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Exploring the association between cognitive activity and symptom resolution following concussion in adolescents aged 11–17 years
  1. Jingzhen Yang1,2,
  2. Enas Alshaikh1,
  3. Nichole Asa3,
  4. Olivia VonDeylen1,
  5. Nikhil Desai1,
  6. Hudson Gerry Taylor1,2,
  7. Thomas Pommering2,4,
  8. James P MacDonald2,4,
  9. Daniel M Cohen2,5,
  10. Keith Owen Yeates6
  11. ReAct Clinical Study Group
    1. 1The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
    2. 2Department of Pediatrics, The Ohio State University College of Medcine, Columbus, Ohio, USA
    3. 3University of Washington, Seattle, Washington, USA
    4. 4Division of Sports Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
    5. 5Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio, USA
    6. 6Department of Psychology, University of Calgary, Calgary, Alberta, Canada
    1. Correspondence to Dr Jingzhen Yang, Nationwide Children’s Hospital, Columbus, Ohio, USA; ginger.yang{at}nationwidechildrens.org

    Abstract

    Objective As opposed to postconcussion physical activity, the potential influence of cognitive activity on concussion recovery is not well characterised. This study evaluated the intensity and duration of daily cognitive activity reported by adolescents following concussion and examined the associations between these daily cognitive activities and postconcussion symptom duration.

    Methods This study prospectively enrolled adolescents aged 11–17 years with a physician-confirmed concussion diagnosis within 72 hours of injury from the emergency department and affiliated concussion clinics. Participants were followed daily until symptom resolution or a maximum of 45 days postinjury to record their daily cognitive activity (intensity and duration) and postconcussion symptom scores.

    Results Participants (n=83) sustained their concussion mostly during sports (84%), had a mean age of 14.2 years, and were primarily male (65%) and white (72%). Participants reported an average of 191 (SD=148), 166 (SD=151) and 38 (SD=61) minutes of low-intensity, moderate-intensity and high-intensity daily cognitive activity postconcussion while still being symptomatic. Every 10 standardised minutes per hour increase in moderate-intensity or high-intensity cognitive activities postconcussion was associated with a 22% greater rate of symptom resolution (adjusted hazard ratio (aHR) 1.22, 95% CI 1.01 to 1.47). Additionally, each extra day’s delay in returning to school postconcussion was associated with an 8% lower rate of symptom resolution (aHR 0.92, 95% CI 0.85 to 0.99).

    Conclusion In adolescents with concussion, more moderate-high intensity cognitive activity is associated with faster symptom resolution, and a delayed return to school is associated with slower symptom resolution. However, these relationships may be bidirectional and do not necessarily imply causality. Randomised controlled trials are needed to determine if exposure to early cognitive activity can promote concussion recovery in adolescents.

    • adolescent
    • brain concussion
    • prospective studies
    • rehabilitation
    • public health

    Data availability statement

    Data are available on reasonable request. JY has full access to all of the study data and takes responsibility for the integrity of the data and the accuracy of the data analysis. The datasets generated and/or analysed during the current study are available from JY on reasonable request. Raw data are not available due to parameters indicated in the participant consent materials.

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    Data availability statement

    Data are available on reasonable request. JY has full access to all of the study data and takes responsibility for the integrity of the data and the accuracy of the data analysis. The datasets generated and/or analysed during the current study are available from JY on reasonable request. Raw data are not available due to parameters indicated in the participant consent materials.

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    Footnotes

    • Twitter @tompommering, @sportingjim

    • Collaborators ReAct Clinical Study Group: Steven C. Cuff, MD; Drew Duerson, MD; Anastasia N. Fischer, MD; Jonathan T. Napolitano, MD; Reno Ravindran, MD; Richard E. Rodenberg Jr., MD; Amy E. Valasek, MD; Division of Sports Medicine, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, College of Medicine, Columbus, Ohio, USA.

    • Contributors Authors contributed to the concept and design (JY, EA and KOY), acquisition of the data (NA, TP, JPM and DMC), statistical analysis (JY, EA and KOY), interpretation of the data (JY, EA, NA, HGT, TP, JPM, DMC and KOY), drafting the manuscript (JY, EA, NA, OV and ND). All authors contributed to critical revision of the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. The corresponding author (JY) acting as a guarantor, attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

    • Funding Research reported in this publication was partially supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (R21HD086451).

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.