Engaging in light physical activity, such as brisk walking; using computers, watching television, and playing video games; and returning to school is recommended for young athletes recovering from a sports-related concussion, according to updated guidelines from the American Academy of Pediatrics (AAP) published online in Pediatrics on November 12.
In 2010, the AAP issued guidelines for health care providers for diagnosing and managing pediatric and adolescent concussions. At the time, the guidelines discouraged activity and using electronics based on evidence that the brain needed time to recuperate.
Since then, knowledge about concussion has progressed.
The new guidelines still recommend removing athletes from play after a concussion, but they no longer recommend eliminating all physical and cognitive activity.
The guidelines also identify the most-high risk sports for boys and girls with ice hockey, football, and lacrosse resulting in the most concussions for boys, and soccer, lacrosse, and field hockey resulting in the most head injuries for girls.
The new guidelines reiterate how to treat an unconscious athlete after a head injury. During an initial assessment, officials should clear the airways and check breathing and circulation (known as the "ABCs"). If the athlete remains unconscious, he should be treated as if he has a cervical spine injury. The spine should be stabilized, and the athlete transported to an emergency facility.
Athletes who continue to exhibit symptoms after a concussion should be evaluated for co-existing problems that may be exacerbating the concussion. Concussion symptoms may overlap with other medical conditions.
Based on an analysis of new evidence, the updated guidelines recommend limiting physical activity to brisk walking and avoiding complete inactivity. This may be self-monitored or through a formal physical therapy program, according to the guidelines.
The guidelines discourage athletes from staying out of school for a prolonged period, and recommend working with teachers to make academic adjustments, such as reducing the workload and avoiding environmental triggers, such as bright lights and screens or noisy cafeterias and hallways, for a smooth transition.
Research suggests that prolonged restrictions from physical activity or removal from school are associated with feelings of social isolation, anxiety, or depression.
No research proves any detrimental effects of using electronics while recovering from a sports-related concussion. Based on that, clinicians discourage the blanket prohibition of electronics, computers, television, video games, and texting.
Athletes with sensitivity to light or who can’t shift their eyes to read or track words, are encouraged to limit their overall screen time and to adjust brightness levels or increase font sizes to keep symptom from worsening.
The updated guidelines are intended to help athletes, coaches, and families manage sports-related concussions more effectively to shorten recovery time and decrease the risk of long-term symptoms and complications. Most athletes should recover one to four weeks later if appropriately managed. However, each concussion is unique, and symptoms can vary in type and severity.
"Additional research is needed in nearly all aspects of concussion in the young athlete," especially in middle school and younger athletes, the authors concluded.