December 23, 2021Michael Hutchison, PhD RKin

Partnering with clinics to create better outcomes for concussion

Rhea & The Active Recovery Approach: Overcoming the challenges for clinics to create better outcomes for concussion treatment

Over the past decade, significant research has been conducted into the best way to treat concussion.  This has culminated in Rhea’s Active Recovery approach, which calls for an early, gradual return to activity versus total rest and complete removal of stimuli. Rhea was developed at the University of Toronto by kinesiologists and physicians, leaders in the field of concussion research and treatment.

Active Recovery: How can clinics create better outcomes for concussion treatment?

The management and treatment of concussion can be challenging for both patients and practitioners, however Active Recovery has shown to be beneficial for patients in several areas. 

Given the individual and multifactorial nature of concussion symptoms, a one-size-fits-all approach is not an effective treatment approach and “recovery” is recognized as process driven, where individuals are advised to move through a gradual progression of functional capacity based on symptoms and goals. This leads to challenges accessing interdisciplinary clinics with rehabilitation expertise, patient education, and treatment adherence. Tracking a patient’s progress and response to treatment is critical for effective therapeutic approaches and recovery but is time-consuming and frequently limited to patient recall. Patients can be either vague on symptom improvement or hypersensitive to changes in symptoms; regardless, this can lead to less than optimal patient outcomes in the clinical setting where typical follow-up times are every 1 to 2 weeks.


The Active Recovery Approach to Concussion: What’s the evidence?

Recent research has shown that an active approach creates better outcomes for concussion treatment. While the active approach is becoming more widely accepted, there are limited effective, individualized, and responsive interventions that are easy to implement with corresponding educational support to reinforce adherence to the protocols.1 Moreover, concussions often require the management of multiple symptoms and systems, such as neck injuries, vestibular issues, mood disorders, sleep disturbance, and cognitive deficits. Addressing and prioritizing the multi-system nature of concussion is time-consuming. Leveraging the intersection between technology and health care enables practitioners to more efficiently manage and track recovery of their patients. The overlapping and interactive nature of multiple body systems in postconcussion presentation challenges the acumen of even the most astute clinician.2

What is Rhea’s unique approach to Active Recovery?

At Rhea, we’ve relied on the growing body of evidence for Active Recovery to create a platform that shows patients can recover faster and more fully following this path. Initially, the utility of aerobic exercise was examined in those with persistent systems, whereby researchers found a reduction in symptom burden and recovery time following the use of a standardized sub-symptom exacerbation aerobic exercise intervention.3  Since the initial work in those with persistent symptoms, we have seen a consistent increase in studies investigating the use of aerobic exercise early following injury. In addition, our University of Toronto team found that early initiation of aerobic exercise following acute concussion was associated with a faster full return to sport and school or work.4  More recently, findings from randomized controlled trials have emerged; Leddy and colleagues conducted the first randomized controlled trial with a large sample size and showed that individualized sub-symptom threshold aerobic exercise treatment prescribed to adolescents with concussion symptoms during the first week following sport-related concussion increases the speed of recovery and may reduce the incidence of delayed recovery.5

One of the main limitations/drawbacks for patients who want to follow an active rehab approach post-concussion is the lack of guidance for exercise outside of in-person appointments. No well-defined protocols exist that clearly outline specific exercises and movements that are tailored, individualized, and responsive to meet the precise needs of a patient every step along their path to recovery; including the frequency, intensity, type, and duration of activity required to optimize healing…until now. Rhea’s Active Recovery approach provides specific details for the type and intensity of exercises that will benefit patients throughout their recovery. Rhea’s Active Recovery includes functional movements eliciting specific intensity, head acceleration, coordination, sensory and cognitive load elements.

Also, Active Recovery extends beyond aerobic exercise given patients require specific rehabilitation based on symptoms and injury mechanism. We have observed the emergence of concussion subtypes, including cognitive, ocular-motor, headache/migraine, vestibular, anxiety/mood, and cervicogenic, and concussion-associated conditions such as sleep disturbance. Specific symptom clusters and complaints require directed intervention, and Rhea provides these therapeutic exercises digitally, recommending professionals for in-person treatment if necessary.

What are the Benefits for Clinics and Practitioners?

Rhea is a browser-based platform that can be accessed on a smartphone, desktop or smart TV and your patients will not need any special equipment to follow the recovery plan. There are four key benefits Rhea provides:

1. Create a tailored, full recovery strategy for patients in minutes

Use Rhea to prescribe evidence-based exercises that patients can do at home between appointments. Each plan comes with interactive videos showing patients exactly how to perform each exercise, ensuring that your patient remembers what to do next.

2. Detailed tracking of patient progress between appointments

Rhea allows patients to track their symptoms and share their progress between appointments. This helps to improve patient recall and significantly reduces the length of time needed for follow-up appointments, which often require individualized attention and care.

3. Peace of mind for your patients

Our platform is a convenient source of information that you can provide directly to patients. Referring them to Rhea helps to address any questions or concerns they might have when they get home, avoiding setbacks and concerns between appointments, and freeing up valuable time during short appointments.

4. Monitor additional touchpoints

Rhea gathers medical data and insights from a patient’s everyday life to flag any changes in symptoms that could ordinarily go undetected for weeks between in-person appointments. This also provides a patient structure and guided autonomy during the recovery process.

How can you implement Rhea’s Active Approach to recovery in your practice?

Your patients can get started by going to and creating an Active Recovery plan. If you would like to speak with us or receive additional information or a demo, you can also connect with us at to realize the benefits of Rhea within your operations.




  1. “How Do We Meet the Challenges of Assessing and Managing Concussion?” in Journal of Orthopaedic & Sports Physical Therapy, Volume 49, Number 11, page 766, November 2019.

  2. Ibid., page 767.

  3. Leddy J, Hinds A, Sirica D, Willer B. The Role of Controlled Exercise in Concussion Management. PM R. 2016;8(3 Suppl):S91-S100.

  4. Lawrence DW, Richards D, Comper P, Hutchison MG. Earlier time to aerobic exercise is associated with faster recovery following acute sport concussion. PLoS One. 2018;13(4):e0196062.

  5. Leddy JJ, Haider MN, Ellis MJ, Mannix R, Darling SR, Freitas MS, et al. Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatr. 2019;173(4):319-25.

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