Post-concussion ‘cognitive rest’ may slow kids’ recovery, study says
Keeping a child home from school for “cognitive rest” after a concussion may do more harm than good, a study suggests. The analysis, in the journal JAMA Network Open, shows an association between an early return to school post-concussion and reduced symptoms for most children and teens.
In reviewing the cases of 1,630 5- to 18-year-olds in Canada diagnosed with concussions between August 2013 and September 2014, researchers found that about half of them adhered to current guidance that suggests children should receive “cognitive rest” and return to school gradually following a head injury. The other half returned to school earlier than the average for their age group, missing zero to two days of school on average. Older kids missed more school on average than younger ones.
Researchers followed up with the children one week, two weeks and four weeks after the injury. They graded them on the Post-Concussion Symptom Inventory, an assessment that measures symptoms such as headache, nausea, dizziness and other issues reported following head injuries.
When the researchers compared the scores of kids who returned to school earlier with those who didn’t, they found that an early return was associated with fewer symptoms in 8- to 12-year-olds and teenagers two weeks after the injury.
A quicker return to school “may directly or indirectly promote faster recovery” for kids in that age group, the researchers write — perhaps due to social factors, reduced stress from missing less school, or adherence to existing routines and physical activity levels.
Current guidance by the Centers for Disease Control and Prevention suggests cognitive rest may be necessary for kids in the first days after a concussion and recommends a gradual increase of activity. But the authors of those guidelines — and of the current study — acknowledge that more research is needed.
“Clinicians can now confidently inform families that missing at least some school after a concussion is common, often between 2 and 5 days, with older kids typically missing more school,” said Christopher Vaughan, a pediatric neuropsychologist at Children’s National Hospital and the study’s lead author, in a news release. “But the earlier a child can return to school with good symptom management strategies and with appropriate academic supports, the better that we think that their recovery will be.”