Association of Self-Paced Physical and Cognitive Activities Across the First Week Postconcussion With Symptom Resolution in Youth

Abstract

Objective: To examine the association of objectively measured, self-paced physical and cognitive activities across the first week postconcussion with symptom resolution in youth. Setting: Emergency department or concussion clinics. Participants: Youth aged 11 to 17 years with physician-confirmed concussion. Design: Prospective cohort with repeated measures. Main Measure(s): Days from injury to symptom resolution, based on daily ratings by youth on the Post-Concussive Symptom Scale. Physical and cognitive activities were assessed using an ActiGraph and a Narrative Clip, respectively. Results: A total of 83 youth participants were included (n = 54 [65%] males; mean age = 14.2 years, SD = 1.9). While self-paced daily physical and cognitive activities increased across the first week postinjury, daily postconcussion symptoms decreased. Increased daily step count was associated with an increased likelihood of early symptom resolution (hazard ratio [HR] = 1.17; 95% confidence interval [CI], 1.02-1.34). However, this association was not statistically significant after adjusting for acute postconcussion symptoms and other covariates. Greater school attendance time was associated with earlier symptom resolution (adjusted HR = 1.14; 95% CI, 1.02-1.27). Conclusion: Self-paced physical and cognitive activities across the first week postinjury alone neither hastened nor prolonged concussion recovery. Youth with concussion may have some latitude to determine their activity levels.

Accelerometer-measured habitual physical activity and sedentary time in pediatric concussion: A controlled cohort study

“…More specifically, one study showed that the number of accelerometer-measured steps from days 1-3, 4-5, and 6-7 post-injury were significantly correlated with symptom scores at each of these intervals, and the increased activity (i.e., number of steps) from days 1-3 post-injury predicted lower activity on days 4-5 post-injury 33 . A second study by this group reported that there was no association between physical and cognitive activity and time to concussion recovery 34 . Another group studied male youth hockey players wearing accelerometers in the early stages of injury and found that those in the “high” activity group (based on a median split, performing more than 148.5 minutes of MVPA/day) took significantly longer to recover than those in the “low” activity group 32 .…”

“…Accelerometers have been used in many pediatric neurological and chronic disease populations to compare the activity of these children to their typically developing peers 29-31 , providing insights about the intensity, time, and frequency of physical activity that recall surveys cannot capture. In concussion, accelerometry has been used to begin to understand the relationship between concussion symptoms and activity 32-34 , although no controlled studies have quantified levels of sedentary time and habitual physical activity.…”

Adolescent and Parent Perceptions of the Impact of Concussion/mTBI on Family Functioning and Activity Levels in Recovery

“…Our findings collectively highlight the need for flexible management and return-to-activity progressions for adolescents with concussion, ideally incorporating self-management by the patient and family. A recent study found that self-paced physical and cognitive activities in the acute recovery phases do not seem to accelerate or delay recovery 30. The American Congress of Rehabilitation Medicine Mild TBI Task Force has developed some expert-guided recommendations that clinicians may find helpful in communicating strategies for self-pacing to adolescents and their families 31.…”

International perspectives on trends in paediatric sports-related concussion: knowledge, management, unanswered questions

“…Therefore, we try to get them back fairly quickly." This is backed up by a recent study by Yang et al who found that self-paced physical and cognitive activity when recovering from concussion was neither helpful nor damaging to the child [56].…”