How do we know when kids are ready to return to learn? Is being symptom free the answer? Waiting till kids are symptom free at rest causes some kids to sit too long and causes problems for other kids. It is not good to look at symptoms at rest. The new goal by many experts is to return when symptoms are mild with exertion. It seems that youth are not a good judge of brain irritation at rest. With cognitive stress or physical stress symptoms usually will worsen. It is important to have injuried individuals gradually increase their activity. It is hard to measure cognitive work, but it is easy to measure physical work. Is it possible just to assess symptoms with physical work to see how youth will do? I believe that it gives us many answers. As heart rate increases, it can create a change in pressure in the brain and let us know whether brain swelling is still a factor in the healing process.
Exertion Testing in Youth Helps Assess Brain Function
In Medicine and Science in Sports and Exercise April 11th 2015, authors studied how to assess return to sport. They studied 54 people age 8.5 to 18.3 years old with symptoms for 0.7 months (21 days) to 35 months (almost 3 years). 63% had increase in symptoms at 50% of peak mechanical power on a progressive continuous Cycling test. Testing in the medical office should include exercising to determine when someone is safe to return to activities. Patients who brains have not fully developed have an increase in symptoms with exercise more so than adults. It is important to ask about symptoms after being active rather than asking about symptoms at rest.
My office, Concussion Healing Clinic, always tests people on a treadmill before returning to work or school.
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