Less Rest Is Best After Concussion

One or two days of rest for patients of concussion can help students to return to their normal activities. Some medicos say that long periods of rest are beneficial, however, recent research suggests that the opposite is better, according to nytimes.com.

In a group of patients aged between 11 to 22 years, a rest of five days by the staff of an emergency department showed that those who rested longer showed more symptoms than those confined for one or two days. Recovery was slower for those undergoing strict rest, researchers said, in a study published in the journal Pediatrics. Those who are confined to bed begin to worry about their schoolwork piling up, and feel cut off from their friends' circle.

Hence, a "cocoon therapy", which confines most patients into a dark room for many days, is not beneficial for mild brain injury patients.

 "More isn't always better," said Dr. Christopher Giza, a professor of pediatric neurology at Mattel Children's Hospital at the University of California, Los Angeles, who was not involved in the research. He added, "There was no advantage to prolonged rest."

The study did not examine those with severe injuries who have been hospitalized. Dr. Danny G. Thomas, a pediatric emergency medicine doctor at Children's Hospital of Wisconsin, head of the team, discovered that patients advised rest for more than five days said that they showed more physical symptoms like headache and nausea in the first few days. In more than 10 days, they exhibited emotional symptoms like irritability and sadness.

"There are potential adverse consequences if you over-restrict activity without respect to individual symptoms," said Gerard Gioia, chief of pediatric neuropsychology at Children's National Medical Center in Washington, who was not involved with the study.

Symptoms in most young patients improve over time. "If you are restricting them beyond what they need," Dr. Gioia said, "they start to get worried and think, 'I can handle it, but I'm not being allowed.' Then you might see mood changes or anxiety."

The team studied 88 young patients in the emergency department at Children's Hospital of Wisconsin within one day. They were advised to get cognitive and physical rest for a day or two.

Their symptoms were compared through computerized tests and paper exams. No difference was found between the groups in either their brain function or the ability to maintain balance, it was found.

Dr. William Meehan, director of the Micheli Center for Sports Injury Prevention in Waltham, Mass., observed that those who were told to rest for longer might have thought of themselves as frailer and more ill.

However, it is also important not to perform "unlimited cognitive activity after a concussion", for it increases the time lag between illness and cure. In a recent research, it was found that the brain needs to rest while it recovers from a concussion, according to contemporarypediatrics.

William Meehan, MD, of Boston Children's Hospital Division of Sports Medicine and colleagues found that participants in his study who engaged in the highest level of cognitive activity took the longest to recover from their concussive symptoms.

"Ten years ago, we were doing very little management or restriction of activity, and kids were doing too much" after concussions, said Dr. Gioia. "I now see kids are actually being forced to do too little. The pendulum has to come back to the middle."