Screen time in aftermath of concussion can prolong symptoms, research shows

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A new study in the United States shows that limiting screen time for young adults after concussion results in a shorter duration of symptoms. 
A new study in the United States shows that limiting screen time for young adults after concussion results in a shorter duration of symptoms. File image by Jan Milne

Concussed horse riders should always take things easy for a while, but how they spend that initial recovery period may influence the length of time they experience symptoms, research suggests.

A new study in the United States shows that limiting screen time for young adults after concussion results in a shorter duration of symptoms.

The research at the University of Massachusetts Chan Medical School, reported in the journal JAMA Pediatrics, provides the first clinical evidence to support restricting computer, phone and TV screens in the acute period following a concussion.

The clinical trial, which involved 125 young adults, showed that those who limited screen time for 48 hours immediately after suffering a concussion had a significantly shorter duration of symptoms than those who were permitted screen time.

An estimated 2.5 million people go to the emergency department annually in the US because of concussions, many of them aged 10 to 19. In 2017, 15 percent of high school students had reported being diagnosed at least once with a concussion.

The US Centers for Disease Control and the International Concussion in Sports Group recommend a period of complete cognitive and physical rest for 24 to 48 hours following a concussion diagnosis. Yet, there are no clear guidelines regarding what constitutes cognitive rest during this period.

“It’s one thing parents and children always ask in the emergency department,” said lead author Theodore Macnow, assistant professor of pediatrics. “Is screen time allowed?”

Theodore Macnow. Photo: UMass Chang Medical School
Theodore Macnow. Photo: UMass Chang Medical School

The average American teen spends as much as seven hours a day in front of a screen, not including time spent doing schoolwork, and many clinicians caution against screen time following a concussion, Dr Macnow said.

Other clinicians, however, believe limited screen time, so long as it doesn’t induce symptoms, is okay as one of the few forms of safe distraction during this time.

“We’re still learning how to treat concussions and there are no clear recommendations regarding screen time,” Macnow said. “Nobody has yet looked at this question in a rigorous way. We wanted to get a better handle on this question, so we conducted a randomized clinical trial.”

From June 2018 to February 2020, Macnow and his colleagues assessed 125 patients age 12 to 25 who presented with a concussion to the Emergency Department at the UMass Memorial Medical Center, the clinical partner of the university’s Chan Medical School in Worcester.

Patients were assessed and randomly placed in one of two groups. Those in the first group were told to abstain from any electronic screens for 48 hours, while the second group was allowed any form of screen so long as it didn’t induce symptoms. Both groups were advised to avoid work and schoolwork for the first 48 hours.

Patients completed a Post-Concussion Symptom Scale (PCSS) at the time of diagnosis and every day for the 10-day length of the study. The PCSS is a 22-symptom scale which grades each symptom from 0 (not present) to 6 (severe). It can be used to reliably detect change over time in concussed patients.

In the absence of a head injury, a baseline score of less than 3 on the PCSS survey is considered normal. Additionally, patients completed a screen time survey on days one to three and an activity survey from days four to 10.

An analysis of the data showed that the group permitted screen time during the initial 48 hours after a concussion experienced a significantly longer time to recover, measured by a PCSS score of less than three. On average, this group experienced a median time of eight days until symptom resolution compared to 3.5 days for the group that abstained from screen time.

During this time, those in the group permitted screen time logged a median of 630 minutes over the 48-hour period while the cohort abstaining from screen time logged a median of 130 minutes.

“These findings support the conclusion that brief screen time abstinence following a concussion is associated with a faster recovery,” Macnow said. “Given this data, preliminary clinical recommendations should be to limit screen time.”

He added: “It’s not clear why screen time exacerbated concussion symptoms but there are a lot of reasons to suspect it’s not good.”

It is possible that electronic photons, which are known triggers for migraines, could play a role. Or that screen use may detract from sleep and resumption of normal activities, both of which are felt to be beneficial to concussion recovery.

“These findings suggest that a larger, more diverse, multicenter study is warranted to see if the results are consistent,” Macnow said.

“What’s more, we only looked at the first 48 hours after diagnosis. It would be worthwhile to see if abstaining from screen time longer had more of an impact or if specific screen time activities — video games versus television — have a more pronounced effect on recovery time.”

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