Cognitive Rest After Concussion Critical To Avoiding Extended Recovery

"While there has been a lot of emphasis in recent years on return to play guidelines for concussed athletes, because our kids are students, I like to now think of concussions as having created concussed students, as opposed to concussed athletes," says Dorothy Bedford, whose daughter, Heidi, suffered a concussion while playing hockey.

"I think from a parent's point of view, and from the point of view of the future of the student, it is more important for pay attention to the cognitive impact [of concussion].  So, not only is it important [for concussed students] to avoid play but to avoid cognitive exertion," she says, because it is "critical to making a successful recovery at an early point, instead of having it extended, as Heidi's was, because we made mistake after mistake" in terms of making sure she got the cognitive rest that she need after her concussion.

Concussion effects cognitive function

Because a concussion impacts the brain's cognitive function (those that involve thinking, concentrating, learning and reasoning), not its structure, it makes sense that engaging in cognitive activities (in other words, doing something that requires thinking or paying attention) is likely to make an athlete's concussion symptoms worse, and even delay recovery (although no link has been established to adverse long-term health effects).

As a result, both the most recent international consensus of concussion experts¹and, most recently, the American Academy of Pediatrics,² recommend that athletes limit scholastic and other cognitive activities to allow the brain time to heal. Just as athletes recovering from a concussion needs to get physical rest, they need to get cognitive (mental) rest as well.

Because a concussion impacts the brain's cognitive function (those that involve thinking, concentrating, learning and reasoning), not its structure, it makes sense that engaging in cognitive activities (in other words, doing something that requires thinking or paying attention ) is likely to make an athlete's concussion symptoms worse (although no link has been established to adverse long-term health effects)

Cognitive rest means:

1. Time off from school or work;
2. No homework;
3. No reading;
4. No visually stimulating activities, such as computers, video games, texting or use of cell phones, and limited or no television;
5. No exercise, athletics, chores that result in perspiration/exertion;
6. No trips, social visits in or out of the home; and
7. Increased rest and sleep.³

Such rest has been recommended despite the fact that, until June 2012, there was no empirical evidence to support such treatment. With the publication of a new study in the Journal of Pediatrics³ documenting the effectiveness of prescribed rest for the treatment of post-concussion symptoms and cognitive disfunction, whether the rest is applied in the early or prolonged stages of recovery, athletes, parents, and school and athletic officials who do not see the therapeutic value of missing school or sports, especially when weeks or months have passed since the injury, will, it is hoped, now be less likely to resist or challenge such clinical judgment.

1. Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Br. J. Sports Med. 2009:43:i76-i84

2. Halstead, M, Walter, K. "Clinical Report - Sport-Related Concussion in Children and Adolescents" Pediatrics. 2010;126(3):597-615. 

3. Moser RS, Glatts C, Schatz P. Efficacy of Immediate and Delayed Cognitive and Physical Rest for Treatment of Sport-Related Concussion. J Pediatrics DOI: 10.1016/j.jpeds.2012.04.012 (in press).

Posted December 9, 2011; revised and updated June 18, 2012