Prolonged Activity Restriction After Concussion: Are We Worsening Outcomes?
Prolonged Activity Restriction After Concussion: Are We Worsening Outcomes?
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DOI：
10.1177/0009922815589914
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发表时间：
2016-05-01
影响因子：
1.6
通讯作者：
Iverson, Grant L.
中科院分区：
文献类型：
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作者：
DiFazio, Marc;Silverberg, Noah D.;Iverson, Grant L.
目前脑震荡或轻度创伤性脑损伤（mTBI）的治疗主要基于专家共识。大多数临床实践指南建议受伤后进行认知和身体休息，包括退出正常的生活活动，如上学，体育参与和技术使用，直到症状消失。一些持续mTBI的人会经历持续的身体，认知和心理健康问题。活动限制本身可能导致恢复时间延长和其他并发症。威廉姆森在20多年前提出的抑郁症活动限制模型是这一假设的核心。我们回顾了长期活动限制的潜在危害的研究证据，并报告了一个mTBI的情况下，作为一个例子，如何活动限制级联可以展开。根据这一模型，从验证生活活动中移除的心理后果，结合身体失调，有助于一些青年mTBI后脑震荡后症状的发展和持续。鼓励修改mTBI指南，强调在耐受的情况下迅速重新参与生活活动。
The current treatment of concussion or mild traumatic brain injury (mTBI) is primarily based on expert consensus. Most clinical practice guidelines advise cognitive and physical rest after injury including withdrawal from normal life activities such as school attendance, sports participation, and technology use until symptoms resolve. Some individuals who sustain an mTBI experience persistent physical, cognitive, and mental health problems. Activity restriction itself may contribute to protracted recovery and other complications. Williamson's Activity Restriction Model of Depression, formulated more than 20 years ago, is central to this hypothesis. We review research evidence for potential harms of prolonged activity restriction and report an mTBI case as an example of how an activity restriction cascade can unfold. According to this model, psychological consequences of removal from validating life activities, combined with physical deconditioning, contribute to the development and persistence of postconcussive symptoms after mTBI in some youth. A modification to mTBI guidelines that emphasizes prompt reengagement in life activities as tolerated is encouraged.