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

摘要

General Guidance: After a mild TBI/concussion there is a 24-hour minimum recovery period. Provide initial education for recovery using the Acute Concussion Educational Brochure. After 24-hour recovery, if this is the first concussion in the past 12 months and service member is asymptomatic, exertional testing can be performed. If the service member is symptomatic after 24 hours, or after exertional testing, or if this is the second concussion in 12 months, provide education using the Return to Activity Educational Brochure. After the additional 24 hours in Stage 1, if this is the first concussion in the past 12 months and service member is asymptomatic, exertional testing can be performed. The service member enters into the full progressive return to activity process if: they remain symptomatic after 48 hours or after extertional testing the current concussion is the second in 12 months The service member completes the Neurobehavioral Symptom Inventory (NSI) daily, after each stage of progression. Progress through one stage per day if symptoms are 0-1 (mild) on the NSI. Instruct the service member to return to the PCM if symptoms are reported as 2 or higher on the NSI. When symptoms increase in number or severity during an activity the service member should stop the activity and rest for the remainder of the day. The following day, if symptoms are 2 or higher on the NSI, the service member should follow up with the PCM. If symptoms remain at 0 or 1 on the NSI, the service member may resume the previous day s stage. When repeating the previous day s activity, if there is an increase in symptom number and severity, the service member should follow up with the PCM. A service member who sustains a second concussion in 12 months must have seven consecutive days of symptom resolution (defined as symptoms of 0-1 on the NSI) at Stage 1 and 2 before completing Stages 3-5.