After a brain injury, common sense would seem to dictate taking it easy for a while to promote recovery. Now new research tells us we may be better off if we resume activity sooner.
While postsurgical patients are often urged to get moving as soon as possible, this has not been the recommendation following a brain trauma. It has long been thought that initiating activity too soon could exacerbate the injury, due to concerns about the sensitivity of the brain to compromised blood flow. But Edward Manno, MD, and Kate Klein, RN, suspected otherwise. Manno, director of the Neurointensive Care Unit at the famed Cleveland Clinic, and Klein, a nurse in the unit, decided to investigate how the timing of activity affected the progress of more than 600 patients with brain injury over the course of a year.
Klein found a clear correlation between the timing of rehabilitation and how long patients required critical care. Those who began activity sooner spent less time in intensive care and were also discharged from the hospital sooner than patients who started later. Moreover, the earlier return to activity didn’t increase risks of fatality or serious health outcomes (such as blood clots).
“They have less pressure ulcers, less infections and spend less time on the ventilator if they need ventilator therapy,” notes Klein about these faster-healing patients in an NPR post. “And most say they feel a lot better.”
Beyond these benefits, getting up and going sooner can also be a boon to the brains of these patients. This is partly due to the brain’s natural ability to rewire itself following a trauma. It forms new connections (known as synapses) to adapt to the injury, enabling non-injured areas of the brain to assume new functions. Physical activity, even in limited amounts, can help stimulate this rewiring process.
It doesn’t take much activity to increase the likelihood of certain positive outcomes. In a study reported in Frontiers in Psychology, improvements in emotional wellbeing—including a reduction in depression and anxiety—occurred in patients after just one session of exercise. This benefit was seen whether the session involved exercise of high or moderate intensity. An added plus: The association of a positive mood with the exercise makes patients more likely to incorporate exercise into their lifestyle, which then helps improve overall health.
Exercise before brain injury improves the prognosis
Animal studies reveal an even wider-ranging role in recovery from brain injury. Researchers at the University of Kansas Medical Center found that mice engaging in six weeks of exercise prior to trauma had fewer post-injury deficits in cognition and motor function compared to mice that didn’t exercise. Other rodent research has shown that spontaneous exercise following injury improves neuronal plasticity and cognitive function.
Back on the human front, initiating activity sooner after brain injury can be challenging, since these patients often find it very difficult to even get out of bed. Cleveland Clinic has met this challenge by installing ceiling-mounted lifts at each patient’s bedside in the Neurointensive Care Unit. Nurses are also being trained to move patients in a safe manner.
Accelerating resumption of activity for these patients seems to be a win-win strategy. It not only results in an earlier return to one’s family and/or job, but also cuts overall healthcare expenses by reducing time spent in the hospital. Let’s hope that the scenario reported in the Cleveland Clinic will become the new standard of care for this type of patient.