2 studies provide clarity on concussion recovery
Friday, January 27, 2017
For a parent with a child suffering a brain injury, the decisions regarding care can be confusing. According to two recently published studies, rest immediately after a sports-related concussive event and physical activity within one week of the event are factors in improved outcome after a pediatric concussion.
Getting up and moving within a week after a sports-related concussion was shown to contribute to a better outcome in a recent study published in the Journal of American Medical Association. Anne M Grool, M.D., Ph.D., from the Children's Hospital of Eastern Ontario Research Institute in Ottawa, and colleagues reviewed information from the records of 3,063 children between the ages of 5 and 18 from nine different emergency centers.
They reported that the postconcussive symptoms that were still present at 28 days after the concussive event were lower when associated with physical activity within the first week, compared to the rate when there was a routine of conservative rest for the week following the event. The difference was significant — 28.7 percent of those with physical activity in the first week reported symptoms at 28 days compared to 40.1 percent of those having had rest during the first week.
The type of post-concussion physical activity varied: light aerobic exercise (32.9 percent), sport-specific exercise (8.9 percent), noncontact drills (5.9 percent), full-contact practice (4.4 percent) and full competition (17.4 percent). The percentage of those who had no physical activity was 30.5 percent.
"Although strenuous exercise in patients recovering from concussion may be deleterious and increase reinjury risk, recent literature suggests that protracted rest may hamper concussion recovery, leading to secondary symptoms of fatigue, depression, anxiety and physiological deconditioning," said Roger L. Zemek, M.D., a pediatric care specialist at Children's Hospital of Eastern Ontario Research Institute.
"Increasing evidence suggests the introduction of controlled, light aerobic physical activity following pediatric concussion may be safe while promoting recovery by enhancing physical, psychological and academic outcomes."
Rest immediately after a concussive event was demonstrated to improve outcomes, according to a separate study. The work was also a prospective observational study and evaluated 95 cases of patients between the ages of 11 and 19 who were seen within seven days of their concussion. The study defined rest as no school, no schoolwork at home, no computer games, no activity that would increase symptoms and no activity that would elevate heart rate.
Lead author Bruce Taubman, M.D., from the Department of Pediatrics and Division of General Pediatrics at the University of Pennsylvania Perelman School of Medicine in Philadelphia, and colleagues concluded that those who had rested immediately after the event had a more rapid recovery.
An extensive review of the literature was the work of a team led by Quinton Sawyer, an athletic trainer for the NBA's Phoenix Suns and part of the Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences. The report published last fall stated that the evidence supports that an initial period of rest is beneficial, but further research is needed to determine what is optimum quality and quantity of rest.
Furthermore, while there is some evidence that low levels of exercise may benefit an athlete, this too requires additional study.
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