The Timing of Cognitive and Physical Rest and Recovery in Concussion

Abstract

Immediate cognitive and physical rest in the concussed patient is almost universally recommended in the concussion literature. The authors conducted a prospective observational in a primary care pediatric office to examine the effect of delayed cognitive and physical rest had on recovery time in pediatric concussion. The authors found that patients who started cognitive and physical rest immediately after injury were more likely to recover within 30 days compared to patients who delayed cognitive and physical rest for 1-7 days after their injury (67% vs 35%, P = .016). Within the group of patients who recovered within 30 days those with immediate cognitive and physical rest recovered 4.6 days sooner than those with delayed cognitive and physical rest (10.29 ± 5.83 vs 14.42 ± 6.15 days, P = .005). These data support the recommendation that cognitive and physical rest should be implemented immediately after injury in concussed patients.

Head Injury in Soccer: From Science to the Field; summary of the head injury summit held in April 2017 in New York City, New York

“…17 This is particularly concerning as researchers recently reported that youth sport participants aged 12-18 years who continued to play after a concussion were nearly nine times more likely to have a prolonged (>21 days) recovery. 18 Taubman et al 19 reported similar findings, with a greater likelihood of prolonged recovery (>30 days) in youth aged 11-19 years who did not rest immediately after concussion versus those who did rest (67% vs 35%). On a positive note, in a recent independent survey, 92% of players were reported to have sought clinical care for their concussion (Kontos, 2017, personal communication).…”

What factors must be considered in ‘return to school’ following concussion and what strategies or accommodations should be followed? A systematic review

“…Rest following injury: Patients who did not initially rest following injury took longer to RTS than those who rested immediately following injury32; high cognitive loads/increased school attendance exacerbated symptoms 24 28…”

Quantifying Activity Levels After Sport-Related Concussion Using Actigraph and Mobile (mHealth) Technologies

“…8 Whereas preclinical studies supported a strong link between patient behaviors and neural recovery from mild head trauma, a lack of objective data on the postinjury activities of human patients limits advancement of evidence-based clinical management guidelines. 6,7,[9][10][11][12] Monitoring concussed athletes' activities more closely via subjective and objective measurement approaches may help us understand how SRCs are currently managed and develop informed hypotheses about the relationship between activity engagement and recovery postinjury. Validating activity-monitoring tools for clinical trials focused on exercise-based rehabilitation of concussed athletes would also be useful.…”