When should children return to school and play following concussion? Taking the proper steps after your child has suffered a concussion can help your child return to activities following concussion.
In a report written at childrenshospital.org, it said the following:
Approximately 300,000 high school athletes are diagnosed with concussion annually, and managing their return to school and sports can present a challenge for the primary care provider. Some physicians recommend cognitive rest, while others don’t, and data supporting either approach have been scant.
The American Academy of Pediatrics (AAP) released a clinical report titled “Return to Learning Following a Concussion” at its annual meeting in October 2013. Designed to provide guidance to physicians caring for adolescents after concussion, the report emphasizes relative cognitive rest — minimizing digital exposure and temporarily making adjustments in studying intensity — and a gradual return to full participation in the classroom.
Full cognitive and physical rest
A prospective cohort study, conducted at Boston Children’s Hospital and published in Pediatrics, provided critical data to support recommendations for temporarily reducing cognitive activity. Researchers reported athletes with concussions who limit high-intensity cognitive demand (which can include texting, reading and playing video games) may recover faster than those who don’t. Interestingly, it also showed that minimal cognitive activity for too long could be associated with prolonged recovery, perhaps due to cognitive deconditioning and the stress of interrupting normal daily routines.
In our office, we can attest to children needing rest in the acute stages. We consider the acute stages 1-4 weeks depending on severity and recovery of symptoms. Why? Because there’s active inflammation in the brain from a concussion, just as if you were to stub you toe on the foot of your bed frame.
Inflammation in the brain comes from injury to nerves. When brain nerves are injured, they release inflammatory chemicals (pro-inflammatory cytokines), and excitatory neurotransmitters in toxic levels (glutamate). Glutamate activates NMDA receptors on cells surrounding it without co-activation of the AMPA receptor. (that’s a tongue twister for proper nutrients are needed to activate BOTH NMDA and AMPA receptors to have proper cellular activation to create stronger neurons. When NMDA receptors are activated by themselves, the neurons actually get weaker.)
Microglial cells are the scavengers or “janitors” of the brain and clean up the mess after an injury, like a concussion. However, these microglial cells can be very hard to turn off.
If you introduce too much stress from returning to school to early (let alone returning to sports when not recovered) cognitive demand, like reading, studying, focusing, paying attention in class, constant exposure to screens (scrolling, brightness, constant erratic eye movements) and a diet high in sugar (fruit, gluten containing foods, coffees and sports drinks) then you are going to continue to fatigue and injure nerve in the brain. That’s a bad thing.
This is also another reason why kids have been shown to take longer to recover from concussion during the school year, rather than during the summer, because there’s more time to rest, allowing the “janitor cells” to do their job and clean up the mess, effectively allowing the inflammation to decrease enough to let the brain function normally again.
If this inflammation continues, it can lead to CTE. The inflammation continues if there are blood sugar dysregulations, anemias (from b12 or iron deficiency), thyroid problems, ADD/ADHD, other sources of inflammation from food in tolerances or sensitivities, genetic SNP abnormalities requiring additional supplementation or other micro-nutrient deficiencies. This is why we often run labs looking for these immediately to make sure our patients have the best chance to recover from concussions.
Look for more information regarding concussions and rehabilitation on our brain blog in the future. Find us on Facebook and follow us on twitter and Instagram.