Don't Think Too Much After a Concussion

Children take longer to return to full cognitive function after a concussion than adults, and their return to cognitive and physical activity should be gradual
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A new study in the journal Pediatrics shows that cognitive rest is an essential part of recovery after a concussion. Patients who engaged in cognitive activities, such as homework, reading, or screen time on computers and other digital devices could take twice as long to recover after a concussion.

Researchers followed 335 pediatric patients who presented at a Sports Concussion clinic within three weeks of injury in order to measure their average rates of cognitive activity and its impact on concussion recovery. Patients self-reported their cognitive activity and the researchers divided these patients into quartiles (full rest to mild activity, moderate activity, significant activity and full activity).

Patients who engaged in their pre-concussion, full levels of cognitive activity took an average of 100 days to recover from their symptoms. However, patients in the lower three quartiles who took a break from cognitive activities recovered the most quickly, reporting no residual symptoms after 50 days.

Naomi Brown of the Children's Hospital of Philadelphia, first author of the study, told me: “We know that there’s an increased metabolic demand in the brain in the first week after the injury, which is one reason decreased activity immediately after the trauma is so important. Every patient is different, so it’s difficult to generalize about concussions, but generally after three weeks patients can try out some light activity, such as stretching or walking the dog as long as there are no symptoms.”

Cognitive function can include activities other than the obvious, such as homework and screen time. I asked Dr. Brown whether the cognitive strain of executive functions, such as organizing school materials, time management, and prioritizing long-term projects, should be included in “cognitive activity” to be avoided in the wake of a concussion, and she replied, “Sure. We know that girls are better at multi-tasking than boys, and some kids are more adept at executive functioning than others, so executive functions would certainly create more of a strain for them.” If a child struggles with attention or the demands of executive function, the weeks following a concussion might be a good time to give your child some extra support and understanding.

Senior study author William Meehan told Health Day, "We recommend a period of near full mental rest after injury—approximately three to five days—followed by a gradual return to full levels of mental activity." Dr. Brown adds, “We are not recommending complete abstinence from school, especially after the first week. If you go to school for a couple of hours and you are doing OK, then the next day you can go for a little bit more and slowly test it out.”

This study follows on the heels of new recommendations from the American Academy of Pediatrics that state “Students with a concussion may need academic adjustments in order to minimize a worsening of symptoms.”

Current recommendations stress that children should not return to any physically demanding activity, let alone activities with the potential for repeated concussions, until the child is completely symptom-free and their cognitive function has returned to baseline. Children take longer to return to full cognitive function after a concussion than adults, and their return to cognitive and physical activity should be gradual and under close supervision.

When asked how this increased recovery time in students who don’t take a cognitive break might impact their return to sports and other physical activities, Dr. Brown said, “School is more important than sports, so it’s important to stay at sub-threshold levels of exertion until all symptoms are gone. At that point, start slow, and stop if symptoms return.” 

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Jessica Lahey is a contributing writer for The Atlantic and an English, Latin, and writing teacher. She writes about education and parenting for The New York Times and on her site, Coming of Age in the Middleand is the author of the forthcoming book The Gift of Failure: How the Best Parents Learn to Let Go So Their Children Can Succeed.

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