IN BRIEF

To Rest or Not To Rest?

April 25, 2015
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Emerging research suggests prolonged postconcussion rest yields no benefit for most patients.

A decade ago, children who suffered a concussion had to be kept from running and playing too soon after the injury. Now, too many rest in bed too long.

The shift was driven by an unproven idea that spread through the medical community: If a little rest helps recovery, more must be better. News shows reinforced the notion, reporting lost memory, decreased cognitive function and personality changes in professional athletes who played despite head injuries.

But a study published by researchers from the Medical College of Wisconsin in the journal Pediatrics early this year provides ammunition that concussion specialists can use to return patients to normal life more quickly. For 80 to 85 percent of concussions — head strikes with no loss of consciousness — keeping a child on strict rest for more than a day or two provides no benefit.

“Some of the patients I see have already seen a sports doctor or their primary physician and they’re miserable because they’ve been sitting in bed for three months,” saysGeoffrey L. Heyer, MD, director of the Complex Concussion Clinic at Nationwide Children’s Hospital. “It’s hard to say to a pediatrician, ‘Why would you recommend this?’ without a paper like this.”

The study’s finding reflects what he and other concussion experts see in practice. “For a simple concussion, we expect rapid recovery,” Dr. Heyer says. “Symptoms should abate in a week, a few days or, in some cases, 24 hours.”

After a day or two at home, ease kids back into school with a lighter load and breaks as needed. “That’s probably the best way to get back on the horse,” says Danny G. Thomas, MD, MPH, an emergency medicine physician at the Children’s Hospital of Wisconsin and lead author of the study. He suggests patients ease into physical activities after managing a few full days of class and homework.

“The primary goal of treating patients who suffer a concussion is to prevent a second concussion before the first has a chance to heal,” Dr. Thomas says.

But exactly how much downtime that requires isn’t clear. Dr. Thomas is seeking funding for a large study with a greater variety of patients, which concussion experts say is needed before they can tailor individual recovery plans for patients.

“We may see that athletes who’ve lost consciousness benefit from strict rest,” Dr. Thomas says. “But for those who haven’t lost consciousness and aren’t suffering amnesia or disorientation, bed rest is probably way too severe.”

Join the conversation. Do you find parents resistant to the idea of swift return to activity after their child has experienced a concussion? 

 

References

  1. Thomas DG, Apps JN, Hoffmann RG, McCrea M, Hammeke. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics. 2015 Feb, 135(2):213-2