Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury: Guidance for the Primary Care Manager in Deployed and Non-deployed Settings.

摘要

More than 287,000 service members have sustained a traumatic brain injury (TBI) between 2000 and the third quarter of 2013.1 The majority of these (83.3 percent), were classified as mild TBI (mTBI), also known as concussion.1, 2 The identification and treatment of mTBI is most beneficial during the acute injury phase and is reported to decrease disability.3 Current literature including the widely accepted consensus guidelines and the Veterans Affairs/Department of Defense Clinical Practice Guideline for Management of Concussion/ Mild Traumatic Brain Injury recommends that patients with mTBI gradually return to normal activity as soon as safely possible using a progressive activity protocol.3,4 The Concussion Management in Deployed Settings Algorithms (CMA) and the Department of Defense Instruction (DoDI) 6490.11, Department of Defense Guidance for Management of Mild Traumatic Brain Injury/ Concussion in the Deployed Setting provide guidance for the evaluation and care of service members with mTBI in the deployed setting.5,6 However, clear guidance on a progressive return to activity following mTBI after the mandatory recovery period is not well described. This clinical recommendation (CR), Progressive Return to Activity Following Acute Concussion/mTBI: Guidance for the Primary Care Manager in Deployed and Non-deployed Settings and clinical support tool (CST) offer guidance for Military Health System (MHS) primary care managers (PCM) and offer a standard approach following mTBI. A companion CR and CST Progressive Return to Activity Following Acute Concussion/Mild TBI: Guidance for Rehabilitation Providers in Deployed and Non-deployed Settings is also available at dvbic.dcoe.mil. These clinical recommendations for the progressive return to pre-injury activity promote standardization of care following mTBI in the Military and Veterans Health Systems. Each service may mandate service-specific requirements for activity following mTBI.