Exercise assessment and aerobic exercise training for postconcussion syndrome (PCS) may reduce concussion-related physiological dysfunction and symptoms by restoring autonomic balance and improving cerebral blood flow autoregulation. In a descriptive pilot study of 91 patients referred to a university clinic for treatment of PCS, a subset of 63 patients were contacted by telephone for assessment of symptoms and return to full daily functioning. Those who experienced symptoms during a graded exercise treadmill test (physiologic PCS, ) were compared to those who could exercise to capacity (PCS, ). Both groups had been offered progressive exercise rehabilitation. Overall 41 of 57 (72%) who participated in the exercise rehabilitation program returned to full daily functioning. This included 27 of 35 (77%) from the physiologic PCS group, and 14 of 22 (64%) from the PCS group. Only 1 of the 6 patients who declined exercise rehabilitation returned to full functioning. Interpretation of these results is limited by the descriptive nature of the study, the small sample size, and the relatively few patients who declined exercise treatment. Nonetheless, exercise assessment indicates that approximately one third of those examined did not have physiologic PCS. 1. Introduction Concussion is most commonly defined as a trauma-induced alteration of mental status that may or may not involve loss of consciousness [1]. Traumatic brain injury and concussion are leading public health problems in the USA [2]. Rates of traumatic brain injury are highest for young children and men, most often from falls and motor vehicle accidents [2]. Sport-related concussion is also a leading public health problem with an estimate of 1.6 to 3.8 million each year in the United States alone [3]. While 85% of these injuries are considered to be mild, a proportion of them may have long-term effects [4]. There is increasing awareness regarding the personal, medical, and societal costs of concussion, including the reported effects of repeated concussions [5–8]. While most patients who suffer a concussion experience resolution over the course of 7–10 days, up to 10% of patients continue to have symptoms [9, 10]. Postconcussion syndrome (PCS) is a constellation of physical, cognitive, and emotional symptoms that persist after concussion [11]. Currently, there is no gold standard for diagnosis of PCS. DSM IV [12] and WHO ICD-10 [13] diagnostic criteria for PCS are symptom based and often lack agreement and specificity. Large differences in the prevalence of PCS have been observed when both criteria are
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