Post Concussion: Cognitive Rest Beneficial for Recovery

William P. Meehan III, MD Director, Micheli Center for Sports Injury Prevention Director, Sports Concussion Clinic, Boston Children?s Hospital 9 Hope Avenue, Suite 100 Waltham, MA 02453MedicalResearch.com Interview with:
William P. Meehan III, MD
Director, Micheli Center for Sports Injury Prevention
Director, Sports Concussion Clinic, Boston Children?s Hospital
Waltham, MA 02453

MedicalResearch.com: What are the main findings of this study?

Dr. Meehan: The study has 2 findings that I believe are the most worthy of attention.  First, although cognitive rest has been recommended as a therapy for concussion for several years now, there has been little data showing its effect. This lack of data has led to variability in the recommendations for cognitive rest, with some experts not recommending it all, and others recommending athletes avoid all cognitive activity, lying alone in a dark room even, until they are completely recovered.  As you can imaging, this has generated controversy.  We believe this is the first study showing the independent, beneficial effect of limiting cognitive activity on recovery from concussion.

Second, only those engaging in the highest levels of cognitive activity had a substantial increase in their symptom duration.  Those engaging in the first 3 quartiles of cognitive activity level recovered in a similar time frame.  This would suggest, that while vigorous cognitive exertion is detrimental to recovery, milder levels of cognitive exertion do not seem to prolong recovery substantially.

In general, 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.  Scholar-athletes in particular, are instructed to engage in as much cognitive activity as they can without making their symptoms worse, and without their grades dropping.

MedicalResearch.com: What further research do you recommend as a result of your study?

Dr. Meehan: I believe the next big question for concussion is, how can we treat it?

For those who suffer prolonged symptoms despite physical and cognitive rest, is there a way to directly treat the underlying pathophysiology?  We are current working on some possible treatments at The Micheli Center for Sports Injury Prevention and the Sports Concussion Clinic at Boston Children’s Hospital.

Citation:

Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms

Naomi J. Brown, Rebekah C. Mannix, Michael J. O’Brien, David Gostine, Michael W. Collins, and William P. Meehan III

Pediatrics peds.2013-2125; published ahead of print January 6, 2014, doi:10.1542/peds.2013-2125