Editorial: Rehabilitation Interventions for Mild Traumatic Brain Injury

Fahim Anwar^1,2*

• ¹Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
• ²Addenbrooke's Hospital Rehabilitation Medicine, Cambridge, United Kingdom

Traumatic brain injury is a significant cause or mortality and morbidity worldwide. Traditionally, traumatic brain injury is classified a mild, moderate and severe in nature. Mild traumatic brain injury (mTBI) is the most common injury compared to the moderate and severe category. The recovery pattern from a mTBI is highly heterogenous with many patients recovering withing day to weeks. However, a significant proportion of mTBI patients will experience persistence of constellation of symptoms ranging from physical, cognitive, vestibular and emotional in nature. The variability in outcomes after mTBI enforces the importance of early assessment and tailored rehabilitation to reduce the impact of their symptoms on the overall quality of life. It also reinforces the need for ongoing research and innovative rehabilitation interventions to address the challenges faced by these individuals which in some case could be lifelong.The research topic "Rehabilitation Interventions for Mild Traumatic Brain Injury" has brought together five articles with diverse and innovate topics exploring the rehabilitation interventions to address the multifaceted challenges of mTBI. These topics range from symptom burden to functional connectivity, and from novel neurostimulation approaches to culturally integrative and holistic management of mTBI.Mercier and colleagues [1] in the study evaluated a 12-week aerobic exercise intervention in adults with persisting post-concussion symptoms. The study included 50 adult mTBI patients who completed a 12-week sub-symptoms threshold aerobic exercise programme. The study provides compelling evidence that individualised aerobic activity is associated with reduce symptom burden, improvement in overall quality of life, improvement in exercise tolerance and dizziness, even in patients with long-standing exercise intolerance. The study also showed that there was no change in autonomic markers such as heart rate variability. This suggested that the symptom improvements were primarily due to the neuroplasticity rather than the direct autonomic recalibration.In a case study, exploring the rapidly developing field of neuromodulation, Riccitelli et al [2] . used a focal-coil transcranial magnetic stimulation (rTMS), combining inhibitory stimulation on the right dorsolateral prefrontal cortex and excitatory on the left dorsolateral prefrontal cortex in a 34-year-old female with severe traumatic brain injury and complex psychopathology. After two weeks of treatment, the patient showed decreased impulsivity and obsessive-compulsive symptoms along with improvement in attention and processing speed. There was further reduction in in the impulsivity at 4-weesks with persistent positive effect observed at 8-weeks. These findings suggest the importance of managing the psychological effects of traumatic brain injury with a novel technique and further exploration of this in clinical trials.A similar innovative approach was described by Chu et al [3] . where an experimental device was used to deliver a translingual neural stimulation (TLNS) during focussed physical therapy session for two weeks in mTBI patients to improve gait and balance. A resting-state fMRI pre and post-intervention was used to collect datasets. The study found that TLNS was an effective tool in increasing somatosensory processing, vestibular-visual interactions, control and flexible shifting. The authors suggested that this could be an effective approach to induce brain plasticity and could serve as a potential therapy for mTBI for improving gait and balance-related deficits in the future for this population.In addition to the innovative techniques, the research topic also included a systematic review and meta-analysis evaluating the synergistic effect of acupuncture combined with hyperbaric oxygen therapy in TBI patients by Li et al [4] . This review included 11 randomized controlled trials involving 896 participants and found that the combination therapy significantly improved Glasgow Coma Scale (GCS) scores, consciousness recovery, and the overall treatment was effective as compared to hyperbaric oxygen alone. These findings highlight the importance of integrating traditional therapeutic modalities with contemporary neurorehabilitation to optimize outcomes in in different clinical setting.Finally, Wu et al [5] . conducted a single-centre randomised controlled trial investigating the perioperative use of hydrogen inhalation in patients undergoing glioma surgery, with implications for TBI-related brain oedema. Although glioma surgery lies outside the strict mTBI domain, the study provides characteristic insights into neuroprotective properties of hydrogen inhalation for managing brain oedema due the secondary brain injury, particularly as a non-invasive and anti-inflammatory interventions. Hydrogen inhalation significantly reduced brain oedema and improved postoperative sleep and pain scores. These findings suggest a potential use of the technique in mild to moderate TBI patients to reduce oedema and prevent secondary brain damage after brain injuries.Overall, this research topic has explored the evolving landscape of rehabilitation interventions following mTBI. The studies have focussed not only on the complexity of the symptoms but also the potential for recovery through the patient-centred conventional and non-conventional interventions. As a topic editor, I commend all the authors for their methodological robustness, innovative ideas and clinical application of their ideas to improve the quality of life of patients with mTBI but with diverse symptomatology. These studies highlight that there not a one-size-fits-all solution for patients with mTBI but rather an adaptive rehabilitation process informed by neurobiology, function, and lived experience. Future research should aim to refine treatment algorithms, personalize interventions, and ultimately bridge the gap between emerging evidence and routine clinical practice.