Concussion and rehabilitation of prolonged post-concussion symptoms

Concussion or mild traumatic brain injury (mTBI) is one of the most frequent neurological diagnoses accounting for up to 90% of all traumatic brain injuries. The majority of patients recover spontaneously within the first 2 to 3 weeks and do not require any treatment. However, a significant minority of concussed individuals experience prolonged post-concussion symptoms (PPCS). Approximately 35% continue to have symptoms 3 to 6 months postinjury, and 5-20% will experience symptoms for 12 months or longer. People with PPCS usually present with a combination of physical and cognitive symptoms together with emotional difficulties, fatigue and sleep disturbances. PPCS have a profound impact on daily functioning and thus far-reaching consequences for the affected individual, their family, and society. Several perimorbid, as well as premorbid and postmorbid factors, can predict the development of PPCS. Persons who develop PPCS have treatment and rehabilitation needs, contrary to those who recover spontaneously within the first weeks. However, their contact with healthcare and other professionals is characterised by a fragmented and untimely approach, difficulties gaining knowledge and personalised advice, and troublesome access to appropriate treatments. Research into the treatment of PPCS is still sparse, but it provides clear indications that PPCS can be treated. Studies within the last decade suggest a much more active approach targeted at persons with known risk factors for prolonged symptoms. Individually tailored, interdisciplinary rehabilitation that is anchored in a bio-psycho-social understanding of the condition shows the most promise since recovery from PPCS is influenced by complex interactions between biological, psychological and social factors.Hjernerystelse udgør op til 90 % af alle hovedtraumer. Størstedelen af personer med hjernerystelse oplever spontan bedring i løbet af de første to-tre uger, men en betydelig andel oplever langvarige fysiske, kognitive og følelsesmæssige symptomer. Ca. 35 % har fortsat symptomer tre-seks måneder efter traumet, og hos 5-20 % varer symptomerne mere end et år. Symptomerne bevirker, at man har svært ved at fungere i hverdagen, og er forbundet med store personlige og arbejdsmæssige konsekvenser. Adskillige perimorbide, præ- og postmorbide faktorer har betydning for prognosen. Forskning i behandling af langvarige symptomer er fortsat i sin spæde begyndelse med få studier i stærkt design. Men der ses lovende resultater. Indsatser rettet mod psykologiske faktorer kan reducere den samlede symptombyrde, forbedre emotionelle symptomer og have positiv indvirkning på livskvalitet. Behandling bygger på principper af individuelt tilpasset, tværfaglig rehabilitering, som forankres i biopsykosocial forståelse af lidelsen, da bedringsprocessen afspejler et komplekst samspil mellem disse faktorer. Og der er behov for en langt mere aktiv tilgang til personer, der er i risiko for et langvarigt forløb