Brain rest may speed concussion recovery in teens

Date: Jan-07-2014While for the last 10 years or so, there has been a general view among doctors and

health experts in the US that people who suffer concussion should give their brains a rest while

they recover, until now there has not been much firm evidence to back it up.

For instance, in October 2013, the American Academy of Pediatrics (AAP) released a clinical

report that suggested students may

need a break from school after concussion. In that report, which was based on expert opinion

and a concussion management program at a children's hospital, the AAP called for more research to

establish the effects of cognitive rest following concussion and how best to help students

recovering from it.

Now a new study from Boston Children's Hospital, published recently in the journal

Pediatrics, appears to have done just that. Senior author Dr. William Meehan of the

hospital's Division of Sports Medicine explains:

"We believe this is the first study showing the independent, beneficial effect of limiting

cognitive activity on recovery from concussion. Previously, the lack of such data has led to varied

practice with regards to implementing cognitive rest, making it even controversial."

The effect of cognitive rest on concussion recovery in student athletes

For their prospective cohort study, Dr. Meehan and colleagues enrolled 335 teen athletes

diagnosed with concussion who were treated at Boston Children's Concussion Clinic between October

2009 and July 2011.

In a study of teen athletes who suffered concussion, researchers found that those who engaged in high levels of cognitive activity needed more time to recover from concussion symptoms.

Using the Post-Concussion Symptom Scale they recorded patients' symptoms, and they also invited

them at each visit to complete a Cognitive Activity Scale to assess their level of cognitive

activity.

They then put the participants into four groups according to level of cognitive activity:

Complete rest
Minimal activity (no reading or homework, less than 5 text messages and less than 20

minutes of online activity or video gaming per day)
Moderate activity (less than 10 pages of

reading, less than 20 text messages and less than one hour homework, online activity and video

gaming combined per day), or
Highest level (no limits).

They found that the participants who engaged in the highest level of cognitive activity needed

the most time to recover from concussion symptoms.

Complete rest may be unnecessary

Although the results showed cognitive rest helped recovery from concussion, they suggest

complete rest may be unnecessary. Participants in the complete rest, minimal activity or moderate

activity groups took about the same length of time to recover from concussion.

The researchers conclude that the findings confirm the importance of making allowances at school

for students suffering from concussion, such as modifying their assignments and giving them more

time to complete schoolwork.

Dr. Meehan says:

"Our findings suggest that while vigorous cognitive exertion is detrimental to recovery, more

moderate levels of cognitive exertion do not seem to prolong recovery substantially."

Thus, we recommend a period of near full cognitive rest acutely after injury, approximately 3-5

days, followed by a gradual return to sub-symptom levels of cognitive activity."

Written by Catharine Paddock PhD

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