Network Analysis and Precision Rehabilitation for the Post-Concussion Syndrome
- 1Department of Physical Medicine and Rehabilitation, Harvard Medical School, United States
- 2Spaulding Rehabilitation Hospital, United States
- 3Home Base clinic, United States
- 4Sports Concussion Program, MassGeneral Hospital for Children, United States
Some people experience persistent symptoms following a mild traumatic brain injury (MTBI), and the etiology of those symptoms has been debated for generations. Post-concussion-like symptoms are caused by many factors both before and after MTBI, and this nonspecificity is the bedrock of the conundrum regarding the existence of the post-concussion syndrome. A latent model or common cause theory for the syndrome is inconsistent with the prevailing biopsychosocial conceptualization. It is the thesis of this paper that adopting a network perspective for persistent symptoms following MTBI, including the post-concussion syndrome, could lead to new insights and targeted treatment and rehabilitation strategies. The network perspective posits that symptoms co-occur because they are strongly inter-related, activating, amplifying, and mutually reinforcing, not because they arise from a common latent disease entity. This approach requires a conceptual shift away from thinking that symptoms reflect an underlying disease or disorder toward viewing inter-related symptoms as constituting the syndrome or disorder. The symptoms do not arise from an underlying syndrome—the symptoms are the syndrome. A network analysis approach allows us to embrace heterogeneity and comorbidity, and it might lead to the identification of new approaches to sequenced care. The promise of precision rehabilitation requires us to better understand the interconnections among symptoms and problems so that we can produce more individualized and effective treatment and rehabilitation.
Keywords: concussion, Traumatic Brain Injury, Rehabilitation, Postconcussional syndrome, Depression
Received: 16 Feb 2019;
Accepted: 23 Apr 2019.
Edited by:Karen M. Barlow, University of Queensland, Australia
Reviewed by:Brad G. Kurowski, Cincinnati Children's Hospital Medical Center, United States
Alessandro Giustini, Consultant, Italy
Copyright: © 2019 Iverson. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Prof. Grant L. Iverson, Harvard Medical School, Department of Physical Medicine and Rehabilitation, Boston, United States, firstname.lastname@example.org