Concussion Recovery: What is Cognitive Rest?
Dr. Robert Cantu talks about how after a concussion the brain is in a metabolic crisis and, without rest, that crisis is exacerbated.
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[Dr. Robert Cantu] The initial treatment of concussion is physical rest, nothing more physically strenuous than walking. You don't want to raise the blood pressure, you don't want to raise the heart rate. And cognitive rest which means they shouldn't be doing their schoolwork. If they have cognitive symptoms or trying to concentrate exacerbates their symptoms. I personally try to allow an individual's schoolwork to be ratcheted down to whatever level it can be, still not making symptoms worse. So I don't take them out of school if they can go to school without making symptoms worse. But it's very common that we don't let them take exams initially. We don't let them do prolonged homework assignments. If just going to school, not even taking an exam, exacerbates symptoms we may need to pull them out of school. So it's a trial and error basis. Well you have to rely on the child to be giving you honest answers, and the child should be able to tell you, "well, I can concentrate for 15 minutes and then I start getting a headache that gets worse" or "the dizziness gets worse", and if that's the case then they need to concentrate for less than 15 minutes. Obviously if it's much less than 15 minutes, it's not even worth doing it at all. But what you're doing is you're gradually ratcheting that up from 15 minutes to 30 minutes to 45, always keeping it under a level of exacerbating any symptoms. A child that's not having appropriate physical or cognitive rest, the brain is being stimulated. The brain is in a metabolic crisis with concussion. You've had the neural cascade of abnormal enzymes, abnormal ions released— potassium ion from inside the cell going extracellularly, calcium ions going intracellularly, neurotransmitters widely released in a chaotic manner. It takes energy to pump that potassium back in, put the neurotransmitters back on so the cell can function. If you ask that cell to exert, you may exacerbate the symptoms that that cell is experiencing because you now make not only it but other cells rendered infunctional if you exceed the energy demands.
Posted on BrainLine August 30, 2013.
Produced by Noel Gunther and Erica Queen, BrainLine.
Robert Cantu, MD is chief of Neurosurgery Service, chairman Department of Surgery, and director of Sports Medicine, Emerson Hospital; clinical professor, Department of Neurosurgery, and co-director, Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine.