Strict rest may not be best medicine for kids’ concussions


CHICAGO – the Strict rest may not be the best medicine for children with a concussion, a Canadian study found, challenging the idea that physical activity should be avoided until the symptoms disappear.

A month after their concussion, current or, even worse, the symptoms were more frequent in children and teenagers who were inactive during the week after the injury, compared with those who engaged in physical activity during that first week. The activity was especially light exercise, such as walking and swimming.

The results were similar, even among those who early on had three or more symptoms of a concussion, which can include nausea, headache, and confusion. Physical activity still appeared to reduce the opportunity for the symptoms persist a month after the concussion.

“It is still important to be careful in the immediate post-injury period,” said lead author Dr. Roger Zemek, an emergency medicine specialist at Children’s Hospital of Eastern Ontario. After a sports-related concussion, children should always be removed from the game and not return that day.”

To prevent re-injury, children should generally be sidelined from the sport or activity that led to the concussion until a physician clears them to return, ” he said. But the results of the study suggest that they can resume sports or other physical activities sooner than thought, ” he said.

The researchers interviewed approximately 2400 children in the age from 5 to 18 years treated for concussion in nine emergency departments in Canada. Most were of sports-related injuries and the majority of children had at least one concussion symptom in the first week.

The results of the 2013-2015 study were published Tuesday in the Journal of the American Medical Association .

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The current guidelines recommend rest until the symptoms disappear to prevent additional concussions, which can increase chances for permanent damage to the brain. But an article published with the study says that the advice “”resulted in a number of athletes resting for weeks or months, at which point the rest are less useful and maybe even harmful.”

The authors of the study say that the resumption of physical activity can increase blood flow to the brain, while inactivity may deprive patients of the benefit, but also the psychological benefits of activities that they enjoy.

Patients in the study and their parents were asked about the symptoms and physical activity at seven days and 28 days after the concussion

In the beginning of the activity of the group, 29 percent reported persistent or worsening symptoms of 28 days after the concussion versus 40 percent of the group reporting no additional physical activity outside of the daily activities.

Among the children who reported three or more symptoms in that first week, to those who are involved in the beginning of physical activity, regardless of the intensity were 25 percent less likely to have current or even worse the symptoms of 28 days than the non-activity of the group.

Zemek said that more research is needed to determine what the ideal timing and intensity of the physical activity recommended after a concussion “to be the best balance between symptom resolution and security.”

Until there are clear answers, the editorial says that doctors and parents should use common sense about allowing limited physical activity to endure, be careful about resting a previously active athlete for extended periods of time.”

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