Skip main navigation

Military Health System

Clear Your Browser Cache

This website has recently undergone changes. Users finding unexpected concerns may care to clear their browser's cache to ensure a seamless experience.

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...

Article Around MHS
Nov 29, 2023

Green Beret Teams Up with the US Southern Command Warrior Care Program Care Coalition Competes in Department of Defenses Warrior Games Challenge and International Invictus Games

U.S. Army Sgt. 1st Class Jacob “Jake” Anthony competing in the 2023 Invictus Games held in Dusseldorf, Germany. (Courtesy photo)

Green Beret U.S. Army Sgt. 1st Class Jacob "Jake” Anthony was deployed to Afghanistan in 2005 on a mission to find a target. His team was breaching a door that turned out to be booby-trapped, resulting in an explosion that killed his teammate in front of him. Anthony would take shrapnel to the right frontal lobe to his brain and had to be initially ...

Publication
Nov 29, 2023

TBICoE's Low-Level Blast Research Efforts Infographic

.PDF | 2.12 MB

This infographic illustrates TBICoE's work to better understand how low-level blast influences warfighter brain health. These efforts directly support Line of Effort 2 of the Warfighter Brain Health Initiative.

Video
Nov 6, 2023

The Warfighter Brain Health for Leaders Training Video

The Warfighter Brain Health for Leaders Training Video

The Warfighter Brain Health for Leaders Training video is an essential resource for enhancing the Department of Defense's Warfighter Brain Health Initiative. It empowers military leaders with strategies for preventing, protecting against, and managing brain injuries. Additionally, the video enhances leaders' abilities to assess and recognize symptoms ...

Fact Sheet
Nov 6, 2023

Warfighter Brain Health After TBI: Guidance for Leaders

.PDF | 895.85 KB

This TBICoE fact sheet, Warfighter Brain Health After TBI: Guidance for Leaders, condenses the basics of recognizing, reporting, and preventing TBI in service members. It updates and supersedes the Line Leader Policy Guidance fact sheet and includes a list of what the DOD has defined as potentially concussive events and outlines leaders’ ...

Publication
Sep 29, 2023

Mild TBI and PTSD Clinical Pearls

.PDF | 924.82 KB

TBICoE's "Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Clinical Pearls," is a new supplemental product to the detailed research review. This resource is designed to be brief and provide key actionable “clinical pearls” that should be considered in the treatment of service members with comorbid mild TBI and PTSD.

Publication
Sep 29, 2023

TBICoE Research Review: Mild TBI and PTSD

.PDF | 435.28 KB

This research review provides an in-depth summary of the available clinical research on the topic of co-morbid mild traumatic brain injury and posttraumatic stress disorder. Specifically, this review will address symptoms, anatomy, diagnosis, and treatment of mild TBI, PTSD, and the unique circumstances associated with the presentation of both.

Video
Sep 21, 2023

TBI and Low-Level Blast Exposure: What Medical Providers Need to Know

TBI and Low-Level Blast Exposure: What Medical Providers Need to Know

This educational video, produced by the Traumatic Brain Injury Center of Excellence, focuses on the effects of low-level blast and traumatic brain injury. Its purpose is to provide supplemental information on low-level blast to health care providers and beneficiaries.

Technical Document
Jul 20, 2023

Infographic: What is the Acute Concussion Care Pathway?

.PDF | 714.95 KB

TBICoE developed this infographic as a quick reference tool that demonstrates application of the standardized acute concussion assessment and care process. By adhering to this established pathway of care for mild TBI, providers across the MHS can ensure a reduction in unwarranted variation and foster an integrated, standardized system of readiness and ...

Fact Sheet
Jul 18, 2023

Low-Level Blast: Fact Sheet for Providers

.PDF | 1.26 MB

Low-level blast is defined as blast generated from firing heavy weapon systems or explosives in combat or training environments. Exposure to low-level blast does not typically result in a clinically diagnosable concussion, also known as mild traumatic brain injury. Both providers and service members should be aware of the potential effects of low ...

Fact Sheet
Jul 18, 2023

Low-Level Blast: Fact Sheet for Service Members

.PDF | 867.41 KB

Low-level blast is defined as blast generated from firing heavy weapon systems or explosives in combat or training environments. Exposure to low-level blast does not typically result in a clinically diagnosable concussion, also known as mild traumatic brain injury. Both providers and service members should be aware of the potential effects of low ...

Skip subpage navigation
Refine your search
Last Updated: January 22, 2024
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery