Michael F. O’Brien

The effect of recommending cognitive rest on recovery from sport-related concussion

Abstract Objective: To determine whether recommending cognitive rest to athletes after a sport-related concussion affects time to symptom resolution. Methods: A retrospective cohort study was conducted of 184 patients who presented to a sports concussion clinic in an academic medical centre between 1 November 2007 and 31 July 2009. The effect of recommending cognitive rest on symptom duration (days) was measured after adjusting for age, gender, initial PCSS score, history of amnesia, history of loss of consciousness and number of previous concussions. Using multivariate logistic regression, independent predictors of prolonged symptoms were identified, defined as >30 days. Results: Of the 135 study patients with complete medical records, 85 (63%) had cognitive rest recommended. Of those, 79 (59%) had prolonged symptoms. In the multivariate analysis, only initial PCSS score was associated with the duration of concussion symptoms (adjusted odds ratio (AOR) = 1.03; 95% CI = 1.01–1.05). The recommendation for cognitive rest was not significantly associated with time to concussion symptom resolution (AOR = 0.5; 95% CI = 0.18–1.37). Conclusions: Given the limited evidence regarding the effects of cognitive rest on recovery from concussion, recommendations of prolonged periods of cognitive rest, particularly absences from school, should be approached cautiously.

Adolescent Overuse Spine Injuries

With the increase in organized sports for young people has come a concomitant rise of a new type of sports injury caused by “overuse.” Overuse injuries of the spine are relatively common in the young athletic population, with athletes in certain sports more likely to sustain such injuries. Spinal overuse injuries may be divided into anterior- and posterior-element injuries. It is important to understand the risk factors for overuse injuries of the spine in order to provide proper diagnosis, treatment, and prevention. In addition to complete history and physical examination, modalities for diagnosis include radiographs and magnetic resonance imaging. Treatment options are wide ranging, depending on the particular condition, and may range from conservative measures such as physical therapy and medication but may also include surgical intervention when necessary.