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CME / ABIM MOC / CE

Can Screen Time Help Concussion Recovery in Kids?

  • Authors: News Author: Lisa Jhung; CME Author: Laurie Barclay, MD
  • CME / ABIM MOC / CE Released: 1/20/2023
  • Valid for credit through: 1/20/2024
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Physician Assistant - 0.25 AAPA hour(s) of Category I credit

    IPCE: 0.25 Interprofessional Continuing Education (IPCE) credit

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for pediatricians, family medicine/primary care clinicians, nurses, physician assistants, neurologists, and other members of the health care team for children with concussion.

The goal of this activity is for learners to be better able to describe the association between early screen time and postconcussion symptom severity in children and adolescents with concussion compared with those with orthopedic injury.

Upon completion of this activity, participants will:

  • Assess the association between early screen time and postconcussion symptom severity in children and adolescents with concussion compared with those with orthopedic injury, based on a planned secondary analysis of a prospective longitudinal cohort study
  • Evaluate the clinical implications of the association between early screen time and postconcussion symptom severity in children and adolescents with concussion compared with those with orthopedic injury, based on a planned secondary analysis of a prospective longitudinal cohort study
  • Outline implications for the healthcare team


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News Author

  • Lisa Jhung

    Freelance writer, Medscape

    Disclosures

    Lisa Jhung has no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Laurie Barclay, MD, has the following relevant financial relationships:
    Formerly owned stocks in: AbbVie Inc.

Editor/Nurse Planner

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.


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In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

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CME / ABIM MOC / CE

Can Screen Time Help Concussion Recovery in Kids?

Authors: News Author: Lisa Jhung; CME Author: Laurie Barclay, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 1/20/2023

Valid for credit through: 1/20/2024

processing....

Clinical Context

Current recommendations to restrict screen time after concussion largely reflect expert opinion and findings from 1 randomized controlled trial. Some clinical guidelines recommend screen avoidance for 1 to 2 days before gradually resuming use as tolerated, whereas others mention gradual return in the context of return-to-school strategies.

Complete cognitive rest (“cocooning”), including prohibiting screen time, might negatively affect youth via social isolation and psychological distress. Researchers in the present study predicted an interaction between injury type (concussion versus orthopedic injury [OI]) and screen time, such that higher levels of early screen time would predict greater postconcussion symptom severity over time in those with concussion relative to those with OI.

Study Synopsis and Perspective

Experts recommend that children and adolescents who have had a concussion rest for a day or 2 before returning to light physical activity. Slowly getting back to normal helps young patients recover faster than strict rest, research shows. 

Now a new study suggests that getting back on social media apps may help, too.[1]

After surveying 700 patients aged 8 to 16 years after an injury, researchers from the University of British Columbia and the University of Calgary, in Canada, found that children and adolescents who had a concussion recovered faster if they engaged in a moderate amount of screen time. 

A “moderate” amount was between 2 and 7 hours per day on various screens. “That includes their phones, computers, and televisions,” said Molly Cairncross, PhD, an assistant professor at Simon Fraser University who did the research. 

People in the study who reported either less or more screen time than that in the 7 to 10 days after injury also reported more symptoms, such as headaches and fatigue, during the first month. After that month, all the participants reported similar symptoms, regardless of their early screen use, suggesting that screen time makes little difference long-term in pediatric concussion recovery. 

The findings differ from a 2021 study by researchers at the University of Massachusetts Medical School that found that screen time slowed recovery. Why the clashing results? “I think what it comes down to are differences in study design,” said Dr Cairncross. While the earlier study measured screen use in the first 48 hours, and recovery over the course of 10 days, “we focused on screen time use over the first 7 to 10 days, and tracked recovery over 6 months,” she said. 

“Taken together, the studies suggest a need to find balance: not too little and not too much time on screens for kids and teens following a concussion,” Dr Cairncross said. 

Ultimately, the findings support moderation rather than blanket restrictions on screen time as the best way to manage pediatric concussion, especially after the first 48 hours. 

“It’s actually unsurprising,” said Sarah Brittain, a speech-language pathologist and founder of Colorado Brain Recovery in Wheat Ridge, Colorado, who was not involved in the study. “An early return to both cognitive and physical activity in a controlled fashion is really important. Sitting in a dark room and resting is not the answer and has been disproven in the literature.”

Old advice involved lying in a quiet, dark room for days, but recent evidence reveals that such “cocoon therapy” may actually prolong symptoms. 

“With time, we have found this can negatively impact quality of life and depression scores, especially in teenagers,” said Katherine Labiner, MD, a child neurologist at Pediatrix Child Neurology Consultants of Austin, Texas, who was not involved in the study. 

So, how might screens help? Dr Labiner, Brittain, and Dr Cairncross all point to the importance of connection--not the internet kind, but the social kind. Children and teenagers use smartphones and computers to stay connected with peers, so banning screen time could have a negative impact on mental health by leading to loneliness, separation, and lack of social support.

“Depression can prolong the course of recovery,” said Brittain.

It’s worth noting that screen time could trigger visual symptoms in some patients, she said. “If someone feels worse within 2 minutes of being on a screen, that’s a good indicator that screens aren’t working for them,” Brittain said. “If being on a screen makes them dizzy or wiped out, or the words on the screen look like they’re moving when they’re not, that means it’s time to back off.”

She advises parents to watch for behavior changes such as increased crankiness, impatience, and/or fatigue, which could mean that the child has returned to screen time--or any activity--too soon and should scale back until symptoms subside. 

“The most important thing to stress with concussion is full recovery before complete return to activity,” Dr Labiner says.

Pediatrics. 2022;150(5):e2022056835.

Study Highlights

  • This planned secondary analysis of a prospective longitudinal cohort study included 633 children and adolescents with acute concussion and 334 with OI aged 8 to 16 years, recruited from 5 Canadian pediatric emergency departments.
  • Postconcussion symptoms, including headache and fatigue, were measured with the Health and Behavior Inventory (HBI) at 7 to 10 days, weekly for 3 months, and biweekly from 3 to 6 months postinjury.
  • Screen time, including telephones, computers, and televisions, was determined from the Healthy Lifestyle Behavior Questionnaire.
  • For 4 HBI outcomes (self- and parent-reported cognitive and somatic symptoms), generalized least squares models were fit with predictors including screen time, covariates associated with concussion recovery, and 2 three-way interactions (self- and parent-reported screen time with group and time postinjury).
  • The association of screen use during postacute recovery with parent-reported cognitive symptoms or self-reported somatic symptoms did not differ in the OI vs postconcussive group.
  • Screen time was a significant but nonlinear moderator of group differences in postconcussion symptom severity for parent-reported somatic (P=.01) and self-reported cognitive symptoms (P=.03).
  • High screen time 7 to 10 days postinjury was not strongly associated with worse symptoms after concussion, especially 30 or more days postinjury,
  • Low (<2 hours; <25th percentile) and high (>7 hours; >75th percentile) screen time were both associated with relatively more severe symptoms in the concussion group than in the OI group during the first 30 days postinjury, but not thereafter.
  • Children and adolescents with concussion with the worst prognosis had similar recovery trajectories regardless of their early screen time.
  • Screen time accounted for only 0.6% to 3.5% of total predictive ability for symptom severity.
  • Risk factors and health behaviors other than screen time (time since injury, group, and preinjury cognitive and somatic symptom severity) had stronger associations with symptom severity.
  • The investigators concluded that the association of early screen time with postconcussion symptoms is not linear.
  • The best strategy for clinical management may be recommending moderation in screen time, rather than blanket restrictions in screen time, especially beyond the first 48 hours, for children and adolescents postconcussion.
  • An early, controlled return to cognitive and physical activity is recommended, rather than complete bedrest in a dark room for days, which may prolong symptoms, negatively affect quality of life, and increase depression, which itself may prolong recovery.
  • Moderate screen time may facilitate social connection and help prevent loneliness, separation, and lack of social support that could exacerbate depression, which itself may prolong postconcussive recovery.
  • However, screen time may trigger visual symptoms, dizziness, increased irritability, impatience, and/or fatigue in some patients, in which case screen use should be postponed until symptoms subside.
  • Full recovery from concussion is needed before complete return to activity.
  • Study limitations include lack of measurement of timing, quality, or nature of screen time, which may be important moderators of the association between screen time and postconcussion symptoms and lack of generalizability to children or adolescents who do not seek care or seek alternative care after injury.
  • Future research should examine whether certain individuals, such as those with vestibulocular dysfunction, are more sensitive to screen use postconcussion.

Clinical Implications

  • The association of early screen time with postconcussion symptoms is strongest for low and high screen time.
  • The best strategy for clinical management may be recommending moderation in screen time rather than blanket restrictions in screen time, especially beyond the first 48 hours.
  • Implications for the Health Care Team: Full recovery from concussion is needed before complete return to activity. Members of the healthcare team should provide education to caregivers on behavioral signs and symptoms that may signal the child is not yet ready to return to full activity.

 

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