Neuroplastic principles in the treatment of concussion
Concussion, also called mild traumatic brain injury, in most cases does not involve structural damage that can be seen on images, but a disruption in how the brain functions. The symptoms arise largely as a result of an altered interaction between different systems in the brain, especially the visual, vestibular, proprioceptive and autonomic systems.
In this context, neuroplasticity, or the brain's ability to reorganize itself as a result of experience, becomes crucial. It is this ability that explains both why symptoms can arise and persist, and how the brain can regain normal function.
Research on neuroplasticity describes several principles for how the brain changes. These principles provide a useful framework for understanding and treating concussions:
1. "Use it or lose it" - What you don't use, you lose
The brain depends on activity to maintain function. If a system is used little over time, it will gradually function worse. After a concussion, it is often seen that patients begin to avoid what causes symptoms, such as light, movement, screen use or physical activity. This may be appropriate in the early phase, but if it persists, it can contribute to the systems becoming more sensitive. For example, reduced use of vision can contribute to increased sensitivity to light, and less movement can maintain or intensify dizziness. Therefore, it is important not to become completely passive over time. Instead, one should gradually begin to use the systems that are affected, in a calm and controlled way, so that the brain can rebuild itself.
2. “Use it and improve it” – What you use, gets better!
While lack of use can impair function, the right type of use can contribute to recovery. When you work purposefully on specific functions, the relevant networks in the brain are stimulated. Over time, this can help the systems function more efficiently and withstand more strain. In practice, this involves an active approach to rehabilitation, for example through vision training, balance training and gradual escalation of physical activity.
3. «Specificity» - Effect requires specificity
The brain adapts to what it is exposed to, which means that improvement occurs in what you are actually training! General measures will therefore not necessarily affect specific symptoms. If the problem lies in the visual system, this system must be stimulated. If balance or movement is the challenge, these functions must be trained. A good mapping of which systems are affected after a concussion is therefore crucial for effective treatment.
4. "Repetition matters" - Practice makes perfect!
For the brain to change over time, repetition or practice is required. Single interventions rarely have a lasting effect and it is often the accumulation of repeated repetitions or practice that is crucial for progress. This means that exercises must be carried out regularly, and that the work done between treatment sessions is crucial for progress and long-term change.
5. "Intensity matters" - The brain must be challenged
To achieve progress, the brain must be challenged, but the load must be properly dosed. Too low a load has little effect, while too high a load can lead to increased symptoms. The goal is to work within a level where the systems are stimulated without being overloaded. Gradual increase in load is therefore an important part of treatment.
6. "Time matters" - Timing is crucial
How and when you start treatment can affect the course. Early after a concussion, the brain is more sensitive, making it more susceptible to change. Later, compensation patterns can develop that cause symptoms to persist. If symptoms last for several weeks, it often indicates that the systems have not returned to balance on their own and need help to normalize. Although the brain is more susceptible to change in the early stages of a concussion, it is still possible to achieve major change with targeted treatment even in cases of long-term symptoms over several years and decades.
7. "Salience matters" - What counts, works
The brain responds best to what is experienced as relevant and meaningful. Exercises that are engaging, challenging and specific will often have a better effect than general exercises, because they activate the systems that are actually affected. If you can also find exercises that fit into the patient's everyday life or sports, this increases the effect considerably.
8. "Age matters" - Age affects neuroplasticity
Age affects the brain's plastic capacity. Younger brains generally have a greater and faster ability to reorganize, while older brains often respond more slowly and may require more repetition and intensity to achieve results. In practice, this means that children and adolescents often recover faster, while adults may need more structured and long-term rehabilitation. Nevertheless, plasticity is present at all ages, and targeted training can provide significant functional improvement regardless of age. It is never too late to have a better everyday life!
9. «Transference» - Training has a transferable effect
The systems in the brain influence each other. For example, better physical capacity can increase tolerance for both cognitive and sensory load, and vision training can contribute to better balance. This is an important reason why different measures are often combined in the treatment of concussion or post-concussion, to achieve a more comprehensive effect.
10. "Interference" - Disturbances inhibit
Neuroplasticity can also have negative consequences, as the brain learns strategies that are not appropriate. For example, after a concussion, compensatory patterns may develop, such as limiting movement or using the body in a way that avoids symptoms. Although this is often felt to be necessary and protective in the short term, over time it can contribute to maintaining and exacerbating the symptoms. Treatment is therefore not only about building function, but also about identifying and gradually changing such patterns, so that the brain learns more appropriate strategies.
These principles demonstrate that recovery from concussion or post-concussion is not simply about waiting for symptoms to subside, but about actively influencing how the brain functions through targeted activity. Effective treatment involves working specifically with the systems affected, repeating the load over time, adjusting intensity, and gradually increasing tolerance. The goal is not just to reduce symptoms, but to regain normal function and capacity.
Sources
Kleim, JA, & Jones, TA (2008). Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. Journal of Speech, Language, and Hearing Research, 51(1), S225–S239.
