsychol 1996;11(2):139-145.
12. Al S, Sandford D. Carson A. Psychological approaches to treatment of postconcussion syndrome: a systematic review. J Neurol Phys. Ther. 2010;34(2):87-93.
13. Postford 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.
14. Alsalaheen B, Mucha A, Morris I, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010;34(2):87-93.
15. Harmon K, Drezner J, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med 2013;47:15-26.
16. Meehan W, Kids, Sports, and Concussions. (Praeger 2011).
17. Harch P, et al. A Phase I Study of Low-Pressure Hyperbaric Oxygen Therapy for Blast-Induced Post-Concussion Syndrome and Post-Traumatic Stress Disorder. J Neurotrauma. 2011; DOI:111122062711007.
18. Wolf G, Cifu D, Baugh L, Carne W, Profenna L. The Effect of Hyperbaric Oxygen on Symptoms after Mild Traumatic Brain Injury. J Neurotrauma 2012;29:2606-2612.
19. Cifu DX, Hart BB, West SL, Walker W, Carne W. The Effect of Hyperbaric Oxygen On Persistent Postconcussion Symptoms. J Head Trauma Rehabil. 2014;29(1):11-20.
20. Food and Drug Administration. Consumer Update: "Can A Dietary Supplement Treat A Concussion? No." December 31, 2013. accessed at http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378845.htm [16]
21. Leddy JJ, Cox JL, Baker JG, Wack DS, Pendergast DR, Zivadinov R, Willer B. Exercise Treatment for Postconcussion Syndrome: A Pilot Study of Changes in Functional Magnetic Resonance Imaging Activation, Physiology and Symptoms. J Head Trauma Rehabil 2013;28(4):241-249.
22. Cabrera Kang CM, Tusa RJ Vestibular rehabilitation: rationale and indications. Semin Neurol 2013;33:276:85.
23. Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. Cerviovestibular rehabilitation in sport-related concussion: a randomized controlled trial. Br J Sports Med 2014;48:1294-8.
24. Ellis MJ, Cordingley D, Vis S, Reimer K, Leiter J, Russell K. Vestibulo-ocular dysfunction in pediatric sports-related concussion. J. Neurosurgery: Pediatrics, published online, ahead of print, June 2, 2015; DOI: 10.3171/2015.1.PEDS14524.
25. Research paper, Exercise Tolerance in Pediatric Patients with Post-Concussion Syndrome. Johnson WR, et. al. Presented at American Academy of Pediatrics National Conference and Exhibition, October 24, 2015. Washington, D.C.
26. Research paper. Vestibular Rehabilitation in Children Following Concussion. Storey E, et al. Presented at American Academy of Pediatrics National Conference and Exhibition, October 24, 2015. Washington, D.C.
Most recently updated November 24, 2015
Links:
[1] https://mail.momsteam.com/node/3227
[2] https://mail.momsteam.com/node/3310
[3] https://mail.momsteam.com/node/4176
[4] https://mail.momsteam.com/node/3468
[5] https://mail.momsteam.com/node/801
[6] https://mail.momsteam.com/node/149
[7] https://mail.momsteam.com/node/4147
[8] https://mail.momsteam.com/node/4381
[9] https://mail.momsteam.com/node/4029
[10] http://www.newswise.com/articles/view/634908/?sc=dwhr&xy=10013227
[11] http://en.wikipedia.org/wiki/Vestibulo–ocular_reflex
[12] http://www.stopdizziness.com/services_vestibular_rehabilitation.asp
[13] https://mail.momsteam.com/concussion-physical-rest/concussion-recovery-starts-with-both-physical-and-cognitive-rest
[14] https://mail.momsteam.com/health-safety/return-to-play/concussion-return-to-play-step-by-step-approach-recommended
[15] https://mail.momsteam.com/node/4363
[16] http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378845.htm
[17] https://mail.momsteam.com/amantadine/concussion-therapies-amantadine-shows-potential-in-treating-post-concussion-syndrome
[18] https://mail.momsteam.com/health-safety/craniosacral-therapy-may-help-lesson-symptoms-post-concussion-syndrome
[19] https://mail.momsteam.com/health-safety/dizziness-at-time-concussion-linked-to-longer-recovery
[20] https://mail.momsteam.com/health-safety/post-concussion-syndrome-is-when-concussion-symptoms-persist
[21] https://mail.momsteam.com/health-safety/unmarked-detour-recovery-helped-by-treatments-old-new
[22] https://mail.momsteam.com/health-safety/unmarked-detour-another-mistake-dead-end-at-school-post-concussion-syndrome
[23] https://mail.momsteam.com/vestibular-rehabilitation-therapy/unmarked-detour-concussion-puzzle-completed-new-normal-achieved
[24] https://mail.momsteam.com/health-safety/treating-sports-concussions-with-hyperbaric-oxygen-therapy
[25] https://mail.momsteam.com/cerebral-blood-flow/controlled-aerobic-exercise-rehabilitation-helps-post-concussion-syndrome-by-restoring-cerebral-blood-flow
[26] https://mail.momsteam.com/health-safety/post-concussion-syndrome-new-therapies-offer-hope-says-mom-hockey-star-Caitlin-Cahow