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Complete Rest Might Not Be Best for Pediatric Concussion Patients

OTTAWA, CANADA – If your usual advice to pediatric patients presenting with concussion is to go home and get some rest, you might want to start rethinking that.

A new study in the Journal of the American Medical Association finds that, among children and adolescents who experienced a concussion, participating in physical activity within seven days of injury, compared with no physical activity, was associated with reduced risk of persistent post-concussive symptoms (PPCS) at 28 days.

That goes against common practice in EDs and elsewhere. Pediatric guidelines universally recommend an initial period of physical rest following a concussion until symptoms have resolved, even though no clear evidence has determined that avoiding physical activity expedites recovery.

To help resolve the issue, researchers from Children’s Hospital of Eastern Ontario Research Institute and colleagues conducted a study that included 3,063 children and adolescents with acute concussion from nine Pediatric Emergency Research Canada network EDs.

Standardized questionnaires in the ED and at days 7 and 28 post-injury were employed to rate physical activity participation and post-concussive symptom severity in a final study group of 2,413 final participants. PPCS at 28 days occurred in 30% of them.

Of the participants, ages 5 to nearly 18 years, 70% participated in physical activity within seven days, primarily with light aerobic exercise. Of those engaging in early physical activity, 31% were symptom free and 48% had at least three persistent or worsening post-concussive symptoms at day 7. Of those who reported engaging in no physical activity at day 7, meanwhile, 80% had at least three persistent or worsening post-concussive symptoms at day 7.

The proportion with post-concussive symptoms at 28 days was 28.7% with participation in early physical activity vs. 40.1% with conservative rest, a significant difference according to the study authors, who point out that the finding was consistent across analytic approaches and intensity of exercise.

“Early physical activity could mitigate the undesired effects of physical and mental deconditioning associated with prolonged rest,” the authors write. “Regardless of potential benefit, caution in the immediate post-injury period is prudent; participation in activities that might introduce risk for collision (e.g., resumption of contact sports) or falls (e.g., skiing, skating, bicycling) should remain prohibited until clearance by a health professional to reduce the risk for a potentially more serious second concussion during a period of increased vulnerability.”

They call for a “well-designed randomized clinical trial” to determine the benefits of early physical activity following concussion.