Examining prescribed rest as treatment for adolescents who are slow to recover from concussion

Abstract

Objective: Rest is a widely recommended treatment for concussion, but its utility is unclear following the acute stage of recovery. This study examined the effects of 1-week of prescribed rest in concussed adolescent athletes.

Method: Participants were 13 adolescent athletes with persistent symptoms following a concussion. More than three-quarters (77%) had self-reported ADHD, learning disability or two prior concussions. All completed ImPACT® at another facility, but none completed a period of comprehensive rest prior to examination at a specialty practice. Three time points of test data were compared, to control for possible spontaneous recovery: Test 1 (external facility), Test 2 (before prescribed rest) and Test 3 (following prescribed rest).

Results: Repeated measures ANOVAs revealed a significant effect of prescribed rest on all ImPACT® composite scores and the total symptom score. Post-hoc analyses revealed no significant differences between Time 1 and Time 2, whereas significant differences were present after prescribed rest. Following prescribed rest, having two or more reliably improved cognitive test scores or having improved symptoms was present in eight of the 13 patients (61.5%).

Conclusions: A substantial percentage of adolescents with persistent symptoms following concussion showed improvement in symptoms and cognitive functioning following education, reassurance and 1-week of prescribed rest.

• Concussion
• baseline testing
• comprehensive rest
• concussion management

Declaration of Interest

Data were collected at the Sports Concussion Center of New Jersey (SCCNJ). Dr Rosemarie Moser is the owner of SCCNJ and some of the authors are employees or consultants at the Center. There were no other study sponsors. In the past, Dr Moser has served as a consultant to the International Brain Research Foundation, ImPACT Applications, Inc. and Pearson. These organizations had no role in the conceptualization or content of the current manuscript or the decision to submit for publication. In addition, she receives royalties from a book on youth concussion and special journal issue on mild traumatic brain injury. Philip Schatz, PhD, is a consultant to the Sports Concussion Center of New Jersey. He has also served as a consultant to the International Brain Research Foundation and to ImPACT Applications, Inc. to study the effects of concussion in high school and collegiate athletes. However, the latter two entities had no role in the conceptualization or content of the current manuscript or the decision to submit for publication. Grant Iverson, PhD has been reimbursed by the government, professional scientific bodies and commercial organizations for discussing or presenting research relating to mild TBI and sport-related concussion at meetings, scientific conferences and symposiums. He has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs (including professional athletes). He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs and Psychological Assessment Resources (PAR, Inc.). He has not received research support from ImPACT Applications, Inc. in the past 3 years. He receives royalties from two books relating to neuropsychology and one test (WCST-64).