Purpose: This project presents a case of a pediatric patient experiencing post-concussive syndrome following a sports-related minor traumatic brain injury and answers the following PICO question via evidence-based analysis: In adolescents aged 12-20 status-post acute concussion, is initiation of light activity more effective than absolute physical rest, in reducing the duration of self- reported postconcussive symptoms?

Background: Current best practice for managing acute pediatric concussions for health care providers involves a period of absolute cognitive and physical rest. Graduated Return to Play (GRP) protocols are initiated after a period of absolute rest, or not initiated at all in the lower levels of completive sport. In young athletes, absolute rest can cause additional problems such as deconditioning, depression, and decreased self-image.1 Investigating this topic and current research can lead to more information regarding the safety and timing of discontinuing absolute rest, as well as the potential benefits of initiating light activity soon after concussion for this particular patient population.

Results: Across the board, studies show that absolute rest did not conclusively benefit the patients or reduce the duration of their symptoms. In fact, some studies showed that absolute rest prolonged the recovery of the patients when compared with physical activity. In one particular study, initiation of light activity showed better performance on neurocognitive testing, with moderate and heavy exercise showing poorer performance. Finally, graded treadmill exercise testing shows that initiating exercise in this population to a specific symptom threshold while measuring physiologic signs of exertion can be beneficial to increasing exercise tolerance and reduce symptom severity.

Discussion: The literature supporting the claim that absolute rest is the best- indicated treatment has been limited. Without strong evidence supporting absolute rest after concussion, many student-athletes and parents are left feeling frustrated with negative psychological and social ramifications. Health-care professionals must develop and implement safe, evidence-based protocol when treating adolescent patients of this population. The research included in this analysis does support initiation of light to moderate activity with little to no evidence of harm.



Document Type


Degree Name

Doctor of Physical Therapy (DPT)

Level of Degree


First Advisor

Tiffany Enache PT, DPT

Second Advisor

Sandra Heimerl, PT, DPT


adolescent concussion, sports-related concussion, rest, activity, exercise