Pertab Jon L, Merkley Tricia L, Winiarski Holly, Cramond Kelly M J, Cramond Alex J
Neurosciences Institute, Intermountain Healthcare, Murray, UT 84107, USA.
Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT 84602, USA.
J Pers Med. 2025 Jan 17;15(1):33. doi: 10.3390/jpm15010033.
A significant proportion of patients who sustain a concussion/mild traumatic brain injury endorse persisting, lingering symptoms. The symptoms associated with concussion are nonspecific, and many other medical conditions present with similar symptoms. Medical conditions that overlap symptomatically with concussion include anxiety, depression, insomnia, chronic pain, chronic fatigue, fibromyalgia, and cervical strain injuries. One of the factors that may account for these similarities is that these conditions all present with disturbances in the optimal functioning of the autonomic nervous system and its intricate interactions with the endocrine system and immune system-the three primary regulatory systems in the body. When clinicians are working with patients presenting with persisting symptoms after concussion, evidence-based treatment options drawn from the literature are limited. We present a framework for the assessment and treatment of persisting symptoms following concussion based on the available evidence (treatment trials), neuroanatomical principles (research into the physiology of concussion), and clinical judgment. We review the research supporting the premise that behavioral interventions designed to stabilize and optimize regulatory systems in the body following injury have the potential to reduce symptoms and improve functioning in patients. Foundational concussion rehabilitation strategies in the areas of sleep stabilization, fatigue management, physical exercise, nutrition, relaxation protocols, and behavioral activation are outlined along with practical strategies for implementing intervention modules with patients.
相当一部分遭受脑震荡/轻度创伤性脑损伤的患者表示存在持续的症状。与脑震荡相关的症状不具有特异性，许多其他医疗状况也会出现类似症状。与脑震荡症状重叠的医疗状况包括焦虑、抑郁、失眠、慢性疼痛、慢性疲劳、纤维肌痛和颈部劳损损伤。这些相似性的一个可能因素是，这些状况都表现为自主神经系统及其与内分泌系统和免疫系统（身体的三个主要调节系统）的复杂相互作用的最佳功能出现紊乱。当临床医生面对脑震荡后出现持续症状的患者时，从文献中得出的循证治疗选择有限。我们基于现有证据（治疗试验）、神经解剖学原理（脑震荡生理学研究）和临床判断，提出了一个评估和治疗脑震荡后持续症状的框架。我们回顾了支持以下前提的研究：旨在损伤后稳定和优化身体调节系统的行为干预有可能减轻症状并改善患者的功能。概述了睡眠稳定、疲劳管理、体育锻炼、营养、放松方案和行为激活等领域的基础脑震荡康复策略，以及与患者实施干预模块的实用策略。
