The management of pediatric patients who have experienced a concussion is one that appears to be constantly in evolution. For a while, the recommendation was that “rest is best” for multiple days until symptoms improved. However, this was associated with social isolation, anxiety, depression, and even worsening of concussion symptoms. As a result, there has been an emphasis on earlier return to play with progressively increasing activity within a few days of the concussion. How effective is the recommendation for early return to physical and social activity?
Chauhan et al from the University of British Columbia (10.1542/peds.2022-059592) share with us the results of a systematic review and meta-analysis with 24 studies, including 7 randomized trials, evaluating early return to physical and social activity following a concussion. This review found a significant improvement in symptoms in for those with early progressive return to physical activity compared to those who did not. The authors did not have sufficient data from the various studies to show an effect of activity-based interventions on quality of life or quicker return to pre-injury activity levels.
How should these findings influence what we tell our patients who experience a concussion? In addition to the many details shared by the authors as to what types of activities might be recommended and when to do so following a concussion, we invited Dr. Carlyn Patterson Gentile, a neurologist at Children’s Hospital of Philadelphia to share her take-aways from this review article in an accompanying commentary (10.1542/peds.2022-060386). Dr. Gentile points out the helpfulness of this review in support of physical activity being part of the recovery plan based on the evidence presented in the review article by Chuan et al. She notes that the review reaffirms the importance of considering aerobic exercises, coordination exercises, and relaxation and visualization techniques as being most successful in managing symptoms post-concussion. The commentary also notes gaps in knowledge, including how early physical and social activities should return after a concussion.
If you want to be up to date on the pediatric concussion literature and learn more about the specifics of what re-introduction of physical activity or social activity might mean for you patients as they recover from a concussion, then this study and commentary will keep you ahead of the game! Link to both and learn more.
