Resting the brain after a concussion

Pennsylvania's brand-new Safety in Youth Sports Act aims to help adults respond better to sports-related head injuries in middle school and high school athletes – so that a kid's brain can fully recover.  As Inquirer writer Kathy Boccella noted in this story on Monday, the law is a response to an alarming rise in reported traumatic brain injuries in high school and middle school sports.

The act requires that athletes suspected of suffering a concussion be removed from play right away and bars them from returning until cleared by a physician. It penalizes coaches who don't follow the rules, requires yearly training in concussions for high school coaches, while parents must sign an information sheet on brain injuries. And it requires that schools grant kids the crucial downtime their little gray cells need for recovery.

I asked Christina Master, M.D., an attending physician at Children's Hospital of Philadelphia (CHOP) whose work includes caring for kids and teens with concussions at the hospital's Sports Medicine and Performance Center. I wanted to know why brain rest is so important – and so challenging for kids and their families – after a concussion.

"The focus after a concussion in an athlete has been the question 'When can they return to play?' but for kids and teens the real focus needs to be 'When can they return to learning?,' she says. "It takes physical and cognitive rest for the brain to recover after a concussion. Kids don't want to take time off from school and sports, especially with so much pressure on high achievement these days. But rest is actually the quickest way to get back to the activities they want to be doing."

Brain rest is more than skipping practices and games. Master said it usually involves at least a few days off from any continuous mental effort as well. "That's difficult these days. It means no texting, no computer, no video games, no TV, no Facebook, along with no reading and no homework" she said. "When my own son had a concussion after taking a fall during ice hockey practice, he had to give up his X-Box. He stayed with his grandparents. The slow pace of visiting, maybe going out to lunch, doing easy activities like baking or playing Legos works well for brain recovery."

Why? It turns out that the brain is in a bind after a concussion. "It needs more energy than usual because it's healing, but at the same time your body reduces blood flow to the brain after a concussion to lower the risk for brain swelling," Master says. "Asking your brain to do more than just heal takes resources away from recovery, especially in kids and teens whose brains are also growing and developing during this time. That's why kids who try to text, watch TV, go back to school too soon or do other activities that call for extended attention can end up with headaches, trouble concentrating, difficulty remembering material, taking notes and processing information on the blackboard or white board. It's too much."

Every kid's concussion-recovery plan is unique, Master says. But the best recovery programs follow the four-step plan CHOP uses – a plan you and your doctor can check out on the CHOP website under Concussion Care for Kids: Minds Matter.  A later Healthy Kids post will look at brain rest after a concussion – and how to know if your child or teen is healing.