Cognitive rest can benefit patients diagnosed with concussion

Limiting texting, homework, online activity may help hasten recovery for teen athletes

A study of 335 teen athletes diagnosed with concussion suggests that patients who comply with cognitive rest limits may recover faster than those who engage in increased cognitive activity, such as texting, reading and playing video games. The prospective cohort study, conducted at Boston Children's Hospital and published Jan. 6 in Pediatrics, provides critical data to support physicians' standard post-concussion advice for restricted cognitive activity.

"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," says William Meehan, MD, from Boston Children's Division of Sports Medicine. 

Doctors have prescribed cognitive rest for patients diagnosed with a concussion for nearly 10 years; however, evidence supporting the recommendation was scant. Meehan and colleagues designed this study to determine the effect of cognitive activity limits on the duration of post-concussion symptoms. 

The researchers enrolled 335 patients with a mean age of 15 years who presented to the Sports Concussion Clinic at Boston Children's Hospital within three weeks of a concussion between October 2009 and July 2011. They recorded patients' symptoms using the Post-Concussion Symptom Scale and asked them to complete a Cognitive Activity Scale that recorded their average level of cognitive activity at each visit.

The 5-point scale ranged from complete cognitive rest—defined as no reading, homework, text messaging, video game playing and online activities—to full cognitive activity, or no limits at all. Cognitive activity levels were divided into quartiles.

Statistical analysis showed that patients who engaged in the highest level of cognitive activity required the most time for concussion symptoms to resolve.   

The findings demonstrate the importance of academic accommodations, such as modified assignments or extra time for schoolwork, for students diagnosed with a concussion.

Although cognitive rest facilitated recovery from concussion, the results suggest balanced activity. Patients who engaged in the three lower cognitive activity quartiles—complete rest, minimal activity (no reading or homework, less than five text messages and less than 20 minutes of online activity and video games per day) and moderate activity (reading less than 10 pages, less than 20 text messages and less than one hour combined of homework, online activity and video games per day)—required about the same length of time to recover.

"These findings indicate that complete abstinence from cognitive activity may be unnecessary," says Meehan. "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."