Pediatric Research 2014: The Year's Most Interesting Studies

Alan Greene, MD; Laurie Scudder, DNP, PNP

Disclosures

September 08, 2014

In This Article

Making Sense of Concussion Research

Medscape: To change gears, the next important study you cite is about concussion. This year has brought some important new understanding about the importance of cognitive rest in managing children who have sustained a concussion.[12] What activities can and cannot be done during a period of cognitive rest? And how much rest is enough?

Dr. Greene: The idea of prescribing cognitive rest after concussion is getting more common. Until now, there weren’t many data showing whether it really works. In this prospective cohort study of kids followed at a sports concussion clinic, it was found that patients who got the most cognitive rest after concussion recovered in about one half the time period of the ones who went right back to exercising their brains. There was a profound difference in outcome: Kids who did not receive cognitive rest had double the days of impairment from the concussion.

Why might that be? According to the study authors, one of the most commonly held hypotheses is that the sheer force that resulted in the concussion leads to ion flux and indiscriminate release of neurotransmitters that spreads throughout the brain. Adenosine triphosphate (ATP) is needed to restore homeostasis. But after the injury, cerebral blood flow is sluggish, and there's this mismatch between increased need for ATP for healing and decreased supply of ATP. Cognition -- the act of thinking or concentrating on something -- uses up a lot of ATP that could otherwise be going toward restoring homeostasis.

That means that while children are still symptomatic, about 1-3 weeks or so after a concussion, studying hard or taking exams is a bad idea -- something kids may well be pleased about. What they might not be as pleased to know is that this also includes such things as texting their friends and playing a video game that requires concentrating while trying to achieve a high score. So the rest really means an active electronic rest as well as schoolwork rest.

Passive screen time is permitted in a period of cognitive rest and is less likely to impair healing. A little bit boring would be fine!

We still have a lot to learn about how long that period should be. The American Academy of Pediatrics report on returning to learning suggests a period of 1-3 weeks.[13] It probably varies from child to child, on the basis of their symptoms, and the earliest days are probably the most important.

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