What I’m reading: Cognitive rest after concussions

In the ED we certainly see a significant number of head injuries. There are an estimated 1.7 million per year in the US. Fortunately most of these are not associated with intracranial bleeding. However, that certainly does not mean that there aren’t important diagnoses to consider. Concussions have gained increased attention over the past decade thanks in part to a growing body of evidence and increased awareness in the athletic community. There are recommendations and guidelines from multiple different bodies and in this post I briefly wanted to share recommendations on one particular facet of post-concussion management that will be important as the new school year dawns and students begin competing in fall sports.

Certainly the symptoms of concussion are varied, and can include:

Headache
Visual symptoms (photosensitivity)
Dizziness
Phonosensitivity
Trouble concentrating, focusing and remembering
Sleep problems

It goes without saying that these symptoms can impact any facet of one’s daily life. In the past research has focused on return to the athletic field, however cognitive rest may be just as important. This includes school work, video games and use of computer and mobile devices (take that Instagram). Fortunately the majority of these symptoms are short lived (<3 weeks). Those that persist longer than 5 days and especially those that have symptoms longer than 3-4 weeks are prime candidates for alteration of their academic situation. It goes without saying that a student with trouble concentrating and remembering things will have trouble accessing and acquiring knowledge in the classroom.

Halstead et al published a clinical report in the November, 2013 edition of Pediatrics. In in they made specific recommendations on when concussed patients should have an adjustment made to their schooling and cognitive load. Parents in the ED may look to us to begin providing recommendations on when their children can return to school. Though we may not be directly contacting school administration and educators I certainly feel that it is important for us to understand the current recommendations. The most important “take home point” to convey to parents in the ED that I gleaned from the aforementioned article is the following: