What is Active Rehabilitation for Persisting Symptoms after Concussion (PSaC)?

Active rehabilitation is a type of therapy used to help people recover from persistent symptoms after a concussion. When someone has symptoms like headaches, dizziness, or difficulty concentrating for weeks or months after a concussion, it’s called “persistent concussion symptoms.” Active rehabilitation includes a combination of physical, cognitive, and functional activities.

Physical activities often include light exercises like walking or biking, done at a sub-maximal threshold, which means just below the level that would worsen symptoms. This helps safely improve the body’s tolerance to activity without triggering symptoms. For cognitive activities, it involves gradually reintroducing school or work tasks, like reading or computer use, with frequent breaks. This structured approach helps improve mental stamina and focus.

Additionally, a return-to-school or return-to-work process is part of active rehabilitation. It starts with simple tasks like short assignments or a few hours of work and slowly increases as the person’s tolerance improves. By using sub-maximal threshold activities and adjusting intensity, active rehabilitation supports a safe and effective return to regular daily routines.

What is Sub-Maximal Threshold Activity?

Sub-maximal threshold activity refers to exercise or physical activity or cognitive activity performed at an intensity level just below the point where symptoms worsen or become uncomfortable. The goal is to stay within an effective range that promotes recovery without overloading the body or brain and triggering symptoms that impact function. This is commonly used in concussion rehabilitation to help the body gradually build tolerance to activity while avoiding setbacks.

What is the best way to develop and carry out an active rehabilitation protocol for PSaC?

To carry out an active rehabilitation protocol, start by developing a daily schedule that includes both physical and cognitive activities. Work with your healthcare team, including:

1. Occupational Therapist (OT): They help create a structured rehab plan that balances cognitive tasks (like reading or using a computer) with rest periods, ensuring you don’t overexert. They can also support your return to school or work by gradually increasing task difficulty.

2. Physiotherapist: They design a physical activity plan that uses sub-maximal threshold exercises, such as light aerobic workouts or stretching. This plan should be done daily, with the intensity increasing gradually based on your symptom tolerance.

3. Psychotherapist: They provide strategies for emotional regulation and stress management, which are crucial for handling frustration or anxiety related to persistent symptoms.

Consistency is key—perform your rehab activities every day and adjust the schedule as recommended by your therapists. Regular check-ins with your team help monitor progress and make necessary adjustments for an effective recovery.

An active rehabilitation protocol and calendar template can be found here.