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Cognitive Rest Tied to Quicker Recovery From Concussions

Student-athletes who sustain concussions may have a shorter recovery if they rest and abstain from regular cognitive activity following that injury, suggests a new study published online today in the journal Pediatrics.

Researchers drew that conclusion after examining data from 335 patients between the ages of 8 and 23 who were seen at the sports concussion clinic of Boston Children's Hospital between Oct. 1, 2009 and July 31, 2011.

The athletes self-reported their degree of cognitive activity—complete rest, minimal activity (no reading or homework, less than 20 minutes per day of online activity and video games), moderate activity (reading less than 10 pages per day, less than one hour combined of homework, online activity, and video games), significant activity (reading less and doing less homework than usual), or full activity.

Nineteen percent the study participants reported a loss of consciousness at the time of their concussion, while 37 percent reported amnesia. Thirty-nine percent also reported having sustained at least one previous concussion. The largest portion of the reported concussions occurred while playing ice hockey (21.8 percent), followed by football (20.6 percent), basketball (14.9 percent), or soccer (13.4 percent).

The researchers discovered that the youth-athletes in the highest quartile of cognitive-activity days statistically took longer to recover than those in the other three quartiles. In other words, those who engaged in the highest levels of cognitive activity experienced a delayed recovery compared to those who engaged in higher levels of cognitive rest.

The patients in the three lower quartiles of cognitive activity had similar durations of symptoms, the study says, suggesting that it may not be necessary for youth-athletes to completely abstain from cognitive activity. The overall mean duration of symptoms for all of the study's participants was 43 days.

"By showing that those engaged in the highest levels of cognitive activity had the longest times to symptom resolution, our study supports the use of cognitive rest and contributes prospective data to the current consensus opinion that limiting extensive cognitive activity reduces duration of concussion symptoms," the authors write.

The latest consensus statement on concussion in sports, released in March 2013, recommends that student-athletes take a gradual approach to returning to school and social activities after sustaining a concussion to "avoid provocation of symptoms."

A clinical report from the American Academy of Pediatrics released in Oct. 2013 echoed those recommendations, saying that forcing a student-athlete to return to his or her normal classroom routine immediately after sustaining a concussion could delay his or her recovery.

In addition, a January 2013 position statement from the American Medical Society for Sports Medicine also emphasized student-athletes' need for cognitive rest following a concussion.

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