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Cognitive rest following concussions: rethinking ‘cognitive rest’
  1. Mark E Halstead1,
  2. Brenda Eagan Brown2,
  3. Karen McAvoy3
  1. 1Department of Pediatrics and Orthopedics, St Louis Children's Hospital, Chesterfield, Missouri, USA
  2. 2Brain Injury Association of Pennsylvania, Carlisle, Pennsylvania, USA
  3. 3Rocky Mountain Children's Hospital, Denver, Colorado, USA
  1. Correspondence to Dr Mark E Halstead, Department of Pediatrics and Orthopedics, St Louis Children's Hospital, 14532 S Outer Forty Drive, Chesterfield, MO 63017, USA; halsteadm{at}

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The concepts of physical and cognitive rest are described as the ‘cornerstones’ of concussion management.1 Over the past several decades, we have seen significant swings in the extremes of these concepts. With physical rest, we have seen approaches from allowing a return to full participation within 15 min after clearing of symptoms to restricting all physical activity until the athlete is without any symptoms. Recently, work by Leddy et al2 encourages more active rehabilitation as tolerated by the athlete promoting exercise before symptoms have completely resolved. Although Leddy's work most likely has not been adopted by most primary care physicians, and possibly some sports medicine physicians, as of yet, clearly we are seeing concussion management take on a more moderate, and likely a more common sense approach, rather than at an extreme.

So what about cognitive rest? Unfortunately for many, cognitive rest is often telling an adolescent after a concussion that they should avoid text messaging, watching television, playing video games and staying out of school until symptoms improve. Yet, despite these recommendations and many individuals preaching …

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