BLOG: Ditch the screens when recovering from concussion
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People who have suffered a concussion are often told to stay home from work, school and sports activities for cognitive and physical rest, although exactly how they should rest is poorly defined.
Many doctors will recommend avoiding bright lights or highly stimulating video games but may or may not offer guidance on other forms of screen time. Kids may actually end up getting more screen time than usual while they are kept out of normal activities.
We have long thought that screens could have a negative effect on concussion recovery, but the literature on the subject was inconclusive. Consequently, none of the official guidelines for concussion care in sports or pediatrics specifically addressed screen time.
My colleagues and I recently conducted a prospective study to better understand this issue (Macnow et al.). An editorial in the issue of JAMA Pediatrics in which it was published noted that our study finally provides a “definitive answer to screen time limits after concussion” (Chrisman).
We enrolled 125 patients aged 12 to 25 years who had sustained a concussion within the previous 24 hours. The mean age of patients enrolled was 17 years, and about half (51.2%) were male. One group was instructed to abstain from all screens of any type for 48 hours. The control group was given our usual instruction to do what they normally do but avoid anything that provokes symptoms. Both groups kept a log of their screen time.
Patients in the “screen abstinence” group weren’t completely compliant – they reported a mean of 130 minutes of screen use during the study period. However, this was much lower than the 630 minutes of screen time in the control group. On average, patients who avoided screens for 48 hours recovered more than 4 days faster. They had a Post-Concussive Symptom Score of greater than 3 for only 3.5 days, compared to 8 days of symptoms for the control group.
We don’t know for sure why screen use has such an impact on recovery. The difference in recovery time could be due to differences in photic stimulation (light), focusing of the eyes, cognitive engagement, or even sleep quality or exercise levels. We are learning that light cardiovascular activity is beneficial after a concussion, and it is possible that patients who weren’t allowed to use screens were more likely to go for a walk, aiding their recovery.
Certainly, this is a subject that is ripe for further research. Is using a smartphone better or worse than a television or computer screen? Would screen avoidance for another 24 hours further hasten recovery or make no difference? It is also possible that concussion type or severity makes some patients more susceptible to screen time than others? For example, it is possible that a patient with an injury to the occipital lobe, which plays such a key role in visual processing, would have more negative effects from screen use than others.
We have a lot more to learn, but this study provides all of us – from ER doctors to eye care providers to parents – with the ammunition to tell kids they will get better faster if they stay off the screens for at least 48 hours.
References:
- Chrisman SPD. JAMA Pediatr. 2021;doi:10.1001/jamapediatrics.2021.2779.
- Macnow T, et al. JAMA Pediatr. 2021;doi:10.1001/jamapediatrics.2021.2782.
For more information:
Theodore E. Macnow, MD, is a pediatric emergency medicine specialist at UMass Memorial Health in Worcester, Massachusetts, and an assistant professor of pediatrics at the University of Massachusetts Medical School. His interests include concussions, injury prevention and transport medicine.
Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.
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