At the “Fourth International conference on Concussion in Sport” held in Zurich in November 2012 there was a consensus among the experts that cognitive and physical rest were the pillars of the treatment of concussion. In 2013 the American Academy of Neurology released a report that concurred; those patients are at an increased risk of re-injury in the event’s aftermath.
The prevalent opinion was that people with a sports concussion should have a period of cognitive and physical rest until the post-concussive symptoms like dizziness, fatigue, headache and irritability have disappeared. Once they go back to the sports practice, they must stop it if their symptoms re-appear. However there is a budding dissenting view, which states that long periods of inactivity may lead to loss of physical fitness, anxiety and depression.
In a secondary analysis of the prospective, multicenter “Predicting Persistent postconcussive Problems in Pediatrics” study, Canadian researchers of the “Pediatric Emergency Concussion Team” enrolled 3,063 participants ranging form 5 to 17 year old who had been admitted to the Emergency Department for an acute concussion between August 2013 and June 2015. At the time of admission, data on their medical history, the characteristics of their injury and their physical and cognitive symptomatology were recorded.
At day 7 and also at day 28 the participants were contacted by telephone or email in order to question them (or their parents) based on the questionnaire of the “Zurich Consensus Statement on Concussion” return-to-play steps. Based on those responses, four levels of early physical activity were defined:
- No physical activity
- Light activity (exercise like walking, swimming, stationary cycling)
- Moderate activity (non-contact sports activities)
- Full exercise (competitive sports and/or contact sports)
The main measurement for the outcome was the presence of “persistent post-concussive symptoms” (PPCS), which was arbitrarily defined as three new or worsening symptoms on the “Post-Concussion Symptom Injury” scale at day 28 compared with the participants’ status before the concussion event.The clinical signs of PPCS happened in 24% of the participants in the group with early physical activity compared to 43.5% in the no activity-group.
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