By NorthShore – Edward-Elmhurst Health

In the past, if a person got a concussion, they were advised to lie low — just rest with minimal distractions. Parents knew what a fight it was to get injured children to comply wih those instructions.

Now, doctors are acknowledging that some activity is actually beneficial for concussion patients.

“We used to treat concussions with laying in a dark quiet room and doing a whole lot of nothing for a couple of weeks, and we waited until symptoms were over and we resumed normal activity,” said Nicole Reams, MD, a sports neurologist and director of the Multidisciplinary Sports Concussion Program at NorthShore University HealthSystem, part of NorthShore – Edward-Elmhurst Health.

“We have found, roughly in the last 10 years or so, from concussion research that people got a lot worse with those recommendations for total brain rest and they didn’t get better as quickly,” she said. “Especially in the athletic population, these are people who are used to being very active and engaged, and removing both social and physical engagement and exertion actually was detrimental.”

Managing the amount of rest as well as cognitive and physical engagement is essential, she said.

“The move towards what we call relative rest is important,” she said. “Allowing them to go back to school, allowing engagement and cognitive exertion like screen time, academic activity, hanging out with family and friends is part of our counseling.”

Dr. Reams serves as an independent neurologic consultant for the Chicago Bears, Chicago Fire, Northwestern University Athletics, and Dominican University Athletics. She also serves on the concussion oversight teams of many local high schools to inform policy and protocol decisions.

Along with neurological conditions that affect athletes — like epilepsy, multiple sclerosis or migraines —the field of sports neurology focuses on concussion.

“Here at NorthShore, we manage all kinds of timing of concussion,” she said. “We see a lot of acute concussion, which we love, we see a lot of very complicated concussion, which we’re also very well-versed at. So if concussion is not getting better in the normal, expected timeframe, we’re very well-trained to evaluate the complicated factors that may be involved in why the concussion isn’t improving and how to help that patient get better.”

She sees patients as young as 10 with brain injuries from sports like football, soccer, cheerleading, lacrosse and ice hockey.

What are the symptoms of a concussion?

The most common symptoms of concussion are headaches, sensitivity to lights and sounds, mental fog, trouble concentrating, nausea, vomiting, blurry or double vision and imbalance. Additionally, there could be changes in emotions like irritability, anxiety or depression, plus fatigue, difficulty sleeping or sleeping more than normal. Symptoms can occur immediately after injury or up to 48 hours post-injury.

“Most people have their peak symptoms 48 hours after injury and they usually get better after two weeks,” Dr. Reams said.

The vast majority of kids won’t require a trip to the emergency room (ER) after a concussion, but she urges parents to err on the side of caution.

How do you know when it’s more serious?

“The recommended medical guidelines for when we’re really worried are things like decreasing mental alertness — so if they’re becoming more lethargic, more confused as you’re watching them before your eyes, then we get very worried,” she said.

Other signs of urgency include recurrent vomiting, weakness or numbness on one side of the body, one pupil differing in size from the other and difficulties in speech and balance.

“Those would all be indications to go to the ER,” she said. “What all of those things are pointing towards or suggestive of is a bleed in the brain, which is what we’re looking for when we do an ER evaluation. The indication would be to get a CT scan.”

What is the treatment for a concussion?

The first step in treating a concussion is to sideline the athlete to prevent further injury. Another blow to the head could prolong the injury or intensify the symptoms. Dr. Reams also recommends staying away from high-risk activities like trampoline parks, downhill skiing or pick-up basketball in addition to formal athletics.

“We also make a lot of recommendations about the level of rest,” she said.

She recommends managing symptoms during this period of recovery by rating their symptoms on a scale of 1 to 10 and not allowing them to get higher from where they began by more than two points. For example, if the headache is a three when they start an activity, not to let it get higher than a level five before taking a break or removing themselves from an environment that makes symptoms feel worse.

She recommends limiting screen time for the first 48 hours after injury, but after that time, screens can be used as tolerated.

The good news is, kids can go back to school and even light activity, Dr. Reams said.

“We used to not allow any physical activity at all and it’s now been shown that lighter physical activity, what we call sub-symptom threshold physical activity, meaning physical activity that doesn’t make symptoms worse, actually helps brain recovery,” she said. “It makes people feel better faster and encourages the brain to recover.”

That would be things like walking and riding a stationary bike and then following a formalized return-to-play protocol after symptoms resolve.

Are there any long-term effects?

Long-term effects of concussion are murky, she said. While a single concussion is not likely have long-term consequences, the broader question for many years has been what are the effects of multiple concussions?

Post-mortem research on high-level athletes — like NFL players — indicates there are changes in the brain seen underneath the microscope that occur after sustaining many hits over a prolonged period of time, she said.

“But our understanding of what happens to a person clinically — what their life is like, how those changes we see under the microscope matter for their behavior, their cognition, are not clear,” she said. “We have not made those connections clearly yet and our understanding is limited.”

Learn more about concussions.

Learn more about neurosciences at NorthShore University HealthSystem.