February 23, 2023
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Evidence-based guidelines for treating youth with lingering concussion symptoms are limited. But a preliminary study suggests that the combination of breathing exercises and a gradual return to aerobic activity can help reduce these symptoms.
It generally takes one month for teenagers to recover from a concussion, but some experience lingering physical, cognitive, emotional or sleep-related symptoms that interfere with their daily activities.
Evidence-based guidelines for treating youth with lingering concussion symptoms are limited. But a preliminary study suggests that the combination of breathing exercises and a gradual return to aerobic activity can help reduce these symptoms.
The most common symptoms associated with a slow recovery include headaches, dizziness, depression, mood changes and difficulties with memory and concentration.
"When someone has a concussion, it can affect the body's autonomic nervous system, and it is increasingly clear that this underlies the inability to tolerate exercise, problems with thinking skills and mood issues in those with persisting symptoms," said researcher R. Davis Moore, of the University of South Carolina.
"Our study used a handheld biofeedback device to help people train their breathing to match their heart rate patterns. This can help balance the autonomic nervous system and manage symptoms."
After a concussion, a person's heart rate variability – the range in the time between heartbeats – also tends to change. Though it usually returns to normal over a few weeks, it may remain elevated among patients with persisting symptoms.
The study divided 30 teenagers, who had lingering symptoms from concussions sustained while playing sports or engaging in other recreational activities, into three groups. The first used a computer program to practice breathing at a slow rate for 20 minutes, four nights each week. The second exercised three times each week, gradually increasing the intensity and duration of their workouts. The third group completed both the workout regimen and the breathing exercises.
All three groups saw improvements in their post-concussive symptoms, but the third group saw the greatest improvements. That group saw greater reductions in overall symptom severity, depression symptoms and mood disturbances. They also had better improvements in heart variability and attention and memory skills.
These therapies are inexpensive and easily can be self-administered, which make them accessible to all concussion patients with persistent symptoms, the researchers said. But studies on larger groups of people are needed to confirm the findings.
A concussion is a type of traumatic brain injury—or TBI—caused by a bump or blow to the head, or by a hit to the body that jolts the head. They cause sudden movement to the brain, which can damage cells and create chemical changes in the brain.
Symptoms can vary, but the most common include amnesia, disorientation, brain fog, slurred speech, headaches, dizziness, hypersensitivity to noise and visual disturbance. The number of initial symptoms a person experiences and their severity is the best determination for how long recovery will take. For most adults, recovery takes about two weeks. For children, it takes about one month.
In 2021, concussion experts published new guidelines that advise against too much bedrest after a concussion because it can prolong symptoms and lead to a slower recovery.
According to the guidelines, risk factors for a more complicated recovery include younger age, previous concussion history, loss of consciousness for more than a minute and preexisting conditions like migraine, attention deficit hyperactivity disorder, learning disabilities, mood disorders and motion sickness.
A gradual return to moderate aerobic exercise during the first week after a concussion can help promote a quicker recovery, prior studies have shown. Concussion treatment generally focuses on the particular symptoms of a patient, and includes cognitive behavioral therapy and improved sleep, nutrition and hydration.
The findings of the latest study will be presented at the American Academy of Neurology's annual meeting, held in Boston from April 22-27.
