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Brain rest after concussion linked to quicker recovery

By Kathryn Doyle

NEW YORK (Reuters Health) - Most U.S. health authorities recommend people who've suffered a concussion give their brain a break while they recover, but there hadn't been strong data to support that. A new study provides some of the first evidence showing "cognitive rest" does make a difference.

Disagreements over whether resting the brain really aids recovery have "generated controversy," Dr. William P. Meehan III, director of the Micheli Center for Sports Injury Prevention in Waltham, Massachusetts, said.

"This lack of data has led to variability in the recommendations for cognitive rest, with some experts not recommending it at all, and others recommending athletes avoid all cognitive activity, lying alone in a dark room even, until they are completely recovered," he told Reuters Health.

Meehan and his colleagues studied 335 kids and young adults who came to a sports concussion clinic within three weeks of their injury between 2009 and 2011.

Most of the young people got their concussions playing ice hockey, football, basketball or soccer. The researchers asked them about their symptoms and how often they were reading, doing homework or playing games at each of their appointments.

Kids with minimal cognitive activity were not reading or doing homework, and spent less than 20 minutes on the Internet or playing video games each day. They could have watched TV or movies or listened to music.

Those with moderate or significant cognitive activity did some reading and some homework, but less than usual.

Other kids had not limited their cognitive activities at all since their last clinic visit.

On average, patients took 43 days to fully recover from their concussions.

Kids with more minor concussions tended to get over their symptoms faster. So did those who did less with their brains while recovering, according to findings published in Pediatrics.

"Only those engaging in the highest levels of cognitive activity had a substantial increase in their symptom duration," Meehan said. Kids at all lower activity levels seemed to recover at about the same pace.

"This would suggest that while vigorous cognitive exertion is detrimental to recovery, milder levels of cognitive exertion do not seem to prolong recovery substantially," Meehan said.

This study could affect how and when kids with a concussion return to school, Dr. Amy K. Wagner told Reuters Health.

Wagner studies brain injuries at the University of Pittsburgh in Pennsylvania and was not involved in the new research.

"The general public, and even those providing care for people with concussion, tend to 'underappreciate' the strain of cognitive effort on the injured brain," she said.

The paper did not mention whether kids saw a brain injury specialist for persistent symptoms, which they should have, and also did not measure their performance in school, she noted.

Academic performance might be difficult to measure, but it's important if research is going to lead to more detailed recommendations for limiting school activity, she said.

In general, Meehan said, doctors recommend almost complete brain rest for three to five days after a concussion, followed by a gradual return to normal activities.

"Scholar-athletes in particular are instructed to engage in as much cognitive activity as they can without making their symptoms worse, and without their grades dropping," he said.

Athletes suspected of having a concussion should be seen by the most immediately available medical personnel, like an athletic trainer or team doctor, he said, with a follow-up visit to their primary care doctor.

"For those with prolonged or complicated recoveries, multiple concussions or other concerning factors, seeing a concussion specialist would be preferable," Meehan said. "The easiest way for folks to find one in their area is to consult their primary care doctor."

SOURCE: http://bit.ly/1gbAnTR Pediatrics, online January 6, 2013.

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