Exercise Reset for Concussion: Modifying the Buffalo Concussion Protocol for Application in a Military Environment
Abstract
Objectives and Rationale: While it guides activity type and duration after concussion, the current DOD Clinical Recommendation for Return to Activity After Concussion does not specify activity intensity, nor is it individually tailored to each patient. The only treatment that has been shown to safely speed concussion recovery is the Buffalo Protocol, i.e., prescription of personalized aerobic exercise based on treadmill exercise test performance. It has been shown to improve recovery in adults with persistent symptoms, and we have also shown that the Buffalo Protocol prescribed to patients within 10 days of concussion speeds their recovery and prevents many from experiencing persistent symptoms (i.e., symptoms lasting more than 1 month). The goals of the proposed work are to show that early aerobic exercise safely improves concussion recovery, speeds return to duty (RTD), and reduces persistent symptoms in concussed service members (SM). We also plan to investigate mechanisms for the beneficial effect of exercise on the concussed brain. FY21 TBIPHRP CTA Treatment Focus Areas to Be Addressed: (a) Interventions that promote sustained functional recovery, including those administered acutely or during the post-acute phase; (b) Effective assessments and interventions for delivery in rural or other resource-limited environments; (c) Novel therapeutic candidates based on theoretical mechanisms of traumatic brain injury and psychological health; (d) Personalized medicine approaches to treatment that may include tailoring treatment to the biological elements of injury; (e) Clinical effectiveness studies comparing novel capabilities to the standard of care; and (f) Understanding mechanisms of action for existing evidence-based treatments. Question to Be Addressed: The question to be addressed is whether early, individualized aerobic exercise safely improves concussion recovery, speeds RTD, and reduces persistent symptoms in concussed SM when compared with usual care. We will also demonstrate the clinical utility of our newly developed exercise test, called the Buffalo Concussion March-in-Place Test. Developed to mimic the Buffalo Concussion Treadmill Test, it measures tolerance to exercise after concussion without the need for equipment and is therefore field-ready. We will also determine fundamental mechanisms for the effect of early exercise treatment on concussion recovery. The research will inform the development of Defense Health Agency standards of care as well as clinical recommendations and RTD guidelines for concussed SM. How the Research Will Improve Understanding and Treatment of Concussion: The proposed work is innovative because it will determine basic mechanisms of action for the beneficial effect of exercise on concussion recovery in SM, which will inform future treatments. The ability to perform the test in the field will allow for earlier diagnosis and earlier treatment to speed recovery and reduce the risk of persistent symptoms that negatively impact SM readiness for duty. Early exercise treatment may also accelerate physiological recovery or reverse physiological dysfunction; thus, the Buffalo Protocol may prevent potential long-term negative health consequences for concussed SM and Veterans. Potential Clinical Applications, Benefits, and Risks: The proposed study will positively impact healthcare for SM and Veterans recovering from concussion by delivering an evidence-based treatment to military rehabilitation specialists that incorporates objective assessment and more proactive and individually tailored activity to safely speed recovery, return concussed SM earlier to limited/light duty and/or to specific deployment readiness, and reduce persistent symptoms. There are minimal risks since no significant adverse effects of the Buffalo Protocol have been reported in thousands of concussed civilians over the past 10 years. Benefits to SM and Veterans: The Buffalo March-in-Place Test d
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2211115
Entities
People
- John Leddy
Organizations
- United States Army
- University at Buffalo