I just saw this on Twitter from @NSAFitness, Time to Re-think the Zürich Guidelines? appearing as an editorial in the Clinical Journal of Sports Medicine March, 2014 issue.
I can think of many reasons to re-think Zurich; the two biggest is no inclusion of return-to-learn/work and the obvious lack of coalition in concussions. It may be a “consensus” but really its a compromise, AT BEST. Here are some excerpts;
The problems with the guidelines include a lack of diagnostic specificity, management strategies that are not evidence based, and rehabilitation goals that are not attainable. Given these problems, the Zürich Guidelines cannot be endorsed.
Don’t know why we have to be more specific, rather more global would make sense: ANY DISRUPTION OF NORMAL BRAIN FUNCTION AFTER AN UNNATURAL TRAUMATIC FORCE IS APPLIED TO THE PATIENT, would fit just fine. I will defend the non-evidence based management strategies; how can they be evidence based if we are just now getting to this part of the puzzle (SPOILER ALERT: the concussion problem is due to the mismanagement of the injury, not the injury itself).
Another major problem with the Zürich Guidelines relates to the management algorithm. The authors continue to state that the cornerstone of concussion management is physical and cognitive rest until the acute symptoms resolve. As in previous iterations of the consensus statement, the authors do not have a citation for their recommendation. Physical and cognitive rest are not defined. The notion of cognitive rest is not intuitively obvious. Rest and the initiation of worklessness have known deleterious consequences.
I happen to agree with the issue of what “rest” is, but how do we even quantify that? I think there has been good strides on that, meaning we have tried to hammer home the need for complete cognitive and physical rest. This includes anything that would require brain power; in other words one should sleep. Refer back to the snow-globe analogy if you will.
I think this is a good discussion point, so please chime in if you will!