Recovery from concussions can be a long and difficult process, especially for children. Active rehabilitation, usually beginning with physiotherapy-based treatments such as mild aerobic exercise, is known to help. But many non-specialist medical professionals remain uncertain about when to initiate it.
Until roughly a decade ago, there was a common consensus that rehab should primarily be rest-based and that a return to physical activity should begin about four weeks after injury.
However, many concussion specialists disagreed and argued for moving treatment up significantly. Among them were clinicians at the Montreal Children's Hospital Concussion Clinic, who changed their policies in 2017. A new study of this protocol change shows the approach benefitted patients and decreased recovery time significantly.
The study was led by Elizabeth Teel , an assistant professor in the Department of Health, Kinesiology and Applied Physiology , and it was published in the Journal of Sport Rehabilitation .
"In 2017, the clinic amended their internal institutional policy toward a two-week start time for treatment, which was the earliest they could fit into their treatment model," Teel says. "We looked at data from two years before and two years after the shift in policy to see whether the policy had an effect.
"We found that kids who started treatment earlier recover about a week faster compared to those who started treatment later."
Policy-driven change
Unlike other studies on childhood concussion treatment, Teel's paper looks at results that have arisen out of a change of institutional policy. They looked at data collected by the hospital's concussion clinic between 2015 and 2019 and randomly selected 150 cases from each year. At the time, the hospital was treating roughly 600 patients annually.
Along with demographic information, the records contained a list of symptoms, evaluations and treatment recommendations. The clinic made any additional data accessible when necessary.
The researchers worked closely with Isabelle Gagnon, a clinical scientist in the Trauma Centre at the Montreal Children's Hospital. She spearheaded the idea of using physiotherapy to treat concussion patients, with research dating back to 2009 suggesting that physical activity could help speed recovery.
Teel says it is important to note that any physical activity after concussion should be low-impact and non-contact, and it should only be taken up after 24 to 48 hours of rest. Typically, concussion specialists recommend exercises like swimming, cycling and running, and only as tolerated. Avoiding re-injury and specific exercises or treatment environments that overly trigger concussion symptoms is the priority.
The authors emphasize that while universal recommendations are unrealistic given the vast differences in accessibility and local environments, this research underscores the importance of institutional policy.
"We recommend that each individual medical facility that is providing care to individuals with concussions should have a standard policy for their institution," she says.
"We know that what is feasible in one location or clinic may not be in a different one, so we are not providing a standard recommendation for policy. What is realistic in each clinical setting will vary greatly. But we are encouraging everyone who is treating children with concussions to consider the resources they have and what is feasible, and to set a standard written policy within those bounds."
Danielle Dobney of the University of Toronto contributed to this study along with Deborah Friedman, Lisa Grilli, Christine Beaulieu and Isabelle Gagnon of the Montreal Children's Hospital, McGill University Health Centre (Trauma Centre).
Read the cited paper: "A Concussion Management Policy Change Promoted Earlier Initiation of Rehabilitation Services and Improved Clinical Recovery Outcomes in Concussion ."
