Limit But Do Not Eliminate Physical and Mental Activity After Concussion, Experts Say
Treating young athletes after a concussive event is uniquely challenging, because their brains are still developing, and their recovery is usually slower than that of adults.
While bed rest is not recommended, there is some evidence to suggest that a limited amount of physical activity may actually help in recovery, and, while the effect of physical activity on concussion recovery has not been extensively researched, there is general consensus among concussion experts on limiting the amount of physical activity in the first few days after concussion, including activities such as bike riding, street hockey, and skateboarding that risk additional head injury or make symptoms worse.
As for resting their brain (cognitive rest), complete mental rest until symptoms clear (or are at least tolerable) was, as recently as 2013, considered the “cornerstone” of concussion management for young athletes. But, in a remarkable about face, most concussion experts now recommend that student-athletes return to school, at least part-time, after only one or two days of rest at home; and, because complete mental rest (no reading, homework, online activity, video games, text messaging and staying home from school for an extended period of time) can lead to other problems, all that is now recommended is reduced reading, homework, working online, and text messaging.
A recently-published study in the journal Pediatrics found that the student-athletes who reduced their cognitive activity the least took from 2 to 5 times longer on average to recover from concussion than those who limited cognitive activity, but that complete abstinence from cognitive activity didn’t help speed recovery.
Another recent study found that athletes who engaged in strict rest for 5 days, compared to a more moderate normal rest period of 1-2 days of rest followed by a return to school, actually took longer to recover and reported more symptoms, leading the authors of a 2016 article in the British Journal of Medicine to observe that, even with limited research, evidence that a more moderate approach to cognitive rest is probably ideal for recovery.
A group of concussion experts meeting in October 2015 at a conference at the University of Pittsburgh Medical Center concluded that strict physical and cognitive rest beyond the first few days after a concussion was not necessary.
“Exercise is a way of treating [concussion],” Dr. Javier Cardenas, a neurologist at the Barrow Concussion and Brain Injury Center in Arizona, told the Pittsburgh Post-Gazette at the time of the conference. “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.”
Another concussion expert who believes that complete cognitive rest may be over-prescribed is Dr. Elizabeth M. Pieroth, a clinical neuropsychologist with North Shore Medical Group in Chicago and a consultant to a number of Chicago professional sports teams, including the Bears.
Like Dr. Cardenas, Dr. Pieroth sees many of the same downsides to keeping concussed athletes out of school for more than a few days after injury, including social isolation, depression, and an unhealthy focus on symptoms instead of recovery.
Dr. Christopher Giza, a pediatric neurologist and director of the UCLA Steve Tisch BrainSPORT Program, agrees. Kids who are cut off from their friends after concussion, Giza says, “quickly start to worry about keeping up in their classes, losing social status and, if they are athletes, whether they will lose their place on the team. It’s important to ease them back into their social circles quickly, and that might mean being a little more permissive when it comes to social media and screen time.”
The American Academy of Pediatrics, mindful of the fact that it is difficult for parents to constantly be monitoring their child and to enforce strict limits on texting, video gaming, computer and TV use and of the relative lack of research in this area, suggests that the most important thing is for a parent to take a common sense approach about their child’s level of cognitive activity, having the child avoid activities that seem to make their symptoms worse.
If symptoms are severe, academic accommodations may be needed, such as shortening the school day or less homework or longer times to take tests. Taking standardized tests while recovering from a concussion should be discouraged, because lower-than-expected test scores may occur and are likely not representative of true ability.
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