The Importance of Rest
The most important factor you must understand when recovering from a concussion is the requirement of complete rest. If an athlete continues to participate in a sport, his or her brain is being subjected to vigorous activity that it is not ready for. In fact, new research suggests that student athletes who are too active not just on the field, but also at home and school, may be hindering their recovery. The brain uses glucose as fuel for both activity and recovery. If the brain is busy reading, watching videos or sending text messages, or is pre-occupied with other cognitive activity, those glucose stores will not be available for recuperation.
Another important reason to keep your child from activity is to ensure that a second concussion is not sustained while the brain is recovering. This is called second impact syndrome (SIS) and can cause uncontrolled cerebral swelling, permanent brain damage and even death.
How to Help Your Child Recover
Concussions are common in contact sports, and as with injury to any other part of the body, the brain needs time to rest and heal. In most instances of concussion, complete recovery can be achieved in days, or in some cases weeks or months. How long it takes to recover depends on how effectively treatment recommendations are followed, how severe the injury is, and whether there are any complications or preexisting vulnerabilities. It is well established that physical and cognitive activity increases the severity of concussion symptoms and makes them last longer. Your doctor will “rst prescribe complete rest as the most important treatment measure. So what does complete rest mean, and how do you make sure your child really rests? Complete rest not only means a stop of physical activity, but also of cognitive activity requiring attention and concentration. Make sure your child is not involved in any activity until all physical, cognitive and emotional symptoms of concussion are gone. Below is a partial list of common activities your child may usually partake in. To many, they may seem harmless, but they are actually taxing to the recovering brain and should be avoided.
Typical Activities to Avoid During Recovery include:
- Attending school
- Watching television or movies
- Computer activities (games, Facebook)
- Video games
- Card or board games
- Listening to music
Sound extreme? Wonder how you are going to keep an active child down?
Initially, getting your child to rest may not be difficult if they are already feeling unwell with headaches, nausea or fatigue. They may very well want to do nothing but rest. As symptoms start to improve, however, make sure your child continues to rest as much as possible until they are completely symptom-free at rest. Thankfully, this phase typically only lasts from a few days to a few weeks.
Once your child is completely symptom-free at rest, they can start a step-wise increase in activity. The New Concussion Management Guidelines developed by the ThinkFirst-SportSmart Concussion Education and Awareness Committee compares this gradual process of returning to activities to the dimmer switch of a light. The brightness, or activity, should be moved gradually with adjustments downward if conditions re-appear. In contrast, using an on-off switch moves the person from no activity back to normal activity without gradual progression and adjustments. This approach has been blamed for the prolonged course of postconcussive indicators that some children experience.
Some light reading, limited television or interacting with parents and siblings is a good way to start returning to activity, as long as the child’s condition does not worsen. If symptoms return, then activity is scaled back. From there, your child may want to return to school for only half days at first, progressing gradually to full days. If post-concussion symptoms return at school, your child may be able to manage attending school with modifications or accommodations to their schedule. For example, your child may function in school better with extra time to finish missed work, indoor recess to avoid excessive physical exertion, limited gym class participation, extra time to complete tests and assignments, a quiet room to write tests or complete work, and/or rest periods throughout the day.
So what do you do if your child seems to be taking longer than expected to be symptom-free?
The first step is to have your child re-checked by a doctor for complications. If there is any concern about bleeding in the brain or fractures of the skull or facial bones, an X-ray, CT scan or MRI may be ordered. These scans are used to create an image of the brain or surrounding bones. In most cases, the tests will be normal in concussions, as they provide information only about how the brain looks, not how it is functioning.
If everything checks out fine, then it may be time to review what activities your child is involved in throughout the day. Do their symptoms disappear with complete rest? What physical or cognitive activities have been added to their day? One of the best ways to find answers to these questions is to make a chart of the types of activities your child does during the day, how much time is spent in each activity, the time of day, the surroundings during the activity (e.g., lighting, noise, distractions) and the number, duration, frequency, and timing of rest breaks your child takes throughout the day. You may be able to modify some of these factors to reduce your child’s symptoms.
If you are unable to be home with your child during their recovery to monitor their activity, share information about your child’s concussion with the caregiver (e.g., a member of the family, a babysitter). Doing so will help the caregiver understand what has happened to your child and how to meet the child’s needs during recovery. Otherwise, a well-meaning caregiver could inadvertently be exposing your child to cognitive activity that may prolong the healing period. You could “nd that the person looking after your child has dutifully had your child lying quietly on the couch while the television has been on all day. In all probability, your child has spent the day watching television, a cognitive activity that takes, at minimum, some attention and concentration to follow. Or your child may have spent the majority of the day quietly sitting in a room but the caregiver was unaware that your child had a hand-held device and was texting, listening to music or playing games.
If your child has suffered a concussion or has any preexisting vulnerabilities, recovery may take longer. You can expect an extended healing period if your child suffered a loss of consciousness or memory (post traumatic amnesia) at the time of the injury. Also, having had a previous concussion may increase the chance that recovery from the current injury will be prolonged. Expect your child to take longer to become symptom-free and to move through a gradual return to normal activities.
The length of time it takes for symptoms to completely disappear can seem endless, especially to athletes wanting to get back to playing their favorite sport. Parents sometimes worry that their child will experience a loss of skill, physical conditioning or stamina the longer it takes to return to play. Additionally, parents may also wonder if the injury can place their child at greater risk of suffering another concussion, once there is a return to play. Various concerns may make it harder to keep players on complete rest until symptoms subside and to only gradually increase activity. However, taking the time to ensure complete rest for a gradual return is the most effective way to get your child safely back into the game.
When Symptoms Linger
The mainstay of treatment for concussions is rest, both physical and mental. With proper rest, the brain can usually heal itself within 7 to 10 days. When symptoms linger, there are additional treatment options that may help. Although there is not a lot of evidence or research that proves these treatment methods are effective, physicians have had a vast amount of clinical success using them to treat athletes with protracted recoveries. Your physician may talk to you and your child about the following treatment options.
If headaches persist, acetaminophen (Tylenol) or ibuprofen (Advil) is an option. Acetaminophen is the preferred choice for headaches related to concussion because there is a potential increased risk of bleeding with ibuprofen. A medication specific to migraines or tension headaches is also an option.
Another drug your doctor may mention is called amitriptyline. Patients who have suffered a post-traumatic injury often take this medicine to help prevent the onset of headaches and to aid with sleep.
If your child is already taking medication for an existing mental health problem such as anxiety or depression, your physician may want to increase the dosage because mental health issues can potentially be exacerbated by a concussion. Finally, if residual attention or focus problems have arisen as a result of concussion, your physician may recommend your child try a psychostimulant, such as Ritalin or Adderall.
Vestibular physical therapy
Athletes experiencing dizziness or vestibular problems associated with a concussion tend to improve after completing vestibular work with a trained physical therapist. Some researchers believe that concussion sufferers sometimes have “convergence insufficiency,” meaning that they have problems turning their eyes toward each other to focus on an object. Simple eye movement and tracking drills can help re-establish this skill. For an athlete, the physical therapist may start with only eye movement before progressing to standard balance drills, then moving on to more sport-specific drills by introducing a ball.
Some athletes benefit from handson therapy from an athletic therapist, osteopath, chiropractor, massage therapist or physiotherapist. These types of therapies are typically directed toward treating symptoms or functional impairments that may be indirectly associated with the concussive injury itself. For example, persistent neck pain, stiffness and joint dysfunction may exacerbate symptoms of headache and dizziness (common in a whiplash-associated injury). Pain or dysfunction at the jaw may also aggravate existing concussive symptoms. Treatment directed at clearing up associated physical impairments may help to decrease pain and aid in recovery.
It can be difficult for an athlete to rest completely. A week or two without activity is fine, but for athletes whose symptoms linger on, it becomes harder to not work out. Their athleticism is part of their identity and wellbeing, and it has been taken away from them with this injury. Thus, in a very controlled manner, athletes with long-term symptoms may bene”t from light exercise that triggers a slight sweat. This does not mean that athletes should return to their sport, but it does mean that a brisk walk or light jog may be allowed. Every case is different, and every athlete with lingering symptoms must proceed with extreme caution, and only as recommended by a physician.