So, here's some info I found as it relates to concussions and adolescents in sports activities. You can't access this unless you are credentialed through a hospital or have a subscription to uptodate. But i'lll paste it here for some recomendations:
While they are recovering from concussion, athletes should also be restricted from activities where they may sustain head injury (eg, contact sports, skiing, skating, or cycling). Incomplete recovery may make the athlete more vulnerable to worsening of symptoms or more catastrophic head injuries in the event of recurrent collisions (ie, second impact syndrome).
Evidence supports sub-symptom threshold, aerobic exercise during recovery to decrease concussion symptom scores and duration of symptoms [
25-31]. For example, in a blinded trial of over 100 adolescents with a sport-related concussion, subthreshold, aerobic exercise initiated within 10 days of the concussion significantly decreased the time to recovery compared with gentle stretching (median recovery time 13 versus 17 days, respectively) [
31]. There was a trend towards a lower incidence of persistent postconcussive symptoms in the aerobic exercise group, but this finding did not achieve statistical significance. In this study, all patients underwent a baseline exercise tolerance assessment using the Buffalo Concussion Treadmill Test to identify the heart rate at which concussion symptoms worsened [
32]. Individuals in the intervention group were then advised to perform daily aerobic exercise on a stationary bicycle or treadmill while wearing a heart rate sensor and to target their heart rate to 80 percent of the rate at which symptoms were exacerbated during the baseline assessment [
31]. Duration of daily exercise prior to the follow-up visit was limited to 20 minutes or until symptoms developed, whichever was shorter. Similarly, in a retrospective, observational study of over 250 adolescents and young adults (median age 17 years), initiation of physical activity at one versus three or seven days was associated with a shorter time to full recovery (full return to school or work and full return to sport) [
33].
By contrast, strict physical rest beyond 48 hours has been demonstrated to exacerbate self-reported symptoms and should be avoided [
26]. For example, in a trial of almost 90 patients (11 to 22 years of age) with concussion, individuals who adhered to strict physical rest for five days had increased symptoms of concussion over 10 days compared with patients who were assigned to usual care (one to two days of rest followed by stepwise return to activity) [
26].
Cognitive rest — Our approach to mental activity in children and adolescents with concussion is as follows:
●
Symptoms worsened by cognitive effort – We suggest that patients who have sustained a concussion, are symptomatic, and have worsening of symptoms by activities such as reading, video games, or screen time avoid all mental activity that makes them feel worse, up to and including absence from school. [
6,34]. Social visits both in and out of the home and trips should be limited. During this period of reasonable rest, the child may often engage in light mental activities, such as watching limited amounts of television and family interaction, without exacerbating symptoms [
34,35].
However, close follow-up with a pediatrician, sports medicine specialist, or other capable provider is needed to help guide the liberalization of mental activity. Patients can return to school as soon as they can tolerate 30 to 45 minutes of concentration. In our experience, concussed patients typically require one to two days of reasonable rest before returning to school. To avoid the harm of prolonged absence from school, we usually return student athletes to school after a maximum of five days of rest.
●
Asymptomatic or low-level symptoms – We suggest that patients who are asymptomatic or have low-level symptoms not worsened by routine mental activities receive anticipatory guidance that emphasizes avoidance of cognitive effort that cause a resumption or worsening of symptoms. In our experience, exposure to video games, loud music, prolonged screen time, or mental activities requiring high levels of focus and concentration (eg, taking standardized tests) are activities that frequently induce symptoms and need to be curtailed for a few days after injury. These patients may continue to attend school.
All children and adolescents returning to school after a concussion warrant monitoring of symptoms and academic adjustments (eg, rest break in the nurse's office or reduced class time (
table 2)), as needed, if symptoms are exacerbated by schoolwork or the school environment [
25,34]. (See
'Return to learn' below.)
Cognitive rest is designed to avoid overtaxing a functionally injured brain and to prevent metabolic overload [
6,34,35]. The recommendation for cognitive rest after a concussion is based upon expert consensus, clinical experience, and the following observational evidence:
●In a prospective observational study of 335 athletes (age 8 to 23 years) with delayed recovery (mean duration of symptoms 43 days) and undergoing treatment by pediatric sports medicine specialists, those patients with the highest degree of cognitive activity after a concussion took the longest time to recover as determined by a cognitive activity scale that was not validated. However, light to moderate cognitive demand was not associated with prolongation of symptoms [
12].
●Small observational studies show that cognitive "overexertion" is frequently associated with worsening symptoms and that the risk for overexertion, as measured by neurocognitive tests, persists for some time after injury. As an example, in 72 students who sustained concussions, 80 percent reported increased symptoms of concussion after cognitive exertion one month after injury [
35]. In a separate study of 20 concussed athletes who were matched to 20 control athletes, measures of executive function were disrupted in the concussed athletes relative to controls for two weeks to two months after injury [
36].
●In one small observational study of 49 high school and college athletes who were prescribed at least one week of cognitive and physical rest from 1 to 30 days after a concussion, cognitive and physical rest was associated with significantly improved neurocognitive function based upon a standardized assessment tool or neuropsychological testing and a decrease in concussion symptoms [
37]. Improvement was seen regardless of the time between injury and the institution of rest.