Cognitive Rest after Concussion
How much and for how long?
Concussed student-athletes are usually advised to avoid physical activity until they are asymptomatic, and then return to play cautiously and in stages. This recommendation evolved from recognition of the “second impact” syndrome and led to a trend toward “complete brain rest.”
Why should cognitive activity be different than physical activity? An extreme view is to restrict all neural stimulation, and patients are instructed to stay in a dark room, wear sunglasses, use no electronic devices of any kind such as for texting, emailing, or accessing social media; not to mention, and to the delight of many teens, studying, doing homework, and taking examinations. Good luck getting teenagers to comply with the screen-time prohibition.
Recent studies have debunked the practice of “cocooning,” as it led to slower recovery and worse outcomes. This makes sense as stimulating environments lead to beneficial functional and structural changes in developing brains. Think synapses and neurotransmitters. Moderate activity which does not worsen symptoms was shown to be the best path.
See JAMA Neurology, April 2018, by Giza CC, at al.
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