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Although reducing cognitive activity to rest the brain is commonly recommended for concussion treat-ment, there has been limited research to back up that advice. But the new study in January's Pediatrics, published online today, lends support to the idea.
In the study of 335 children and young adults, ages 8 to 23, those reporting the most cognitive activity (including homework, video games, crossword puzzles, text messaging and online activities) after a concussion took the longest to fully recover -- approximately 100 days on average, compared with approximately 20 to 50 days for patients reporting lesser levels of activity.
Cognitive activities were defined as "activities that require you to think harder than usual," and study participants were grouped according to the average amount of cognitive activity -- from complete cognitive rest to a full schedule -- that they reported doing between each visit to a concussion clinic.
In addition to showing that cognitive rest works, the findings also show "there's no need to take cognitive rest to the extreme," such as putting patients in a dark room and eliminating all cognitive activity, as advocated by some. "Those who were doing milder levels of cognitive activity recovered at about the same rate as those who were doing minimal levels," says study co-author William Meehan, director of research for the Brain Injury Center at Boston Children's Hospital and director of the Micheli Center for Sports Injury Prevention.
The findings bolster recommendations in favor of academic accommodations that allow cognitive rest for students recovering from concussions, Meehan says.
Even though there are guidelines by the American Academy of Pediatrics, the American College of Sports Medicine, the American Academy of Neurology and others, "the implementation of cognitive rest has been variable and even controversial," in part because of the lack of empirical evidence, he says.
According to statistics from the University of Pittsburgh Medical Center Sports Medicine Concussion Program, 1.7 million to 3 million sports- and recreation-related concussions occur every year. Five of 10 concussions go unreported or undetected. One in 10 high school athletes who play contact sports will suffer a concussion this year.
"Most of us involved in concussion management have been telling folks for years to do some degree of cognitive rest up front, (although) we didn't have great evidence behind that" recommendation, says Greg Canty, director of the Center for Sports Medicine at Children's Mercy Hospitals and Clinics in Kansas City, Mo. This research "starts to build a better body of evidence," says Canty, who was not involved in the study.
It also "adds some recognition that it's not just physical rest that may allow that brain to heal, but that some degree of cognitive rest is also likely beneficial."