Buffalo Concussion Treadmill Test (BCTT)

Exercise is medicine... and an evidence-based treatment for concussion. The Buffalo Concussion Treadmill Test was created to test for cerebral blood flow impairments and/or subsequent recovery.  According to Leddy, the test, "has been shown to diagnose physiologic dysfunction in concussion safely and reliably, differentiate it from other diagnoses (e.g., cervical injury), and quantify the clinical severity and exercise capacity of concussed patients. It is used in PCS to establish a safe aerobic exercise treatment program to help speed recovery and return to activity." If a physiological cerebral blood flow dysfunction is found, the healthcare provider will prescribe a sub-threshold aerobic exercise program. Exercise is an evidence based treatment for concussion. BCTT can identify cerebral blood flow impairments and safely establish a sub symptom threshold exercise program. It's also used as part of a battery of tests to determine full concussion recovery/return to play.

Ask your healthcare provider if this is right for you. Return to exercise must be done by licensed healthcare provider who can safely return you to activity. It is important that the right activity be done at the right time, in the right dosage. This test may NOT be indicated for some people.

Leddy, J.J., & Willer, B. (2013). Use of graded exercise testing in concussion and return-to-management activity, Curr Sports Med Rep, 12(6), 370-376.

Write up by Molly Parker

John Leddy/ Buffalo Protocol- (And also the world's cutest boxing gloves.) In contrast to the previous advice of complete physical rest immediately following concussion, the Leddy Protocol encourages return to (some) play shortly following the injury. Subsymptom Threshold Exercise (SSTE) is calculated off of heart rate. The patient exercises until their concussive symptoms appear, and then perform at no higher than 80% of that heart rate for two weeks. This SSTE heart rate is re-calculated every two weeks until the symptoms disappear. Don't be discouraged if your SSTE is dramatically lower than the level at which you are used to exercising (mine started at 105!) Your brain is healing- give it a break. The brain needs adequate blood flow to heal, therefore exercise (and the increased brain blood flow exercise involves) seems to be replacing the current silent-dark-room theories of recovery. Two activities perfect for cardio while keeping a low heart rate are water aerobics and the recumbent bike. This protocol is incredibly effective for those mTBI patients with little symptoms at rest, but sudden, debilitating symptoms with exercise.

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