Wednesday, October 28, 2015

How Little We Know

This study came out recently: Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial.

Here are the study methods:
Patients aged 11 to 22 years presenting to a pediatric ED within 24 hours of concussion
were recruited. Participants underwent neurocognitive, balance, and symptom assessment in
the ED and were randomized to strict rest for 5 days versus usual care (1–2 days rest, followed
by stepwise return to activity). Patients completed a diary used to record physical and mental
activity level, calculate energy exertion, and record daily postconcussive symptoms.
Neurocognitive and balance assessments were performed at 3 and 10 days postinjury. Sample
size calculations were powered to detect clinically meaningful differences in postconcussive
symptom, neurocognitive, and balance scores between treatment groups. 

Recommending strict rest for adolescents immediately after concussion offered no
added benefit over the usual care. Adolescents’ symptom reporting was influenced by
recommending strict rest.

This is the first time, as far as I know, that a study of this type has been performed. And it just emphasizes how little we still know about concussions and recovery.

Almost everyone agrees now that maximum rest and absolutely minimal cognitive stimulation in the first 48-72 hours following a concussion assist recovery. That means no phone, no video games, and no television unless it's base-level children's programming (like Noggin--something basically for preschool children) at half brightness and low volume levels.

What's surprising, though, is that reducing stimulation from days 3 to 5 may not make any difference in terms of recovery. Or maybe it does, and the study sample was too small.

There are so many layers of knowledge that need to be accumulated to optimally treat concussions, and even now, after years of increasing focus on the problem, we still know so little.

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