Moderator's Note: Today we are pleased to introduce a new blog contributor, Dr. Daniel Corwin. Dr. Corwin is a pediatric emergency medicine specialist at CHOP and an Associate Fellow at CIRP@CHOP with a research focus on concussion injury.
Summer is in full swing, and our children are enjoying the weather with outdoor activities, games, and sports. Injuries of all kinds increase during the summer months, including concussion. There are some differences in concussion management during the summertime, though the overarching concepts of treatment remain the same.
Rest: How Much Is Ideal?
The key to concussion recovery is rest. Our approach to resting children after a concussion, however, has shifted in the past several years. No longer do we recommend children to rest until they are fully symptom-free.
In fact, recent studies have shown complete rest for too long may actually prolong recovery. Danny Thomas and colleagues in Wisconsin found the symptoms of children who rested for 1-2 days following a concussion resolved more quickly than those who rested for 5 days. Thomas Buckley and colleagues in Delaware found college-aged athletes who completely abstained from activity for 48 hours took twice as long to recover as those who began gradually returning to activity shortly after the injury.
While the ideal period of rest following a concussion remains unknown, we recommend a brief (24-48 hour) period of rest with symptom improvement followed by gradual reintroduction of both physical and cognitive activity.
What Is Different About the Summer?
The daily activities of a child are different in the summertime compared to during the school year. Not only is the exposure to the cognitive workload of school absent in the summer, but the demands of the vestibular system (the body’s “steadycam”) that accompany schoolwork (including reading, taking notes, and focusing on a computer screen) are also lacking.
It is important as a child recovers from a concussion in the summer to exercise this system with tasks such as reading (or other academic-type work), in addition to gradually adding in physical activity, to allow children to adequately rehabilitate both their cognitive and physical systems.
Keep in mind that children who are still symptomatic should generally avoid high-risk activities whereby they could be exposed to a second head injury during the acute recovery phase.
Back to School
Unfortunately, summer does eventually end, and the start of the school year is just around the corner. This is important for concussion recovery, as the extra demands of school may push a child who appears to have fully recovered to begin re-experiencing symptoms.
Parents and teachers should be especially vigilant about those students who experienced concussions over the summertime when school resumes. If they begin exhibiting symptoms, their activity levels should be scaled back to what is tolerated, in concert with their primary doctor. Referral to a specialist for formal rehabilitation for the concussion deficits should also be considered.
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