According to new research, children who have had concussions should step up their activity days after injury because excessive rest itself may compromise recovery and "do more harm than good."
Physicians have often advised lengthy rest after injury, until symptoms, such as headaches, are fully cleared, which may take weeks. The rest often has an impact on school attendance, sports participation, and other activities.
Latest research shows that there may be more negative psychological consequences for children who are not active, and may even contribute to persistence of post-concussive symptoms, says Marc P. DiFazio, MD, a neurologist and medical director of Children's National Ambulatory Neurology. Dr. DiFazio and other researchers' findings, "Prolonged Activity Restriction After Concussion: Are We Worsening Outcomes?" were published in Clinical Pediatrics.
"It is important that we rethink how we are approaching concussions," says Dr. DiFazio. "We are saying that it is critical for kids to be engaged, and not have as much rest, especially for lengthy periods that have often been suggested.
Rethinking Concussion Care
Over the last two decades, activity restrictions following concussions have included recommendations that rest should end only if an individual no longer has headaches, or dizziness, which can take up to six days or more, depending on the event.
"Although well-intentioned, we believe that in many cases prolonged rest may do more harm than good, and as with other interventions, the potential benefits of prescribing long-term rest or withdrawal from activities should be weighed against the potential harm," Dr. DiFazio and co-authors wrote.
Dr. DiFazio and colleagues recommend that healthcare takes a balanced approach to clinical management of concussion. He cautions that while patients who had concussions should return to sports, academics, and social events relatively quickly, they should not return to "high risk activities" because of vulnerability to re-injury. For instance, if a youth returns to the baseball or football fields, they should exercise, but avoid repeated impact, Dr. DiFazio says.
Children's National Concussion Programs
Children's National has taken major steps to develop programs to improve concussion awareness and initiate coordination with families and experts to improve care. The Children's National SCORE (Safe Concussion Outcome, Recovery & Education Program partners with coaches across the DC/Maryland/Virginia region and beyond to support them in recognizing and responding to potential concussions in their players.
Gerard A. Gioia, PhD, Children's National Division Chief of Neuropsychology, and director of SCORE, says Dr.DiFazio's paper "presents an important message to practicing pediatricians about managing patients with concussions activity, encouraging them to gradually resume activity to promote recovery."
"The days of 'rest only' are over," Dr. Gioia stated. "While more restriction may be necessary in the first few days after a concussion, most kids can begin that gradual reintroduction of their school, social and physical (noncontact) activity as long as it does not significantly increase their symptoms. This is a critical message for pediatricians as they manage their patients."
Another Children's National concussion expert, Shireen Atabaki, MD, MPH, a physician in the emergency department, leads HITS for Kids (Health IT Solutions for Kids), a national initiative to improve concussion care by knowledge translation of evidence-based medicine harnessing health IT. She said Dr. DiFazio's study underscored the importance of "educating and engaging emergency medicine physicians about a graduated plan (for concussion patients) to return to activity versus absolute rest."
Children's National concussion experts have also teamed up with MedStar Sports Medicine to conduct a six-month-long concussion awareness training program aimed at young athletes, coaches, and parents in the District of Columbia. The health organizations, chosen as the first in the country to receive funding for this work, have also collaborated with the DC Department of Health, DC Department of Parks and Recreation, The Office of the State Superintendent of Education, Brain Injury Association of Washington DC, and the Children's School Services through Children's National. To learn more about the remaining training events, visit ChildrensNational.org/PlaySmartYourBrainMatters.