Acute Cognitive and Physical Rest May Not Improve Concussion Recovery Time

Abstract

Objective: To evaluate the effectiveness of an acute period of cognitive and physical rest on concussion.

Participants: Fifty consecutive patients with a diagnosis of concussions.

Design: Participants were evaluated before (n = 25) and after (n = 25) a policy change that incorporated cognitive and physical rest. Patients in the rest group were withheld from activities, including classes, for the remainder of the injury day and the following day, whereas patients in the no-rest group were not provided any postinjury accommodations.

Main measures: Patients were evaluated on a graded symptom checklist, Balance Error Scoring System, Standard Assessment of Concussion, and computerized neuropsychological tests. The number of days until each test achieved baseline values was compared between groups with independent-samples t test.

Results: The no-rest group achieved asymptomatic status sooner than the rest group (5.2 ± 2.9 days and 3.9 ± 1.9 days, respectively; P = .047). There were no differences between groups for time to baseline values on the Balance Error Scoring System, Standard Assessment of Concussion, computerized neuropsychological tests, or time to clinical recovery.

Conclusion: A prescribed day of cognitive and physical rest was not effective in reducing postconcussion recovery time. These results agree with a previous study and suggest that light activity postconcussion may not be deleterious to the concussion recovery process.

Figure 1. SAC and BESS Scores at Baseline and Day 1 Post–Injury

For the BESS, there were no differences between Rest and No-Rest groups at Baseline (12.1 ± 3.9 errors and 11.5 ± 4.4 errors respectively, P=0.578), on Day 1 (14.3 ± 6.3 errors and 13.4 ± 5.9 errors respectively, P=0.608), or the change from Baseline to Day 1 (2.2 ± 5.8 errors and 2.0 ± 5.6 errors respectively, P=0.883). For the SAC, there were no differences between Rest and No-Rest groups at Baseline (27.6 ± 1.6 errors and 26.7 ± 1.9 errors respectively, P=0.073), on Day 1 (26.6 ± 2.6 errors and 25.5 ± 3.0 errors respectively, P=0.209), or the change from Baseline to Day 1 (1.0 ± 2.8 errors and 1.1 ± 3.1 errors respectively, P=0.920).

Figure 2. Graded Symptom Checklist Scores at Baseline and Day 1 Post–Injury

There were no differences between Rest and No-Rest groups at Baseline (4.2 ± 4.7 and 4.0 ± 4.5 respectively, P=0.854), at Day 1 (34.2 ± 28.7 and 28.5 ± 22.9 respectively, P=0.437), and for change between Baseline and Day 1 (30.0 ± 27.8 and 25.2 ± 23.7 respectively, P=0.517). There was a significant increase within groups for both Rest (P<0.001) and No-Rest (P<0.001) between Baseline and Day 1.

Figure 3. Days to baseline values for each clinical measure between the Rest and No-Rest groups

*There was a significant difference between groups for time to self-report symptom free status (Rest: 5.2 ± 2.9 days and No-Rest: 3.9 ± 1.9 days, t=2.035, P=0.047). (BESS: Balance Error Scoring System; SAC: Standard Assessment of Concussion; CNT: Computerized Neuropsychological Testing; GSC: Graded Symptom Checklist; Clinical Recovery: Number of Days until Baseline on All Tests).