The American Academy of Pediatrics (AAP) released “Return to Learning Following a Concussion,” a clinical report, at its annual meeting in late October. Designed to provide guidance to physicians caring for children after concussion, the report emphasizes cognitive rest and a gradual return to full participation in the classroom. Doctors at Boston Children’s Hospital’s Division of Sports Medicine Sports Concussion Clinic have offered similar advice since the clinic launched in 2007.
For the 300,000 high school athletes diagnosed with a concussion every year, bright lights, busy hallways and derivatives may be more than they can, and should, tackle in the first few weeks after their injury.
Post-injury care is critical for high schoolers with a concussion. “We believe physical and cognitive rest are the cornerstones of concussion treatment,” says Michael O’Brien, MD, associate director of the Sports Concussion Clinic. Cognitive rest means minimizing digital exposure, such as video games, texting and computer screen time. It often means temporary adjustments to the amount of time dedicated to studying and reading. A growing body of research suggests intense participation in these activities, also known as cognitive challenge, could prolong concussion symptoms.
However, experts have not yet developed an evidence-based determination for the optimal amount and duration of rest. And there’s the rub.
Too much of a good thing?
The new AAP guidelines note that most patients recover within three to four weeks from their injury with appropriate treatment. However, up to 3 percent of students with concussions may fall into a group requiring prolonged recovery. These kids may face a Catch-22 as physical deconditioning and social isolation can create new problems.
“There are definite consequences of too much rest,” cautions O’Brien. Too much physical inactivity may affect sleep quality, or make kids sluggish and irritable, but too little rest may prolong symptoms.
Some providers might recommend concussed kids refrain from all activity until complete resolution of symptoms. Adhering to that strict definition could mean no school or activity for four to six weeks or more in some cases, which has academic and social consequences. It is important to note that, while sometimes necessary, missing that much school may put the student’s academic year in jeopardy.
Boston Children’s Sports Concussion Clinic sends a detailed note to the student’s school with recommendations in line with the AAP guidelines:
- Full physical and cognitive rest with no school, often for up to three to five days from the injury.
- When students can tolerate 30 to 45 minutes of reading at home, initiate return to the classroom.
- Students return, often with half-day school attendance and academic accommodations, such as deferring high stakes testing and providing extra time for projects and tests.
- Increase school work to normal workload as symptoms improve.
As patients prepare to return to the classroom, O’Brien and other researchers are working to unravel some mysteries surrounding concussion.
Current questions on the research agenda include:
- Does heavy cognitive challenge prolong recovery?
- Does complete rest shorten recovery?
- When it comes to physical and cognitive rest, how much is enough? And how much is too much?
- Are there medical and non-medical interventions, such as physical therapy, acupuncture or massage that can speed recovery or reduce symptoms?
If your child is recovering from a concussion, it’s important to enforce rest and reduce cognitive stimulation in the first days after the concussion. Current guidelines emphasize communication and accommodations with the school team during the recovery period. Consider an evaluation by a concussion specialist, particularly if symptoms are worsening or don’t resolve in the typical period of three to four weeks, says O’Brien.
Click here to download Boston Children’s Concussion Prevention Guide.