Efficacy of Immediate and Delayed Cognitive and Physical Rest for Treatment of Sports-Related Concussion

Moser, Rosemarie Scolaro; Glatts, Colette; Schatz, Philip

doi:10.1016/j.jpeds.2012.04.012

Cited by 179 publications

(154 citation statements)

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“…7 Moser et al (2012) found decreased concussion symptoms and improved scores on ImPACT after 1 week of cognitive and physical rest, even when implemented weeks to months after concussion. 39 Gibson et al (2013) assessed the influence of recommending cognitive rest to patients presenting to a concussion clinic on symptom duration and found no association with time to symptom resolution. 40 Brown et al (2014) found a correlation between reporting high cognitive activity after injury and longer symptom duration in patients seen in a concussion clinic.…”

Section: Figurementioning

confidence: 99%

Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial

et al. 2015

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OBJECTIVES: To determine if recommending strict rest improved concussion recovery and outcome after discharge from the pediatric emergency department (ED).METHODS: Patients aged 11 to 22 years presenting to a pediatric ED within 24 hours of concussion were recruited. Participants underwent neurocognitive, balance, and symptom assessment in the ED and were randomized to strict rest for 5 days versus usual care (1-2 days rest, followed by stepwise return to activity). Patients completed a diary used to record physical and mental activity level, calculate energy exertion, and record daily postconcussive symptoms. Neurocognitive and balance assessments were performed at 3 and 10 days postinjury. Sample size calculations were powered to detect clinically meaningful differences in postconcussive symptom, neurocognitive, and balance scores between treatment groups. Linear mixed modeling was used to detect contributions of group assignment to individual recovery trajectory.RESULTS: Ninety-nine patients were enrolled; 88 completed all study procedures (45 intervention, 43 control). Postdischarge, both groups reported a 20% decrease in energy exertion and physical activity levels. As expected, the intervention group reported less school and after-school attendance for days 2 to 5 postconcussion (3.8 vs 6.7 hours total, P , .05). There was no clinically significant difference in neurocognitive or balance outcomes. However, the intervention group reported more daily postconcussive symptoms (total symptom score over 10 days, 187.9 vs 131.9, P , .03) and slower symptom resolution.CONCLUSIONS: Recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care. Adolescents' symptom reporting was influenced by recommending strict rest. WHAT'S KNOWN ON THIS SUBJECT:Expert consensus recommends rest after concussion with stepwise return to activity. Animal and retrospective human data suggest that early mental and physical activity may worsen outcome. There are no pediatric studies testing the efficacy of recommending strict rest after concussion. WHAT THIS STUDY ADDS:Recommending strict rest postinjury did not improve outcome and may have contributed to increased symptom reporting. Usual care (rest for 1-2 days with stepwise return to activity) is currently the best discharge strategy for pediatric mild traumatic brain injury/concussion. Dr Thomas developed the study concept and design, obtained funding, supervised the study, acquired data, analyzed and interpreted data, and drafted and revised the manuscript; Dr Apps assisted with study concept and design, supervised the study, provided technical support, analyzed and interpreted data, and critically revised the manuscript; Dr Hoffmann assisted with study design, analyzed data, provided statistical expertise, and critically revised the manuscript; Dr McCrea assisted with study design, analyzed and interpreted data, provided technical support, and critically revised the manuscript; Dr Hammeke assisted with study concept and ...

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Section: Figurementioning

confidence: 99%

Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial

et al. 2015

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“…Whereas recommendations for cognitive rest may be appropriate immediately after concussion for symptomatic student-athletes, the duration of cognitive rest and its effectiveness in facilitating the healing process remain unclear. 9 To aid the student-athlete's recovery after concussion, temporary academic-support strategies may be necessary. In the school setting, formalized assistance for healthrelated conditions is available in 2 types: (1) an individualized education program (IEP), and (2) a Section 504 plan.…”

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confidence: 99%

Examining Academic Support After Concussion for the Adolescent Student-Athlete: Perspectives of the Athletic Trainer

Kasamatsu

Cleary

Bennett

et al. 2016

Journal of Athletic Training

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Context: Student-athletes may require cognitive rest and academic support after concussion. Athletic trainers (ATs) in secondary schools are uniquely positioned to provide medical care and to collaborate with school professionals while managing concussions. However, little is known regarding return-to-learn policies and their implementation in secondary schools.Objective: To examine ATs' perspectives on return to learn, cognitive rest, and communication with school professionals after concussion.Design: Cross-sectional study. Conclusions: Overall, ATs followed best practices for cognitive rest and return to learn after concussion. Although ATs are central to the management of student-athletes' physical health after concussion, school professionals may be better suited to monitor academic progress. Increased communication between the AT and school professionals is recommended to monitor recovery and facilitate academic support for symptomatic student-athletes.

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“…While retrospective studies indicate that cognitive and physical rest may decrease symptoms and improve cognitive performance post-concussion (Moser, Glatts, & Schatz, 2012), other research suggests little or no beneficial effect of physical rest (Willer & Leddy, 2006;Gibson, Nigrovic, O'Brien, & Meehan, 2013).…”

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confidence: 99%