Skip to main content

Military Health System

Test of Sitewide Banner

This is a test of the sitewide banner capability. In the case of an emergency, site visitors would be able to visit the news page for addition information.

Balancing rest, activity key to recovering from concussion

Image of Two football teams facing off in the middle of a play. Proper concussion recovery protocols are critical to returning service members and trainees and students such as these U.S. Military Academy cadets and U.S. Naval Academy midshipmen during the annual Army Navy football game (Photo by: Navy Petty Officer 2nd Class Alexander Kubitza, Office of the Secretary of the Navy).

A newly revised suite of tools and resources for military health care providers will help improve the treatment of service members with concussions, and ensure their safe return to full duty, according to the Defense Health Agency's Traumatic Brain Injury Center of Excellence.

"The Progressive Return to Activity Following Acute Concussion (PRA)" clinical recommendation updates a previous version and incorporates another guide called the Concussion Management Tool.

The clinical recommendation features a six-step approach for providers to smoothly transition service members from a concussion diagnosis to managing their symptoms through recovery. Each stage focuses not only on returning patients to physical activity, but also on the gradual return to normal brain function.

If a service member returns to duty too soon after a concussion, research suggests there is a greater risk of accidents and falls, prolonged symptoms, more concussions, poor marksmanship, and decreased readiness. In one recent study, published in September 2020, medical professionals followed 508 U.S. Naval Academy midshipmen with concussions until they exhibited normal balance and had no symptoms at rest or with exertion. When the midshipmen were given a mental test, however, 25% had not fully recovered, demonstrating underlying concerns with a premature return to duty.

"The PRA walks you through that process of what to expect, what do you need to achieve before you go to the next stage, (and) what are the restrictions for each stage in both of those components - cognitively and physically," said Navy Cmdr. (Dr.) Adam Susmarski, medical director of the U.S. Naval Academy Concussion Center of Excellence and a member of the Traumatic Brain Injury Center of Excellence (TBICoE) group that assessed the clinical recommendations in practice.

Among significant changes to the recommendations are:

  • Updating evaluation criteria for the advancement to increased levels of activity; patients will now rate their symptoms daily as the same, better, or worse. Completing the longer self-assessment questionnaire, called the Neurobehavioral Symptom Inventory, will now take place at follow-up provider visits.
  • Replacing "rest" with "relative rest" in the first stage of the PRA to reflect recent research showing prolonged complete rest may extend recovery.
  • Enhancing activity recommendations and developing guidelines for duty modification at each stage.
  • Clarifying and expanding return to duty screening to include testing both physical and cognitive skills.

TBICoE developed its recommendations by collaborating with military service branches, an expert working group, and an end user group. TBICoE is a division aligned under the DHA's Research and Development Directorate.

Recent studies have found concussion recovery is a gradual process, indicating the need to strike a balance between rest and activity in the early stages of recovery. While overexertion slows recovery, so can too much rest, according to TBICoE.

TBICoE researchers found patients cared for by providers who had completed a two-hour, in-person training at three military installations using a progressive return to activity process reported a greater overall reduction in symptoms after one week, one month, and three months, compared to patients who were treated by providers who had not received the instructions.

You also may be interested in...

Brain Injury Awareness Month: Treat

Infographic
2/7/2023
Treat: See your medical provider as soon as you experience a potentially concussive event. Learn to recognize and manage TBI symptoms.

#BeABrainWarrior – learn to recognize #TBI symptoms and don’t delay treatment. Find resources to #ProtectTreatOptimize your brain health. https://health.mil/BIAMonth #BIAMonth

Brain Injury Awareness Month: Protect

Infographic
2/7/2023
Protect: Wear a Helmet, Practice safe driving techniques and be aware of your surroundings

#BeABrainWarrior = protect your head. Learn how to #ProtectTreatOptimize your brain health. https://health.mil/BIAMonth #BIAMonth #TBI

Brain Injury Awareness Month: Hearing and Vision 3

Infographic
2/7/2023
Brain Injury Awareness: Wear Protective Gear

Vision and hearing are vital senses for effective communication and situational awareness. To defend yourself against injury and maintain mission readiness, wear the proper vision and hearing protection while on and off duty. Learn more: • Vision: https://vce.health.mil/Eye-Injury-Prevention-and-Response/Eye-Protection • Hearing: https://hearing.health.mil/Prevention/Evaluated-Hearing-Protection-Devices #BIAMonth #TBI

Brain Injury Awareness Month: Fact 1

Infographic
2/7/2023
Brain Injury Awareness Month Facts: More than 460k TBIs reported since 2000 by members of the U.S. Armed Forces

Do you or a loved one have a #TBI? You aren’t alone. Service members have reported more than 460,000 TBIs since 2000. Find tools to protect yourself from further injury, talk to your provider about your treatment, and optimize your recovery. Learn more: https://health.mil/BIAMonth. #BIAMonth #ProtectTreatOptimize #BeABrainWarrior

Brain Injury Awareness Month: Fact 2

Infographic
2/7/2023
Brain Injury Awareness Month Facts: 82.3% Categorized as Mild TBI, also known as concussion

#DYK? Most #TBI happen in garrison, not on the battlefield. Find fact sheets to help you becomes a #BeABrainWarrior and protect your head anytime, anywhere. https://health.mil/BIAMonth. #BIAMonth #ProtectTreatOptimize

Brain Injury Awareness Month: Hearing and Vision 2

Infographic
2/7/2023
Brain Injury Awareness: Heads Up

Head injuries, especially from a blast, are one of the most common combat-related injuries among deployed service members. Typical symptoms after a head injury are trouble hearing speech in noisy settings, ringing or other sounds in your ears or head, or dizziness when you move your head while walking or bending down. Talk to your provider if you have any of these symptoms. Learn more about #TBI and hearing loss: https://hearing.health.mil/Resources/Education/Conditions-and-Concerns/TBI-and-Hearing-Loss #BIAMonth

Brain Injury Awareness Month: Hearing and Vision 1

Infographic
2/7/2023
Brain Injury Awareness: Our hearing and vision providers have unique capabilities to support vision and hearing dysfunction related to TBI.

Our providers are prepared and ready to treat vision and hearing dysfunctions associated with TBI. Learn more: https://vce.health.mil/Clinicians-and-Researchers/Clinical-Practice-Recommendations, and https://hearing.health.mil/For-Providers. #BIAMonth

Brain Injury Awareness Month: Infographic

Infographic
2/7/2023
Brian Injury Awareness month infographic

Even a mild traumatic brain injury can impact mission readiness and the ability to deploy. #BeABrainWarrior by understanding the signs and symptoms of TBI and knowing when to seek care. TBI is treatable & recovery is possible. https://health.mil/BIAMonth #BIAMonth

Brain Injury Awareness Month: Main Graphic

Infographic
2/7/2023
March is Brain Injury Awareness Month. Be a Brain Warrior

Are you ready to #BeABrainWarrior? Learn how to protect, treat, and optimize brain health during Brain Injury Awareness Month. Visit https://health.mil/BIAMonth. #BIAMonth #TBI #ProtectTreatOptimize

Brain Injury Awareness Month: Optimize

Infographic
2/7/2023
Optimize. Be a Brain Warrior

#BeABrainWarrior by optimizing your #TBI recovery journey and safely return to duty. Learn how you can #ProtectTreatOptimize your brain health. https://health.mil/BIAMonth #BIAMonth

Progressive Return to Activity: Primary Care for Acute Concussion Management

Publication
1/23/2023

The Progressive Return to Activity (PRA): Primary Care for Acute Concussion Management clinical recommendation is an evidence-based return to activity protocol for primary care managers and concussion/traumatic brain injury (TBI) clinic providers. The PRA is a six-step approach that begins after the provider performs the Military Acute Concussion Evaluation 2 (MACE 2) and diagnoses the patient with a concussion/TBI. The PRA stages start with relative rest and allow service members to gradually increase activities until they receive clearance for return to full duty or activity. In each stage, it offers general and military specific activities and options to help providers manage their patients’ primary symptom clusters. The PRA also offers recommendations on specialty referrals and handouts are available for providers to give patients and leadership.

Blast Overpressure Research Brings NATO Group to DHHQ

Article
12/13/2022
Military personnel fire mortar rounds

DOD and NATO experts recently met to continue their work on warfighter brain health to protect soldiers from the overblast pressure of their weaponry.

More Inclusive Research Key to Understanding Prevalence of Dementia

Article
12/7/2022
Animated image of brain

Dementia and its most common form, Alzheimer’s disease, are cognitive disorders that affect more women than men. Although there are various theories on why, more equitable research is needed.

DHA's E Caregiver Directory Puts Resources at Your Fingertips

Article
11/30/2022
Woman on left stretching her husband's left arm and right leg

Caregivers now have needed resources at their fingertips on their mobile phones, tablets, and computers.

DOD Brain Health Initiative is at Work Across the Military

Article
11/17/2022
Two hands holding damaged wearable blast mesurement gauges from a study on blast pressure exposure.

From enlistment to retirement, the brain health of service members is being checked. See why the results are creating new action plans for the DOD.

Page 3 of 19 , showing items 31 - 45
First < 1 2 3 4 5  ... > Last 
Refine your search
Last Updated: December 28, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery