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Adolescents take longer to recover from concussions

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To recover from concussion, young brains require not only restrictions on physical activity, but also reduction of mental effort.

That's part of the consensus reached by a recent international conference on concussions from sports injuries and the central theme of new guidelines published in The British Journal of Sports Medicine.

A concussion is more than a jolt or bump to the head. The injury is defined as any alteration to mental status resulting from the brain being jolted inside the skull due to a blow to the head or upper body. Symptoms can include amnesia, dizziness, confusion, headache and loss of consciousness. Later symptoms can include dizziness, sleep problems, irritability and concentration problems.

Researchers have repeatedly found evidence that the brains of children and adolescents take longer to recover from concussion than those of adults. A 2006 study sponsored by the National Football League compared the reaction times of adult pros and high-school athletes before and after a concussion.

The adult players were back to preseason scores on reaction, attention, memory and information processing when they were tested a week after an injury, but most high-school players still had substantial deficits in mental abilities seven days out.

Experts think one difference is that teen brains are not fully developed. Numerous brain-imaging studies and other research show that brain connections and growth isn't complete until people hit their mid-20s.

However, longer-term studies of former pro athletes also show that multiple concussions can lead to increased risk for depression, memory deficits and other neurological problems later in life, which suggests that adults may be getting back in the game too quickly, as well.

The main reason for staying off the field is concern that a second concussion before the lining of the brain heals from the first can lead to swelling, which can cause permanent brain damage and even death. That threat, along with a greater understanding that symptoms in kids may take longer to assess, is a major reason that the new guidelines rule out any return to play in young athletes the same day of a concussion and suggest that kids be entirely free of symptoms before being cleared for the field.

Damage inside the brain is harder to assess, but putting heavy demands on the gray and white matter is now considered unwise.

Scientists from the University of Pittsburgh and the University of North Carolina at Chapel Hill last year reported on the experiences of 95 high-school athletes tested up to a month after a concussion.

They paid close attention not only to the severity of the injuries, but also what the teens did in the weeks between injury and testing. Some stayed out of school entirely, some went to school but did nothing else, some did schoolwork and some chores at home, some also resumed sports practice along with school and chores, and some did schoolwork and resumed at least some play.

The scientists found that those who engaged in moderate activity -- attended school and did homework, along with limited physical activity such as chores -- had the best recovery, based on tests of memory, reaction time and other cognitive checks, better even than those who were less active. Those who engaged in any greater levels of activity, such as practice or play, scored much worse.

Thus, the new protocols stress "cognitive rest" that may include limits on schoolwork as well as activities such as texting, video games and TV watching, while still recognizing that the brain needs some stimulation.

Other research has shown that female athletes often take longer than males to recover from a concussion, and that coaches, trainers and caregivers need to consider this in mapping rehab plans.

"The new protocols take into consideration that the developing brain of the child and adolescent requires special attention. And the guidelines point to the important role that parents, coaches and teachers play in assessing and treating young athletes," said Gerard Gioia, a concussion specialist and neuro-psychologist at Children's National Medical Center in Washington who took part in the international conference.