Concussion study finds shorter rest period just as effective for adolescents

By David Templeton

Pittsburgh Post-Gazette

It might seem sensible for parents to “cocoon” their children so they can recover from a concussion.

That could mean five days in a darkened room devoid of superhero movies, music, bright lights and smartphone chirping, but a randomized controlled trial that a former University of Pittsburgh Medical Center fellow led found that the current regimen of quiet time until symptoms are gone followed by a step-by-step return to normal levels of activity is likely preferable to cocooning.

“Recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care,” an American Academy of Pediatrics study published online Monday in the journal Pediatrics states. “We also found that adolescents’ symptom-reporting may be influenced by restricting activity.”

Specifically, the study found little difference in 45 adolescents with traumatic brain injuries who underwent 24 to 48 hours of general rest with a step-wise return to a normal routine, as compared with 43 who underwent tighter restrictions in activity and school attendance for up to five days. The participants were age 11 to 22.

Little research has focused on the ideal rest time after a concussion, with clear evidence that physical or mental activity too soon afterward can impair recovery.

Micky Collins, clinical and executive director of the UPMC Sports Medicine Concussion Program, said concussions result from brain trauma that causes some chemicals to leave and others to enter brain cells known as neurons. That leaves the neurons depleted of energy, preventing their normal function until energy levels are restored.

Concussion effects can include problems with cognition, balance, mood and anxiety. Visual impairment, migraines, nausea and neck problems also can occur, depending on the type of concussion. Impacts may match problems the person routinely experiences, including migraines, motion sickness or problems with balance or vision.

“I thought the study was well done and methodologically sound, but honestly the results do not surprise me at all,” said Collins, who was not involved in the study.