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Cognitive Rest After Concussion: A Guide for Clinicians

November 26, 2013

Cognitive Rest After Concussion: A Guide for Clinicians

  1. Louis M. Bell, MD

Specific recommendations for returning a student to learning after concussion

  1. Louis M. Bell, MD

Sponsoring Organization: Clinical report based largely on expert opinion from the American Academy of Pediatrics

Target Population: Primary care providers

Background and Objective

Although research on appropriate management of concussion in children is lacking, known symptoms include headache, dizziness, visual symptoms, light sensitivity, noise sensitivity, difficulty concentrating or remembering, and sleep disturbances, all of which can affect school performance. In the past, the primary focus following concussion was determining when a child could return safely to sports and other physical activities. More recently, awareness is growing that cognitive rest (from texting, video games, and school work) might be just as important.

What's Changed

Experts now believe that cognitive rest with a thoughtful plan for “returning to learn” is important, and early return to school could actually prolong the symptoms.

Key Points

  • Students with concussion might need academic adjustment in school to slowly reintegrate and return to their schedules.

  • Most concussion symptoms resolve within 3 weeks, so adjustments are temporary.

  • If symptoms persist longer than 3 to 4 weeks, referral to a specialist (pediatric neurologist or sports medicine specialist) is advised.

  • A team of family, school, and medical participants with clear communication is important to individualize the pace of return to learning.

  • Patients should be performing at their academic baseline before returning to sports or other physical activities.

  • Educating teachers and educators, pediatricians, and families about these adjustments is important.

  • More research is needed to establish optimal management of concussion in children.

Comment

The management of concussion during the past 5 years has changed. This clinical report summarizes those important changes. With an estimated 1.7 million traumatic brain injuries in the U.S. annually (mostly concussions), the chances are high that the guidance provided in this report and the recently published report from the Institute of Medicine will be useful.

  • Disclosures for Louis M. Bell, MD at time of publication Grant / research support Institutional Clinical and Translational Science Award; National Center for Pediatric Practice Based Research Learning Editorial boards Current Problems in Pediatric Adolescent Healthcare Leadership positions in professional societies Academic Pediatric Association (Chair, Academic General Pediatrics Fellowship Accreditation Committee)

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