People who experience concussions are advised to halt or limit certain physical activities until they are recovered. Another important treatment recommendation is to limit cognitive (mental) activity.
Evidence shows that brain rest, also called cognitive rest, aids the concussion recovery process.1 While almost all physicians will prescribe brain rest to concussion patients, research in this area is ongoing and exact recommendations may vary among physicians.
Defining Brain Rest
Concussion experts define brain rest as limiting any cognitive activities that may be metabolically demanding and/or aggravate concussion symptoms. These cognitive activities can range from focused work, like doing math problems, to attending large social gatherings with lots of people, visual stimuli, and background noise.
Why is brain rest important?
The brain needs energy for normal cognitive and physical activity. These energy demands increase after a concussive event because:
An injured brain needs additional energy to heal itself.
A concussive event can decrease cerebral blood flow, which restricts the brain’s ability to access and use energy.
Brain Rest for Concussion Recovery
Deciding how much cognitive rest is appropriate can be difficult. Every person is different, and patients must work with their doctors to figure out the optimal amount of brain rest for concussion recovery.
Brain rest is essential for concussion recovery
Research suggests cognitive rest can allow patients to recover more quickly, and that a lack of brain rest during early recovery can:
Lead to prolonged or worsened post-concussion symptoms
Make the brain more susceptible to repeat injury
A concussion patient who exerts unnecessary mental effort can diminish the brain’s ability to heal in a timely manner.
Too much brain rest may slow down concussion recovery
Perhaps confusingly, engaging in too much brain rest has also been associated with slower recovery.Research suggests that brain rest should not be too strict nor extended; for example, patients are no longer advised to sit in a dark room doing nothing for days in a row.
Finding the right balance between brain rest and brain activity
Getting brain rest should be part of the immediate, post-injury recovery process—generally considered the first 24 to 48 hours after injury. After this time, patients are advised to gradually add cognitive activities into their routines. If symptoms worsen, it is a sign that the mental exertion is too much and cognitive activity should be decreased.
The exact amount of cognitive rest required during recovery varies from person to person, and the plan for brain rest should be individualized.
Getting Brain Rest After a Concussion
Patients may believe that brain rest is only effective if they avoid all activities—for example, lying in a dark room doing nothing—but research suggests that engaging in minimal to moderate cognitive activity post-concussion may be acceptable. Patients are encouraged to take note of how they feel before, during, and after cognitive activities, and to adjust their behavior accordingly.
Health care providers can also guide patients regarding the need to reduce workloads and avoid mentally taxing activities.
Reduce Post-Concussion Workloads
Maintaining minimal to moderate cognitive activity can still be challenging for busy people. Cutting back on work and chores and simplifying tasks can help.
Stay home. Taking time away from work or family obligations may be hard, but it is necessary in order to attain brain rest. After a few days of complete brain rest, if symptoms are diminished, people who have experienced concussions can often return to work. If patients are not sure when a return to work is appropriate, they are encouraged to consult their physician.
Complete one task at a time. This approach helps minimize distractions and reduces the stress of concentrating on too many things at once.
Limit household chores. The physical and cognitive demands of maintaining a household can strain a recovering concussion patient. If possible, more physically involved housework, bill paying, and other chores should be undertaken by others or postponed until recovery is well underway.
Health care providers can provide information to help patients communicate with bosses and family about the prescribed rest.
Avoid Mentally Taxing Activities
Even activities that are not labeled as “work” can still demand a lot of cognitive energy. People with concussions are advised to limit or avoid:
Participating in activities for which reaction time is important. Driving, bike riding, operating heavy machinery, playing many sports, and similar activities may put the patient or others in danger.
Making important decisions. Decisions about finances, personal or professional relationships, and other large decisions should be shared with trusted friends or family or delayed until the patient is further along in recovery.
Relying heavily on short-term memory. Memory and recall may be affected by a concussion and may not improve until the late stages of recovery. People recovering from concussions are encouraged to write down anything that is difficult to remember and refer to their notes as needed rather than struggle to retain information.
Eliminating as many mentally taxing activities as possible during concussion recovery can help reduce recovery times. While it may not be feasible for patients to postpone everything until recovery is complete, asking friends, family, and coworkers for help can help reduce mental stressors.
Relax and Rest
Reducing physical and mental workloads can also make it easier for patients to get the needed amount of physical rest during recovery.
Sleep. Keeping a regular sleep schedule is important to the recovery process. A regular sleep schedule requires good sleep hygiene practices, such as avoiding caffeine and snacks before sleep, keeping the room dark, and sticking to a bedtime routine. Nighttime sleep may be supplemented with short daytime naps, if needed.
Limit physical activities. Sports, exercise, and other activities should be reduced. Minimizing physical activity helps prevent aggravating physical and mental symptoms. It also helps protect against additional injury.
No non-prescribed drugs or alcohol. Drugs and alcohol are known to slow neural recovery and impair judgment. Patients with concussion would be advised to avoid such substances. Patients should consider checking with their health care provider before resuming alcohol use.
Reducing workloads, avoiding physically and mentally taxing activities, and getting enough rest all contribute to concussion recovery. Resuming normal daily life is a gradual process.
Resuming Daily Life After a Concussion
After 24 to 48 hours of significantly reduced cognitive and physical activity, it is usually safe for concussion patients to slowly resume daily routines as long as symptoms have improved.
Resuming Cognitive Activities
As recovery progresses and symptoms diminish, it is appropriate for a person recovering from concussion to slowly resume cognitive activities. Below are tips for deciding when and how to resume cognitive activities:
Consult a physician. Concussion patients may consult their primary doctor. Depending on the severity of the injury or other risk factors, a patient may be referred to a concussion specialist or center. Any of these physicians will be able to help the concussion patient gauge when it is time to return to regular daily activity.
Discuss work accommodations. Options might include returning for half days at first or a reduction or change in workload or type until fully recovered.
Increase cognitive engagement incrementally. People can start by reading, using the computer, or working for only small increments of time to ensure symptoms do not worsen. They can then begin gradually increasing the amount of time spent working.
People easing back into work and daily life are advised to scale back their activities and consult their doctor if symptoms reappear.
Resuming Physical Activities
Once athletes feel essentially back to themselves and their symptoms have basically returned to baseline, they may begin a step-wise, graduated program of increasing activity levels.
The Centers for Disease Control and Prevention (CDC) recommends a 6-step approach to help athletes and hobbyists return to physical activities after a concussion:
Step 1: Back to regular activities. Returning to school, work, or other daily responsibilities is the first important step in concussion recovery.
Step 2: Light aerobic exercise. Patients may participate in stationary biking, walking, light jogging, and other similar activities. Patients are typically safe to continue these activities for 5 to 10 minutes at a time.
Step 3: Moderate exercise. More rigorous activities may be resumed (e.g. jogging, weightlifting, etc.), but not at the rate prior to the concussive event.
Step 4: Heavy, non-contact exercise. Athletes may resume sport-related drills, but should abstain from practice and competitive play. Casual athletes should increase their levels of exertion and the amount of time spent being active.
Step 5: Practice, including contact. Athletes may resume full-contact practice with their teams. Athletes who do solitary physical activities may use this step to increase their levels of physical exertion.
Step 6: Play. A return to full-contact competitive play or vigorous solitary activities can be made.
This kind of progression is typically done under the supervision of a health care professional and not undertaken independently by the patient. It is especially important for contact-sport athletes to follow a regimented return to play progression under the supervision of a health care professional, such as a physical therapist or concussion specialist.
Self-awareness is critical while increasing cognitive and physical activities after a concussion. Keeping track of sustained, emerging, or worsening symptoms is important, and concussion patients should check in with their physicians if symptoms worsen or unexpected symptoms occur.
Be Patient and Stay Vigilant Post-Concussion
Recovery from a concussion takes time. Patients who rush the recovery process or “power through” their symptoms may find it takes longer to comfortably resume their daily routine. Being patient with the recovery process, keeping track of symptoms, and consulting with a physician if symptoms worsen can help ease the recovery process.
Article courtesy of Sports Health
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