Thursday, April 23, 2015

Extended Complete Rest Is Not The Answer

This was one of the most quoted articles at the Harvard Concussion conference in May.  We have no research data on how long to rest post concussion.  The experts are basing their opinions on the scary cases of people who did not rest and became significantly worse.  Some people aren't healing from concussions for months, could they have done better with more rest?  There are many unanswered questions.  I think this article helps us to say, "Don't prescribe extended rest without a reason.

In the Journal of Pediatrics on 1/5/2015

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

Children's Hospital of Wisconsin in Madison Wisconsin tested 11-22 year old individuals.  They found that individuals who received a random recommendation of 5 days of complete rest did worse than those who received a recommendation of 2 days of complete rest.  Individuals who rested longer had more symptoms and more intense symptoms and they took longer to recover completely.   Although there was no difference between the 2 groups in neurocognition or balance.  The idea of being forced to rest when there is no need can lead to worsening of symptoms theorized due to the time to focus on symptoms.

A recommendation of complete rest is not an answer to concussion recovery.  Patients should be encouraged to slowly return to activities as soon as possible.  Movement can decrease stress and provide deeper rest and recovery.

I, Dr. Lansky, encourage controlled exercise early in the concussion recovery and have seen faster recovery results than others are reporting. 

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