In October, 2015, leading concussion clinicians and researchers
gathered at UPMC in Pittsburgh for the “Targeted Evaluation and Active
Management” (TEAM) symposium, an unprecedented meeting and white paper
designed to propose and share nationally the participants’ agreement on
the best practices, protocols and active therapies for treating
concussions.
The conference discussions, led by chair Micky Collins, Ph.D., director of the UPMC Sports Medicine Concussion Program, along with co-directors Anthony Kontos, Ph.D., and David Okonkwo, M.D., Ph.D., of UPMC and the University of Pittsburgh, resulted in the Statement of Agreement publication. The two-day meeting was fully funded by a grant from the NFL Foundation.
“This conference was remarkable because it brought together a
diverse group of leading experts in cutting-edge research and clinical
treatment to approach this injury in ways that will help move concussion
treatment forward,” said Anthony Kontos, Ph.D., research director for
the UPMC Concussion Program, associate professor in the University of Pittsburgh Department of Orthopaedic Surgery.
The U.S. Center for Disease Control (CDC)
estimates that as many as 4 million concussions occur each year in the
U.S., and sport- and recreation-related concussions in particular have
increasing incidence. Symptoms, which can be subtle and last days or
weeks, include but are not limited to headache, confusion and nausea.
“There has been only limited evidence-based guidance, particularly
for primary care providers, about the active treatment of concussion,”
Dr. Collins said. “This makes it difficult for clinicians to determine
how best to treat patients with this injury. Many are treating patients
with concussion using a uniform, rest-based approach today much the same
way they did a decade ago.”
Doctors typically advise patients to rest—both the brain and
body—until symptoms abate, which might require accommodations at school
or work. If the injury was sustained during sports, the patient is
instructed not to return to play on the same day and to gradually
increase aerobic, exertion-based activity while symptoms are carefully
monitored.
But, as described at the symposium and in the published Statement
of Agreement, research is beginning to show active rehabilitation can
help people recover more quickly and safely than simply resting.
“More research in large, multicenter trials is needed to figure out
what kinds of treatments are most effective for a set of symptoms and
for individual patients,” Dr. Collins said. Most importantly, we believe
concussions are treatable and patients can and do get better.”
A 2015 Harris Poll of more than 2,000 U.S. adults found that 71
percent did not recognize that concussions are treatable. In the same
report, 1 in 3 patients who had been diagnosed with a concussion
reported receiving no prescribed treatment.
“The purpose of the UPMC symposium was to engage leading clinicians
and scientists in a discussion of what we know about concussion and its
treatment,” Dr. Okonkwo said. “We hope to build on this effort to share
the best available information to improve public understanding and
guide future research.”
The authors feel the Statement of Agreement is a step forward in the field and will lead to a collaborative era.
“Over the past decade, many of us individually have accumulated
quite a bit of experience about which treatments work for specific
symptoms and deficits caused by concussion. We are looking forward to
working together to rigorously test these treatments,” said David Brody, M.D., Ph.D., co-author and professor of neurology, Washington University School of Medicine in St Louis.