Outdated Advice for Prolonged Rest May Slow Concussion Recovery

Increasing evidence supports light activity

Outdated Advice for Prolonged Rest May Slow Concussion Recovery

When it comes to caring for a person who’s been diagnosed with a concussion, taking the proper precautions is necessary for a speedy recovery.

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For many years, the generally accepted guidelines for treating concussion called for the patient to completely avoid activity or too much stimulation in the days following diagnosis. The thinking was that avoiding stimulation would speed recovery.

A new study says there is no clear evidence that this approach benefits the concussion patient.

Some activity is okay

The study, led by researchers from Children’s Hospital of Eastern Ontario, looked at data from more than 3,000 children and teens between the ages of 5 and 18. These youngsters had been diagnosed with acute concussions by emergency department physicians.

One group participated in light activity in the first seven days following diagnosis, while the other group did nothing but rest. After rating each child’s physical activity participation and post-concussive symptom severity using standardized questionnaires at day seven, the researchers assessed persistent post-concussive symptoms at day 28.

Researchers found that the group who performed light activities actually had a lower risk of post-concussion symptoms after a month than did the group that refrained from activity. A long period of inactivity can lead to fatigue, depression, anxiety and loss of physical conditioning, the study says.

The study results appeared recently in the Journal of the American Medical Association.

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New views in treatment

Until now, physician advised their young concussion patients to stay home from school and curtail mental activities such as reading or watching television.  Recommendations also included avoiding any physical activity until symptoms ended.

Although post-concussion symptoms usually go away within three months, some can last a year or more.

These guidelines were based on physician consensus and precautionary principles, the study says. High-quality research was scarce.

But now, evidence is building that limiting activity too much after a concussion might not be good for the long haul, says neurologist Andrew Russman, DO.

The study from Children’s Hospital adds to other recent research that suggests that prolonged rest may hamper concussion recovery and that the introduction of controlled, light aerobic physical activity following concussion may be safe while promoting recovery.

The gradual resumption of activities could begin as soon as tolerated provided there is no increased risk of re-injury, the study says.

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Dr. Russman advises patients who are recovering from a concussion to refrain from activities that worsen symptoms, but not to avoid the things that don’t make them feel worse.

“There’s good evidence that if we avoid doing lots of activities, then once we start resuming those activities, we’re much more sensitive to them,” Dr. Russman says. “So it’s not a good idea for patients with a concussion to sit in a dark room for a long time or not expose themselves to the things that they normally encounter in their environment.”

Sleep peacefully

Some generally accepted advice about concussion — such as constantly waking a concussion patient from sleep — is outdated and may even slow recovery progress, Dr. Russman says.

“There’s really no benefit to waking a child or an adolescent or an adult to check on them,” Dr. Russman says. “After the patient has had a sufficient period of observation by physicians to make sure they’re not developing areas of concern, then all we’re doing by waking someone up is depriving them of sleep.” 

It’s important for physicians and parents to stay up-to-date on the precautions and recommendations as more research is conducted on concussion recovery, Dr. Russman says.

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