THE EFFECTS OF PHYSICAL AND COGNITIVE ACTIVITY LEVELS POST-CONCUSSION ON RECOVERY

Context: The current recommendation for the management of sport-related concussions is rest, both physical and cognitive. The efficacy of rest in promoting recovery post-concussion is unclear. Objective: To characterize the effect of cognitive activity on recovery following concussion, and determine the relationship between patient characteristics and recovery. Participants: Forty high school athletes diagnosed with concussions were enrolled in the study (20 standard-of-care, 20 intervention, 27 males, 13 females, age: 15.7 ± 1.1, height: 175.3 ± 9.1 cm, weight: 69.5 ± 34.2 kg). Interventions: Participants were administered baseline testing on measures of concussion symptoms, neurocognition, postural control and vision. Two schools were randomly assigned to the intervention group and two schools were assigned to the standard-of-care group. Participant assignments were based on school. Both groups recorded their physical and cognitive activity from the time of injury until they were deemed recovered. Intervention group participants received instructions on how much cognitive activity to complete on a daily basis; standard-of-care participants followed recommendations given by their health care providers. Main Outcome Measures: Days to recovery, patient satisfaction, amount and intensity of school-related cognitive activity, sex, age, history of concussion, average cognitive activity per day, average physical activity per day and modifiers of concussion. Results: There were no statistically significant differences in the days to recovery (standard of care: 9.10 ± 4.38, intervention: 11.45 ± 5.04; p=0.12) or patient satisfaction (t33=0.24, p=0.53) between the standard-of-care and intervention group. None of the following variables were predictors of recovery: sex, age, previous history of concussion, cumulative cognitive activity, cumulative physical activity, symptoms at the time of injury, or premorbid conditions (p>0.05 for all). There were no statistically significant associations between the amount or intensity of a session of cognitive activity and an increase in symptoms (p>0.05). Conclusions: Although cognitive rest is widely recommended following concussion, in this study, a gradual return to school-related cognitive activity intervention did not provide evidence of a benefit.Doctor of Philosoph