A new study published in the Journal of Head Trauma Rehabilitation calls into question whether acute cognitive and physical rest improves concussion recovery times. Thomas A. Buckley, EdD, ATC of the Department Kinesiology and Applied Physiology at the University of Delaware conducted a study to determine if rest after concussion would result in a shorter recovery time in a population of college-aged student-athletes.

This hypothesis was based on the 4th International Consensus Statement on Concussion in Sport which recommends rest after injury as “a corner stone for acute concussion treatment” and outcomes. The authors noted that “rest” was achieved by discontinuing “school attendance, academic work, electronics usage and [any] exercise.” Prescribing rest was also believed to reduce the risk of repeated concussion and the “rare, but potentially fatal, second-impact syndrome.”

Continue Reading New Study Questions Whether Cognitive and Physical Rest Improves Concussion Recovery Time

Symptoms of concussions often disappear within 7-10 days of an injury–prompting medical release back to sports play. However, preliminary results of a new imaging study presented at a recent American Academy of Neurology conference showed that brain changes caused by “temporary” concussions may last six months or more after the injury. The study, which is ongoing, used diffusion tensor imaging (DTI) to exam connective brain tissue or “white matter” in eighteen students with concussions. White matter brain changes are also associated with stroke and Alzheimer’s.

Continue Reading Athlete Concussions: Are Players Returning to the Field Prematurely?

It is presently the standard of care to keep children who have sustained concussion/traumatic brain injuries off the field and not to return to play until they are cleared by a competent professional.  Assemblywoman, Pamela R. Lampitt (D Burlington and Camden) has introduced a bill in the New Jersey Assembly, which would require any student who suffers a concussion to be evaluated by a doctor or other health care provider and to get written clearance before the child can go back to school. Under the bill, each school district that deals with students with disabilities would be responsible for enforcing any limits on a student’s activities that were determined by the health care provider.

The statement accompanying the bill states:

This bill provides that a student enrolled in a school district who sustains a concussion must receive an evaluation by a physician trained in the evaluation and management of concussions and written clearance from the physician to return to school.  In the event that the physician provides notice that the student requires accommodations for learning, the school district must immediately implement the accommodations and notify all teachers and staff who have contact with the student of the accommodations.  The school district’s child study team will promptly evaluate the student in order to identify the manner in which the accommodations will be provided to the student during recovery and the need for the continuation or adjustment of the accommodations, and to determine the duration of the accommodations.

The bill also provides that a student enrolled in a school district who sustains a concussion is prohibited from engaging in any physical activity at school including, but not limited to, recess, physical education, sports, or cheerleading.  The student may not participate in any physical activity until he is evaluated by a physician and receives written clearance to participate.

The sponsor’s intent is to have the child study team use the physician’s diagnosis and recommendations to guide accommodations upon the student’s return to school for the period of time prescribed by the physician.

A copy of the bill  can be found here. You can read  the story published in New Jersey Spotlight here.

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.

If you or a loved one have suffered from a brain injury and have legal questions, contact Stark & Stark today.