Following a concussion, patients are instructed to rest for twenty-four to forty-eight hours beginning any type of return to normal activities. Many doctors recommend an even longer period of rest so as to reduce the risk of re-injury during recovery from the concussion. Some clinicians even advocate “cocoon therapy” which “restricts patients to several days in a darkened room before slowly returning to activity.”
A new study out of the Department of Pediatrics at the Medical College of Wisconsin calls into question the efficacy of cocoon therapy.
Danny G. Thomas, M.D. and his colleagues conducted a study of patients aged between eleven and twenty-two years who presented to a pediatric emergency department within twenty-four hours of having sustained a concussion. Participants underwent neuro cognitive, balance and symptom assessment in the emergency room and were randomized to strict rest for five days versus the usual care of one-two days rest followed by stepwise return to activity. Patients were asked to complete a diary to record physical and mental activity level, calculate energy exertion, and record daily post concussive symptoms.
Ninety-nine patients were enrolled and eighty-eight completed all study procedures. Post discharge, both groups reported a 20% decrease in energy exertion and physical activity levels. As expected, the intervention group reported less school and after-school attendance for days two to five post concussion. However, “there was no clinically significant difference in neuro cognitive or balance outcomes. However, the intervention group reported more daily post-concussive symptoms and slower symptom resolution.” The conclusion of the researchers was “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 study can be downloaded from pediatrics.aappublications.org. The study is entitled “Benefits of Strict Rest after Acute Concussion: A randomized controlled trial, Thomas
Space, DG, APPS JN, Hoffman RG and McCrea M, and Hammeke T. Pediatrics, Vol. 135, No. 2, February 2015.
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