While 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."