Rest not best for concussion recovery, experts conclude during UPMC Concussion Conference
October 17, 2015 12:00 AM
From left to right: Michael “Micky” Collins, Javier Cardenas, Jeff Bazarian and David O. Okonkwo held a panel at U.S. Steel Tower to inform the public of the results of a two-day meeting with 33 other concussion experts on how to treat concussions.
Michael “Micky” Collins, Ph.D., executive director, UPMC Sports Medicine Concussion Program and nationally renowned clinician answers questions on how to treat concussions while colleague Javier Cardenas, M.D., director, Barrow Concussion and Brain Injury Center at Barrow Neurological Institute, Phoenix listens at the UPMC offices in the U.S. Steel Tower.
By Craig Meyer / Pittsburgh Post-Gazette
A meeting of 37 concussion clinicians and researchers this week in Pittsburgh — described as “unprecedented” by UPMC, but viewed with skepticism by others — produced a consensus that prolonged rest, a popular treatment option for concussions, does not aid recovery and can actually worsen it.
“Experts here in Pittsburgh recognized how critical a need it was for us to bring experts together and finally make this statement,” Dr. David Okonkwo of UPMC said. “This is paradigm shifting. People may underestimate the impact of this, but on a global basis, every single person who sustains a concussion is told prolonged rest.
“Now, you have 37 of the best and brightest minds in the field saying ‘That’s wrong and, in fact, concussions are treatable and active treatments are superior to doing nothing.’”
The experts reached those conclusions during the two-day UPMC Concussion Conference, “Targeted Evaluation and Active Management.” While no sweeping protocols were recommended, conference attendees believe this consensus will help research move forward.
The summit, however, did not come without some level of doubt about what it could accomplish.
There were concerns about conflicts of interest. UPMC sponsored the summit, and the health giant has received funding in the past from the NFL, and several of the doctors present have a connection to a sports team or league.
She also criticized the conference for not allowing reporters or other interested parties to observe the meeting.
“In the past week, it’s been mentioned a few times,” Ms. Fisher said in a phone interview. “In each case, both by people who were invited and by people who were not invited, there was kind of a hesitation, primarily because of some of the other concussion summits that have happened in the past year or two.
“The NFL has been very silent, if not distant. To not do any press around this, to not allow certain people in, there’s a little bit of a ‘wait and see’ mentality.”
Though she was critical of the way the meeting came together, she said she wanted to wait and review the findings of the conference before reaching a conclusion of her own.
Doctors who convened at UPMC this week believe that an active approach in treating concussions, from active rehabilitation to active physical therapy, is preferable to basic rest.
“Exercise is a way of treating this,” said Dr. Javier Cardenas, a neurologist at the Barrow Concussion and Brain Injury Center in Arizona. “Many times, we see patients who are completely restricted from any physical activity.
“As one of the major sources of this injury is sports and athletics, for those who are involved in athletics, this is actually a punishment. They become depressed. They become anxious. So allowing them to participate in physical activity — while keeping them out of harms’ way, of course — is actually a rehabilitation method.”
The increasing attention paid to concussions, in part, be tied to their prevalence in sports, particularly football. It has raised the kind of questions that were not being routinely asked decades ago. If a player doesn’t appear normal, should they be removed from the game? How soon should they return? In what way should it be treated?
Part of the problem with concussions is that there isn’t a concrete medical definition for them and, therefore, is no standardized way of treating this complex, variable condition.
“This is not a one-size-fits-all injury,” said Micky Collins of UPMC. “There are different profiles and problems that we see. Now that we understand that and we have treatments that can actively treat those different profiles, we are very confident that progress can be made.”
The group’s findings will be published in a medical journal, likely in the next month or two, and subsequent papers will come from that.
Now that a consensus has been reached, the doctors’ task is now to spread that information to a public in need of answers and direction.
“We need to go beyond [the meeting] and transfer this knowledge to the public at large,” Mr. Collins said. “We came out as a group with 100-percent unanimous agreement that this is a treatable injury. It’s a powerful statement and now we really have to disseminate how we do that.”
Craig Meyer: firstname.lastname@example.org and Twitter @CraigMeyerPG.
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