Taking Time Out After a Concussion

Concussion recovery relied partly on cognitive rest

(RxWiki News) Despite precautions, young athletes are still at risk for experiencing concussions during sports activities. The important thing is to recover from them.

A recent study found that a major factor in how quickly children and teens recovered from a concussion was how much cognitive rest they got.

Cognitive rest means limiting activities that require concentration and attention, including school work and daily living activities that require exertion.

A person's cognitive activity level refers to how much they are using their brain for demanding activities.

"Rest while recovering from a concussion."

This study, led by Naomi J. Brown, MD, at the Division of Sports Medicine at Children's Hospital of Philadelphia, looked at the effects of cognitive activity levels on a person's recovery from concussion.

Right now, the American Academy of Pediatrics, the American Medical Society for Sports Medicine, the American College of Sports Medicine and the American Academy of Neurology all recommend cognitive rest in their guidelines for concussion recovery.

For their study, Dr. Brown and colleagues tracked the recoveries of 335 patients starting within three weeks of when the patients experienced their concussions during a sports activity.

These patients ranged in age from 8 to 23, with half being younger than age 15.

During each clinic visit, the patients filled out short scaled surveys about how much cognitive activity they had had since their last visit.

Among the patients, 19 percent had lost consciousness when they had their concussion, and 37 percent had experienced some memory loss at the time.

In addition, just over a third of the patients (39 percent) had previously had a concussion.

On average, it took about 43 days for patients' symptoms to fully go away.

When the researchers considered all the characteristics of the patients during their visits, they found two factors that influenced how long the patients' symptoms lasted.

The first factor was how severe a patient's symptoms were at the first visit.

The second factor was the amount of cognitive activity the patients had during their recovery.

The higher the patients' cognitive activity levels were, the longer it took for the symptoms to go away.

"Increased cognitive activity is associated with longer recovery from concussion," the researchers wrote. "This study supports the use of cognitive rest and adds to the current consensus opinion."

They wrote, "Although it is difficult to quantify, cognitive rest entails limiting activities that require attention and concentration, such as reading, text messaging, video game playing, working online, and performing schoolwork."

Daniel Clearfield, DO, a sports medicine and concussion specialist and an assistant professor of orthopedic surgery at the University of North Texas Health Science Center, said this study reinforces what most ports medicine doctors and concussion specialists already recommend – physical and cognitive rest after a concussion.

"The extent of how much cognitive rest is needed is still one of the debatable topics," Dr. Clearfield said. "Some physicians and neuropsychologists advocate for complete academic rest after suffering a concussion for at least two to three days." 

However, Dr. Clearfield noted that this amount of time is difficult for athletes who experience concussions in the early or middle part of the week.

"I typically send the athletes home with some direction on what is and is not acceptable for them to do, both physically and cognitively," he said. "I allow them to go to school the next day unless they are severely symptomatic at the onset of the injury."

This study was published January 6 in the journal Pediatrics. The research was funded by the National Institutes of Health.

One author has a financial interest in the software used to assess cognitive performance after a concussion. No other potential conflicts of interest existed for the authors.

Review Date: 
January 8, 2014