When it comes to concussions, children and teens require different treatment, according to international experts who recently published consensus recommendations. The British Journal of Sports Medicine’s new guidelines say children and teens must be strictly monitored and activities restricted until fully healed. These restrictions include no return to the field of play, no return to school, and no cognitive activity.
The no cognitive activity could be the hard part. For children they are saying that this should be adhered to for more than 7-10 days. No school. No texting. No video games. No TV. I would figure that reading would also be included.
How does anyone have ‘no cognitive activity’ at all for 2 weeks? Does thinking actually damage the brain? Let’s look at the Consensus Statement:
The panel strongly endorsed the view that children should not be returned to practice or play until clinically completely symptom-free, which may require a longer time frame than for adults. In addition, the concept of “cognitive rest” was highlighted with special reference to a child’s need to limit exertion with activities of daily living and to limit scholastic and other cognitive stressors (eg, text messaging, videogames, etc) while symptomatic. School attendance and activities may also need to be modified to avoid provocation of symptoms.
So, it is just cognitive rest until the symptoms go away. Here are the symptoms they discuss:
The suspected diagnosis of concussion can include one or more of the following clinical domains:
Symptoms—somatic (eg, headache), cognitive (eg, feeling like in a fog) and/or emotional symptoms (eg, lability).
Physical signs (eg, loss of consciousness, amnesia).
Behavioural changes (eg, irritability).
Cognitive impairment (eg, slowed reaction times).
Sleep disturbance (eg, drowsiness).
If any one or more of these components is present, a concussion should be suspected and the appropriate management strategy instituted.
No cognitive work until the symptoms go away. The thought of a teenager stuck at home who can not use their cell phone, watch TV or play video games is pretty harsh.
Of course, this makes sure the teen does not malinger in order to stay out of school. The old ‘You can stay home but you can not text, play video games, read, watch TV or think’ approach.
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