Standard treatment for mild traumatic brain injury (mTBI) in children includes a period of rest. There is no consensus regarding the duration of limited activity, and whether it includes physical rest, cognitive rest, or both. Thomas et al performed a randomized controlled trial comparing usual care (1-2 days rest, stepwise return to activity) with strict rest (5 days, including cognitive rest) in 99 enrolled 11-22 yo mTBI patients. Neurocognitive, balance, and symptom assessment was performed at baseline, 3 and 10 days post injury in 88 children completing study. There was no difference in balance or neurocognitive outcome, but strict rest patients reported significantly more daily post-concussive symptoms and slower symptom resolution. This study was adequately powered to show a clinically relevant difference in the post concussion symptoms scale (PCSS). The result calls into question the benefit of strict rest after concussion.
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