Cognitive Rest After a Child's Head Injury

Cognitive rest is rest for the brain, just like physical rest is rest for the body. Following a concussion, medical professionals may direct a patient to complete a period of both physical and cognitive rest. Both of these are important in helping the brain heal after an injury. Resting conserves energy so the body and brain can use it for recovery. But it's hard to do, especially for kids and teens and especially when you consider the list of banned activities (below).

In most cases, patients need to rest until 24 hours after having any concussion-related symptoms. After that, they should return to physical and cognitive activity gradually. If an activity causes symptoms to return — say, a child experiences headaches after reading—then more rest is needed. "A careful balance between cognitive activity and rest is paramount in these early stages of recovery and beyond," one research study explained. "Children and adolescents, with the help of adults involved in their care, should maintain a level of cognitive activity that does not make symptoms worse or reappear, to avoid exacerbating symptoms and possibly delaying recovery."

Or, as one nurse counsels her patients: "If you're not completely bored, you're doing too much." In kids and teens, cognitive rest may mean limiting, or completely avoiding, activities that require mental exertion. These could include:

• Going to school (in person or online)
• Reading, writing or studying
• Working on a computer
• Watching TV or playing video games on a TV or tablet
• Texting or otherwise using a smartphone or any device with a screen
• Listening to music, talk radio, or audiobooks

Following a concussion and a period of cognitive rest, some kids need a slow return to full activity. Support at school can help. Students may need accommodations such as:

• A shortened school day, and/or extra rest breaks during the day
• Postponed or staggered tests, or different ways of showing knowledge (such as a portfolio of past work or an oral exam instead of a written one)
• Extended deadlines for assignments
• Reduced distractions and sensory inputs, such as bright lights and loud noises. This could mean moving a child's seat away from a window or closer to the front of the room. It could also mean avoiding crowded hallways and noisy lunchrooms.
• Help from a note-taker and/or a tutor

It's also important to note that cognitive rest can be very difficult emotionally for a child or teen. Kids spend so much of their time learning, reading, and interacting with screens. It's hard for them to avoid these activities. And they may worry about falling behind in school and in sports, or missing out on social interactions both at school and online. They often need reassurance that the recovery period is difficult but temporary. Sometimes they also need a reminder about how serious concussions can be. The consequences of returning to play (or cognitive activity) before a full recovery are scary but real.