Acute Cognitive and Physical Rest May Not Improve Concussion Recovery Time

Buckley, Thomas A.; Munkasy, Barry A.; Clouse, Brandy

doi:10.1097/htr.0000000000000165

Cited by 82 publications

(72 citation statements)

References 44 publications

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“…For example, patients who were advised immediately after concussion to rest for 2 days and then return to normal activities according to their symptoms recovered faster than those who were advised to maintain strict bed rest for 5 days. 71 In another investigation, 72 concussed patients in a rest group were withheld from activities, including classes, for the remainder of the injury day and the following day, whereas patients in a no-rest group were not provided any postinjury accommodations. The prescribed day of cognitive and physical rest did not reduce postconcussion recovery time, suggesting that light activity after concussion may not be deleterious to the recovery process.…”

Section: The Athlete With Prolonged Recoverymentioning

confidence: 99%

A Physiological Approach to Prolonged Recovery From Sport-Related Concussion

Leddy¹,

Baker²,

Haider

et al. 2017

Journal of Athletic Training

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Management of the athlete with postconcussion syndrome (PCS) is challenging because of the nonspecificity of PCS symptoms. Ongoing symptoms reflect prolonged concussion pathophysiology or conditions such as migraine headaches, depression or anxiety, chronic pain, cervical injury, visual dysfunction, vestibular dysfunction, or some combination of these. In this paper, we focus on the physiological signs of concussion to help narrow the differential diagnosis of PCS in athletes. The physiological effects of exercise on concussion are especially important for athletes. Some athletes with PCS have exercise intolerance that may result from altered control of cerebral blood flow. Systematic evaluation of exercise tolerance combined with a physical examination of the neurologic, visual, cervical, and vestibular systems can in many cases identify one or more treatable postconcussion disorders.

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Section: The Athlete With Prolonged Recoverymentioning

confidence: 99%

A Physiological Approach to Prolonged Recovery From Sport-Related Concussion

Leddy¹,

Baker²,

Haider

et al. 2017

Journal of Athletic Training

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“… Of the 16 studies, only five studies met the inclusion criteria: two randomized control trials, 6,7 two prospective cohort studies, 8,9 and one retrospective cohort study.…”

Section: Summary Of Search "Best Evidence" Appraised and Key Findingsmentioning

confidence: 99%

“…1 Our findings suggest that early physical activity during the acute phase of concussion (0-7 days) may decrease symptom severity and duration and ultimately influence time missed from academics or sport. Each reviewed article compared either early physical activity to strict physical rest 7,8,10 or a combination of physical and cognitive rest 6,9 ;…”

Section: Summary Of Best Evidence Implications For Practice Educatiomentioning

confidence: 99%

“…9 Participants concussed after the policy change underwent physical and cognitive rest with full academic withholding for one day following initial head impact with instructions to rest in a quiet environment. Participants concussed prior to the policy change did not receive any academic accommodation and were withheld from intercollegiate athletics if symptomatic, but were not restricted on any activity outside their athletic role.…”

Section: Summary Of Best Evidence Implications For Practice Educatiomentioning

confidence: 99%

“…Four studies [7][8][9][10] followed up within seven days, all five studies followed up within the first month, and one study 6 followed out to six months post-injury.…”

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confidence: 99%

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The Effects of Early Physical Activity Compared to Early Physical Rest on Concussion Symptoms

Lempke¹,

Jaffri²,

Erdman³

2019

Journal of Sport Rehabilitation

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Clinical Scenario: Currently, rest following concussion serves as the keystone of concussion treatment, but substantial evidence to support it is lacking. Recent literature suggests that early physical activity may be beneficial in reducing concussion symptoms which may influence clinical recovery time. Clinical Question: Does early physical activity decrease postconcussion symptoms compared to physical rest following concussion? Summary of Key Findings: A total of 5 articles were included that examined symptom duration changes at multiple time points. All 5 studies utilized follow-up time points compared to initial examination, but there was variance in the specific time points reported. Two studies employed control groups and compared strict or recommended rest to early activity or limited rest. Three studies were observational studies that directly compared baseline measurements to follow-up assessments. Clinical Bottom Line: Current evidence suggests that early physical activity in the acute phase following a concussion may decrease the time needed for symptom resolution compared to immediate rest. Strength of Recommendation: Using Centre for Evidence-Based Medicine 2011 level 3 evidence and higher, the results suggest that early physical activity during the acute phase of a concussion may decrease symptom duration; however, a lack of high-quality studies and inconsistent interventions are limitations to this recommendation.

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Effect of Screen Time on Recovery From Concussion

et al. 2021

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IMPORTANCE There are limited data to guide screen time recommendations after concussion. OBJECTIVE To determine whether screen time in the first 48 hours after concussion has an effect on the duration of concussive symptoms.DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted in the pediatric and adult emergency departments of a tertiary medical center between June 2018 and February 2020. Participants included a convenience sample of patients aged 12 to 25 years presenting to the emergency department within 24 hours of sustaining a concussion. A total of 162 patients were approached, 22 patients met exclusion criteria, and 15 patients declined participation; 125 participants were enrolled and randomized.INTERVENTIONS Patients were either permitted to engage in screen time (screen time permitted group) or asked to abstain from screen time (screen time abstinent group) for 48 hours after injury. MAIN OUTCOMES AND MEASURESThe primary outcome was days to resolution of symptoms, defined as a total Post-Concussive Symptom Scale (PCSS) score of 3 points or lower. Patients completed the PCSS, a 22-symptom scale that grades each symptom from 0 (not present) to 6 (severe), each day for 10 days. Kaplan-Meier curves and Cox regression modeling were used to compare the 2 groups. A Wilcoxon rank sum test was also performed among participants who completed the PCSS each day through recovery or conclusion of the study period. RESULTS Among 125 patients with concussion, the mean (SD) age was 17.0 (3.4) years; 64 participants (51.2%) were male. A total of 66 patients were randomized to the screen time permitted group, and 59 patients were randomized to the screen time abstinent group. The Cox regression model including the intervention group and the patient's self-identified sex demonstrated a significant effect of screen time (hazard ratio [HR], 0.51; 95% CI, 0.29-0.90), indicating that participants who engaged in screen time were less likely to recover during the study period. In total, 91 patients were included in the Wilcoxon rank sum test (47 patients from the screen time permitted group, and 44 patients from the screen time abstinent group). The screen time permitted group had a significantly longer median recovery time of 8.0 days (interquartile range [IQR], 3.0 to >10.0 days) compared with 3.5 days (IQR, 2.0 to >10.0 days; P = .03) in the screen time abstinent group. The screen time permitted group reported a median screen time of 630 minutes (IQR, 415-995 minutes) during the intervention period compared with 130 minutes (IQR, 61-275 minutes) in the screen time abstinent group. CONCLUSIONS AND RELEVANCEThe findings of this study indicated that avoiding screen time during acute concussion recovery may shorten the duration of symptoms. A multicenter study would help to further assess the effect of screen time exposure. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03564210

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Acute Cognitive and Physical Rest May Not Improve Concussion Recovery Time

Cited by 82 publications

References 44 publications

A Physiological Approach to Prolonged Recovery From Sport-Related Concussion

A Physiological Approach to Prolonged Recovery From Sport-Related Concussion

The Effects of Early Physical Activity Compared to Early Physical Rest on Concussion Symptoms

Effect of Screen Time on Recovery From Concussion

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