Children’s concussions and brain rest

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For years neurologists have been telling kids with sports-related concussions to give their brains a rest — not only by avoiding physical activity, but also by abstaining from cognitive challenges such as reading, texting, or playing video games for several days. But that advice wasn’t backed by evidence that it helped the brain heal faster, until now.

A new study conducted by researchers at Boston Children's Hospital tracked 335 student athletes who were treated for concussions incurred on the playing field. They found that those who took the most time off from tasks that required a lot of thinking had the quickest recovery from headaches, dizziness, nausea, and other concussion symptoms.

A majority of those who got the most cognitive rest were symptom-free 40 days after their head injury, but it took 100 days for symptoms to resolve in the majority of those who got the least amount of rest, according to the study published Monday in the journal Pediatrics.

While the study couldn’t determine exactly how much rest was optimal, study coauthor Dr. William Meehan said the results confirmed the sensibility of recommendations to avoid mental challenges right after a concussion.

“For the first three to five days, we tell our patients with concussions that they should really aim to be at a zero level or complete cognitive rest,” said Meehan, director of the sports concussion clinic at Boston Children’s. That means no reading, homework, text messaging, or video game playing; basically, it’s fine to lie in bed quietly, watching TV or listening to music with the volume on low.

“Those experiencing severe symptoms may prefer to be resting anyway,” Meehan said, “but those with mild symptoms may think they can go back to school or resume exercise right away, which may delay their recovery.”

After a few days, kids can slowly add mental activities such as doing a crossword puzzle or sending a few text messages to see how they feel. “If symptoms exacerbate, they should go back to resting,” Meehan said. If they’re feeling OK, they can continue to gradually add mental challenges, resuming some school work on a lighter schedule. Throughout, they should continue to assess their symptoms and cut back if the headaches or dizziness return.

The brain likely needs to rest from mental processing to reserve its precious energy to balance its systems after the injury. Neurologists believe that the blunt trauma to the brain triggers nerve cells to release a flood of chemicals causing an imbalance that leads to concussion symptoms. At the same time, there’s often reduced blood flow to the brain following an injury, which lowers the brain’s supply of glucose for energy. Any glucose expended for mental challenges means less energy is available to restore a biochemical balance.

“Concussions are really a problem with brain function and the movement of ions, or charged particles, around the cell membrane,” Meehan said. This type of malfunction, though, doesn’t appear on brain-imaging tests, though technological advances may enable such imaging in the future.

For the time being, parents helping their kids recover from concussions may need to explain why rest is necessary when the brain scan looks fine.

In a recommendation on managing concussions, the American Academy of Pediatrics states, “cognitive rest is recommended and may include a temporary leave of absence from school, shortening of the school day, reduction of workload, and an allowance of more time to complete assignments or take tests.” Athletes taking over-the-counter pain relievers for headaches should not return to the field until they’re off their medication and are symptom-free, the group recommends.

Rest and time are the only proven remedies that work to heal the injury. In fact, the US Food and Drug Administration issued an alert to consumers last week, advising them not to buy any dietary supplements “that claim to prevent, treat, or cure concussions” since the claims “are not backed by scientific evidence and FDA is concerned that false assurances of a faster recovery will convince someone who has suffered a concussion to resume activities too early to be safe.”

The agency issued warning letters to three companies last year marketing products that claimed to treat traumatic brain injuries including an anti-inflammatory drug called Anatabloc made by Virginia-based Star Scientific and a product called Neuro Impact Concussion Response Formula made by Trinity Sports Group in Texas. Deborah Kotz