A 16 year-old running back suffers a direct blow to the head in a Friday night game. He immediately has a headache and dizziness and is removed from the game. He is sent home in the care of his parents after a discussion of particular signs and symptoms that would require emergency evaluation. Follow-up on Monday has been arranged with the his pediatrician.
In the meantime, what should he be able to do over the weekend?
Traditional post-concussion recommendations have focused on strict limitations in cognitive and physical activity until resolution of concussion related symptoms. The “cocoon treatment” where absolute avoidance of all stimulation, often carried out in a dark bedroom for several days, was one such initial recommendation.
More recent data suggests that over-aggressive reduction of cognitive and physical stimulation may actually prolong post-concussion recovery. Thomas et al in Pediatrics found that a strict 5 days of rest resulted in more daily reported symptom scores and slower symptom resolution versus 1-2 days of rest followed by stepwise return to activity. Zemek et al presented a paper at the 2016 Pediatric Academic Societies Meeting reporting that exercise within seven days of injury was associated with nearly half the rate of persistent post-concussive symptoms, or those that last beyond a month.
Striking a balance between overstimulation and understimulation is best done on an individual basis taking into account symptoms and patient preference. Allowing brief (initially 10-15 minute) intervals of activity such as light reading, listening to music, easy walking, or even texting can reduce feelings of isolation and foster recovery. Patients should focus on one activity at a time (no “multitasking”) and should immediately stop activities that result in worsening of symptoms. Regular medical follow-up evaluation can help determine further at-home activity recommendations and also guide return to learn and ultimate return to sport progression.
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VIDEO: Return to Sport after concussion
