I have always loved the concept of a meme, which is why the subheading of the journal Neurosurgery (from Wolters Kluwer Health) “The Register Of The Neurosurgical Meme” intrigues me.
Along those lines, concussion guidelines are like nutritional recommendations: If you think you have a handle on best practices, wait a year (in some cases a few months) and the guidelines will change. Case in point, the latest “new” thinking on concussion treatment, as reported in yesterday’s Wall Street Journal, which includes the following statement: “In a white paper summarizing the views of more than three dozen concussion experts, published online Friday in the journal Neurosurgery, the authors aim to clarify the role of rest and physical activity in concussion treatment. The paper says most that concussions are treatable and that active rehabilitation may improve symptoms more than strict rest.”
The white paper they refer to in the article is: “Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015.” If you click on the hyperlink it will give you the option of obtaining the full PDF.
Point 14 of the white paper, found on pages 11 and 12, will be of interest (I added the bold print for vision therapy):
“14. Matching targeted and active treatments to clinical profiles may improve recovery trajectories after concussion.
Although there are no clear evidence-based treatments for concussion, emerging clinical research and observations suggest that recovery after concussion may be facilitated when targeted, active interventions are matched to the patient’s clinical profile on the basis of presentation and history. For example, patients who present with postconcussion vestibular impairment and symptoms (eg, dizziness, vertigo, impaired balance, visual motion sensitivity) may benefit from vestibular rehabilitation exercises that treat benign paroxysmal positional vertigo and improve balance, gaze stability, eye-head coordination, and gait. Similarly, vision therapy was recently reported to be beneficial for patients with concussion and mTBI who exhibited common oculomotor issues such as reading difficulty, vergence, accommodation, saccade, or pursuit impairment. Vision therapy (orthoptics) uses a variety of vision exercises and tools designed to improve oculomotor control, focusing, coordination, and teaming. In addition to vestibular rehabilitation and vision therapy, exercise prescribed as an adjunct to other therapies or medication may reduce symptoms of depression and anxiety. and may prevent or modify the intensity of migraines that often accompany concussion.”