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

摘要

The goal of progresive activity is to promote full recovery by gradually increasing physical, cognitive and vestibular/ balance activities. The progressive activity process as defined in this recommendation may begin if symptoms remain following the mandatory recovery period as indicated by DoDI 6490.11 and the CMAs. The service member may progress through the stages when symptoms are reported at pre-injury level or no higher than 1 (mild) on the NSI, resting HR is not greater than 100 bpm and resting BP does not exceed 140/90 mm Hg. Patient 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. The early identification and treatment of mTBI is most beneficial during the acute injury phase and has been reported to decrease disability. Current literature including widely accepted consensus guidelines and the Department of Veterans Affairs (VA)/Department of Defense (DoD) Clinical Practice Guideline (CPG) for Management of Concussion/mTBI recommends that patients with mTBI gradually return to normal activity as soon as safely possible using progressive activity combining multiple components. The Concussion Management Algorithms (CMA) in Deployed Settings and Department of Defense Guidance for Management of Mild Traumatic Brain Injury/Concussion in the Deployed Setting (Department of Defense Instruction DoDI 6490.11) provide guidance for the evaluation and care of service members with mTBI in the deployed setting. However, for those concussed service members who remain symptomatic following the initial recovery period, progression of activity is not well defined.