Survey of over 3,000 children finds traditional treatment of rest may need revision

Concussions play a major role in the lives of athletes. Almost every sport carries the risk of concussion, and we still know very little about the best way to treat them.

But a recent study led by University of Ottawa researcher Dr. Roger Zemek represents a gradual shift in the way we view concussion treatment.

After surveying over 3,000 children aged five to 18, Zemek and his researchers found that physical activity may lead to quicker concussion recovery in children.

“Kids who were recruited into our study had to fill out a questionnaire at seven days post-injury and at 28 days post-injury, where we monitored their symptoms,” said Dr. Andrée-Anne Ledoux, a co-author on the study and part-time professor at the U of O.

“So we had questions such as ‘Do you have headaches?’ ‘How do you feel?’ etc. and we also had questions about their physical activity routines.”

The study was looking to find out if children who engaged in physical activity earlier after experiencing a concussion actually had a reduced risk of persistent post-concussive symptoms (PPCS). Ledoux explained that PPCS refers to long-term symptoms that can last for months in some cases, and can include “headache, nausea, feeling dizzy, feeling disoriented, anxiety, (and) cognitive disorders.”

Zemek and his team found that “the proportion with PPCS at 28 days was 28.7 per cent with participation in early physical activity vs. 40.1 per cent with conservative rest, a significant difference.”

These findings counter the traditional concussion guidelines, which suggest that the injured should rest until they are completely asymptomatic.

“Right now we’re telling them they’re not even allowed to walk (based on) these conservative guidelines,” said Ledoux. In reality, Ledoux explained that a better way to stave off PPCS may be to slowly reintroduce children to walking, mild jogging, riding a stationary bicycle, or swimming.

However, this doesn’t mean children should jump right back into heavy physical activity after sustaining a concussion. Ledoux urged that children who sustain a concussion should be removed immediately from physical activity and get diagnosed by a physician.

“We do have studies that are telling us that rest is good, but rest for a long period of time like we’re doing right now is not good,” she said. “That small window of rest is very important at the beginning, but we cannot exaggerate that window. We can’t have that window for four weeks is what we’re saying.”

While this study could have major ramifications on the way concussions and concussion recoveries are viewed, Ledoux cautioned that it is still early on in the process of discovering the optimal treatment for concussions.

“This is a limitation to this paper, that it’s based on questionnaires,” said Ledoux. “So we did not give a physical activity treatment to ‘group A’ and a rest treatment to ‘group B’. That would be a second study that we’re working on currently.”

Ledoux also explained that due to the developmental differences between children’s and adults’ brains, the study could not be applied to adults.

“We would need a study to figure out if it’s the same in adults, just due to the fact that the brain is so different.”