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Additional Rest Found to Have No Benefit for Concussion Recovery

Following a concussion, expert consensus dictates that student-athletes should be limited to at least 24 to 48 hours of strict rest to give their brains time to recover. However, according to a new study published online in the journal Pediatrics on Monday, there's no clinical benefit to extending the amount of strict rest for student-athletes after a concussion.

The study authors enrolled 88 patients between the ages of 11 and 22 who presented to the Children's Hospital of Wisconsin Emergency Department and Trauma Center within 24 hours of suffering a concussion between May 2010 and December 2012. To determine the effect strict rest had on concussion recovery, they divided the enrollees into two groups: one limited to strict rest for five days following their discharge from the emergency department (45 patients) and one that followed the traditional stepwise return to activity following a day or two of rest (43). Each group had follow-up appointments with a trained research assistant three and 10 days after their emergency department visits, where they underwent repeat neurocognitive tests and balance assessments at that time.

Both groups reported roughly a 20 percent decrease in energy expenditure and physical activity level in the first five days following their injuries. As the study authors expected, the usual-care group reported more total hours in high and moderate mental activity during days two through five than the strict-rest group, including more school and after-school mental activity.

Among both groups, more than 60 percent of patients reported symptom resolution during the 10-day follow-up period. However, it took three days longer for 50 percent of patients in the strict-rest group to report symptom resolution compared to those in the usual-care group. Patients in the strict-rest group also reported a higher number of postconcussive symptoms during the follow-up period.

In terms of neurological recovery, the study authors found no significant difference in computer-based neurocognitive tests and balance scores at three or 10 days following the injury between either group. Only one paper neuropsychological assessment demonstrated a significant difference: the strict-rest group performed better at day three and worse at day 10 compared to the usual-care group.

Since recommending strict rest did not improve symptom, neurocognitive, and balance outcomes in student-athletes with concussions, the study authors conclude that such a recommendation "may inherently lack efficacy over our current modest rest recommendations." They also note the need for more information regarding the optimal amount of rest for a student-athlete following a concussion.

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