Exercise following concussion
Cocooning, or complete bedrest, following concussion, is a thing of the past. The seminal work of Dr. John Leddy and his colleagues at the University of Buffalo Concussion Management and Research Center has informed much of present-day best-practice clinical care for individuals with concussions. They have reported that restriction of activity following concussion prolongs recovery and may even make symptoms worse. [1] Though this may seem at first blush to be counter-intuitive, both science and anecdotal evidence back it up.
There is ample clinical evidence to support a progressive….
Cocooning, or complete bedrest, following concussion, is a thing of the past. The seminal work of Dr. John Leddy and his colleagues at the University of Buffalo Concussion Management and Research Center has informed much of present-day best-practice clinical care for individuals with concussions. They have reported that restriction of activity following concussion prolongs recovery and may even make symptoms worse. [1] Though this may seem at first blush to be counter-intuitive, both science and anecdotal evidence back it up.
There is ample clinical evidence to support a progressive, individualized subthreshold aerobic exercise treatment program for safely returning patients to sport, notably derived from systematic assessments of exercise tolerance using the Buffalo Concussion Treadmill Test. The key terms here are progressive and individualized. Aerobic exercise may be used as non-pharmacological medicine, but like with any medicine, type and dosage are determined individually. Numerous factors contribute to a prescription for exercise, including injury severity, pre-existing conditions, and support systems. One thing is clear, however, and that is that no concussed i—p-p1‘“ndividual should return to pre-injury activities within at least 48 hours post- injury.
From an elite athlete to a weekend warrior to an individual who attends physical fitness class once or twice per week, none should return to strenuous sports in the first couple of days following concussion but should start moving with low-impact exercises such as walking, cycling, or swimming. Too much too soon could cause setbacks in physical function, cognitive function, and even emotional stability. Paradoxically, too much rest could even cause fatigue. Too little exercise, such as “cocooning,” as recommended in years past, could result in the development of post-concussion syndrome, a condition in which symptoms may last weeks or even months or more.
Resting during the first 48 hours following a concussion is essential, but this should not entail a lack of movement or thinking. Sports and other strenuous activities should be avoided, such as attending school or work, doing homework, using electronic devices, listening to or playing loud music, and reading. Though this sounds highly restrictive, there are plenty of ways to occupy one’s time during the earliest stages of concussion, and adherence to this advice will pay enormous dividends. So, what may one do during the earliest stages of recovery? Listening to audiobooks, meditation, arts and crafts, simple cooking, massage, taking a short walk in the fresh air, making quiet visits with friends, playing gently with a pet, and playing simple board games are some of the things that could occupy one’s time.
One needs to pay close attention to how it feels when introducing increasingly complex or challenging activities. Is brain fog present? Is there dizziness? Irritability? Weakness or fatigue? Symptoms may appear a few hours or more following activity, so paying close attention to how one feels is critically essential. Know when to stop!
Dr. Leddy and his colleagues’ research has found that progressive, paced, and moderate aerobic activity beginning 48 hours post-concussion results in a speeding up of a return to regular activity and a decrease in symptoms, with a greater chance of restoration of function.[2] If symptoms worsen once the exercise starts, a rest period is in order, and after a couple of days, another attempt should be made. Of course, specific physical and cognitive symptoms may interfere with a smooth return to exercise, including headache, dizziness, fatigue, insomnia, decreased concentration, diminished memory, and autonomic nervous system (ANS) dysfunction. Again, only the individual will know what feels “off” and should thus be encouraged to listen to what their body and mind are saying.
Low-impact sports such as a recumbent bike are recommended as a return to physical activity as there is less gravitational pull on the bloodstream pumping to the heart. Other beneficial exercises are walking, aqua aerobics, or water running, as the pressure of the water facilitates healthy blood flow. Dr. Robert Scales, the director of cardiac rehabilitation and wellness at the Mayo Clinic, underscores the direct relationship between cardiovascular health and brain health, noting that increased vasodilation (opening of blood vessels) results in better flow to the brain. Subthreshold aerobic exercise normalizes cerebrovascular physiological dysfunction.
FITT is a vital acronym when using exercise to facilitate brain health, referring to Frequency, Intensity, Time, and Type. Frequency refers to how often you exercise; the point is to meet your goals without overtraining the body. Intensity is how laborious an exercise is and will be determined by heart rate increase. Time, of course, refers to the duration of each exercise, with a gradual rise of notable importance. Type refers to the exercise you’ll do under cardio or strength training. All of these elements should be determined by your healthcare specialist and monitored closely by them.
Even careful adherence to a plan set forth by one’s healthcare professional may not yield the desired rate of change as numerous factors contribute to prolonged recovery. Some contributing factors are loss of consciousness of more than one minute, repeated concussions, age of injury (the younger the person, the more time is required for recovery), and specific pre-existing conditions, including migraine, cognitive dysfunction, and depression or anxiety. No two individuals are the same; thus, no two recovery patterns are the same. However, one’s best chance at recovery is to go slowly, not be afraid, and know that a return to pre-injury level will likely happen.
[1]
Current Opinions in Neurology (2018) Dec;31(6):681-686.
[2] issue of Current Sports Medical Report
Peter Pan Syndrome After Concussion
As parents, watching your child navigate the challenging path to adulthood can be exciting and nerve-wracking. Yet, for many young adults today, this transition can be daunting, leading to "failure to launch" or Peter Pan Syndrome. This phenomenon describes individuals who struggle to embrace adult responsibilities, opting to remain in childhood comforts. For young adults with concussion-related challenges, this transition often requires additional care, understanding, and patience. Parents who make…
As parents, watching your child navigate the challenging path to adulthood can be exciting and nerve-wracking. Yet, for many young adults today, this transition can be daunting, leading to "failure to launch" or Peter Pan Syndrome. This phenomenon describes individuals who struggle to embrace adult responsibilities, opting to remain in childhood comforts. For young adults with concussion-related challenges, this transition often requires additional care, understanding, and patience. Parents who make intentional choices about helping their children navigate the journey to adulthood have a greater chance of witnessing their success.
Let’s explore the history of this syndrome, the statistics surrounding it, the role of parents, and what you can do to support your child while navigating this complex journey together.
A Brief History of Peter Pan Syndrome
The term "Peter Pan Syndrome" was popularized in the 1980s by Dr. Dan Kiley in his book Peter Pan Syndrome: Men Who Never Grow Up. Kiley described adult men who resist maturity, much like the beloved character from J.M. Barrie’s story and responsibility. Over time, the concept expanded to include young adults of all genders, highlighting a growing societal trend of extended adolescence. This shift reflects broader changes in cultural expectations, economic realities, and parenting styles.
Eye-Opening Statistics
The prevalence of failure to launch is striking:
Living at Home: As of 2021, around 52% of young adults aged 18 to 29 lived with their parents, according to Pew Research.
Employment Rates: The U.S. Bureau of Labor Statistics reported that about 15% of young adults in this age group were unemployed in 2023, underscoring the challenges they face in gaining independence.
Mental Health: A 2022 survey by the American Psychological Association found that 60% of young adults reported feeling overwhelmed by anxiety about their future, contributing to their struggles with launching.
These statistics highlight a concerning trend that many families are grappling with today.
Where Have We Gone Wrong?
1. Overprotective Parenting
Many parents today are inclined to shield their children from failure, believing that by doing so, they are offering support. However, this approach can inadvertently lead to dependency. We may rob children of the resilience needed to navigate adulthood by preventing them from facing challenges. This becomes very tricky when we are parenting a child who has suffered a concussion (or any injury or illness, for that matter). We may be scared about their course of recovery, and we may coddle them.
2. Societal Pressures and Expectations
The pressure to succeed has never been higher. Rising tuition costs and a competitive job market often overwhelm young adults. Many are waiting longer to enter the workforce, pursue further education, or take on adult responsibilities, frequently exacerbated by societal expectations that seem out of reach. Often, young adults feel that their concussion symptoms will preclude them from competing in the job market.
3. Economic Factors
The current economic landscape presents significant challenges. Skyrocketing living costs and student debt leave many young adults feeling trapped, leading them to stay home longer. The combination of these financial pressures can create a cycle of dependence.
4. Changing Milestones
Cultural norms around adulthood have shifted dramatically. Traditional markers of adulthood—like marriage, home ownership, and stable careers—are being postponed. This shift can lead to a broader definition of what it means to be an adult, which may contribute to feelings of inadequacy among young people.
The Role of Parents
Parents play a crucial role in the development of their children’s independence. Your support can either facilitate a successful transition or inadvertently contribute to prolonged dependency. Remember that your child is always looking to you for guidance, even though, at times, it doesn’t seem so. It is vital to model strength and the conviction that the symptoms of concussion will subside and that they will flourish.
What Can We Do Better?
1. Encourage Independence
Parents should focus on fostering independence from an early age. Allowing children to make choices, face consequences, and manage responsibilities can help them develop the skills necessary for adulthood. In the context of concussion, we may be frightened for them to venture out on their own, for fear of re-injury or the inability to do certain things as quickly as before. Remember that your child is always looking to you for guidance, even though, at times, it doesn’t seem so. It is vital to model strength and the conviction that the symptoms of concussion will subside and that they will flourish.
2. Promote Open Communication
Creating a safe space for dialogue allows young adults to express their fears and aspirations. Active listening can strengthen relationships and encourage them to share their challenges openly. Have frequent conversation with your child and also encourage them to take advantage of group sessions with other who are experiencing the effects of concussion too.
3. Set Realistic Expectations
Establishing clear expectations around responsibilities can provide a framework for young adults to understand what is required. These expectations should be balanced with encouragement to pursue personal goals.
4. Teach Life Skills
Equipping young adults with essential life skills—such as budgeting, cooking, and job searching—can empower them to take charge of their lives. Encouraging involvement in practical experiences can build confidence.
5. Seek Professional Guidance
If families find themselves stuck in patterns of dependency, seeking the help of a coach or therapist can provide valuable insights. These professionals can offer strategies for fostering independence and breaking unhealthy cycles.
Conclusion
While failure to launch is a complex issue influenced by various societal factors, it’s clear that parenting plays a significant role in shaping young adults’ readiness for independence. By reflecting on our approaches and making intentional changes, we can better support our children as they navigate adulthood.
Remember, you are not alone on this journey. Embrace the process together, and celebrate each small victory along the way. With your love and support, your child can find the confidence and skills to navigate the complexities of adulthood and truly take flight.
