Imagine living with no screen time for a few days. Could you to do it? These days, computers, smart phones, gaming consoles, TV and other electronic devices are such an integral part of our lives. This is especially true with teens and young adults. That why there’s always been a concern among medical professionals who focus on traumatic brain injury (TBI) about screen-time usage immediately following a concussion. In fact, the U.S. Centers for Disease Control (CDC) recommends limiting screen time to help assist with brain health recovery.
Are Screens Bad for Concussion Recovery in Kids and Teens?
Parents and doctors hear all kinds of questions from kids regarding screen time in post-concussion recovery:
- “How soon after a concussion can I watch TV?”
- “How long do I have to wait until I can use the computer to do my homework?”
- “When can I get back to gaming?”
- “Do I really have to give up my phone for a few days?”
While numbers vary, it’s estimated that teens in particular may spend up to nine hours of their day watching or using a combination of various types of screens. So it’s understandable that they would have a lot of questions about being separated, even temporarily, from their beloved devices. But taking time off from screens may be even more important for recovery than we previously suspected. Research and recommendations published in the Journal of Family Practice suggest that putting aside the screen-heavy technology during the first few post-concussion days may help speed recovery.
Clinical Evidence Supports Limiting Screen Time, at Least Initially
In research from the University of Massachusetts Chan Medical School provides the first clinical evidence to support the reduction of screen time for post-concussive patients. The findings indicate that avoiding screen time during the first 48 hours of acute-concussion recovery may greatly shorten the duration of concussion symptoms, at least among 12- to 25-year-olds.
From June, 2018 to February 2020, the UMass researchers randomly placed 125 concussion patients aged 12 to 25 into two groups. The first group was told to avoid screen time or schoolwork for the first 48 hours. The second group was told they could still use screens as long as the use didn’t provoke new symptoms. All patients were asked to complete a post-concussion symptom scale (PCSS) when they were initially diagnosed, and then again each day during a 10-day study period. The PCSS is a self-reported measure that records the severity of symptoms using a 7-point scale system.
According to results reported by the researchers, the data showed that the group permitted screen time during the initial 48 hours after a concussion experienced a “significantly longer time to recover.” In fact, individuals using screens took a median of eight days to recover compared to 3 and a half days for individuals in the group that abstained from any screen time.
How Exactly Does Screen Time Impact Recovery?
Medical director and founder of Mid-Atlantic Concussion (MAC) Alliance, Vincent Schaller, MD, DABFM, CIC, prescribes reduced electronic screen time with little brain stimulation for all his post-TBI patients. This allows for important cognitive brain rest immediately following concussion. Dr. Schaller says that screen use can hamper the initial recovery process in another way too. The rapid eye movement involved with watching continually-refreshing LED screen pixilation can cause eye muscle strain for someone who has just suffered a TBI.
“In addition to eye strain, backlighting from most screens and the loud noise from some electronic devices may also cause other negative symptoms in post-concussive patients, such as headaches and even nausea,” says Dr. Schaller.
Dr. Schaller agrees with lead UMass study author Dr. Theodore E. Macnow, who said of his team’s findings, “It’s not clear why screen time exacerbated concussion symptoms but there are a lot of reasons to suspect it’s not good.” Possibly electronic photons, which are known to set off migraines, may be a factor. Or perhaps screen use may negatively impact sleep and the gradual return to normal activities that are considered beneficial to concussion recovery.
Dr. Schaller also agrees that these findings suggest that a larger, more diverse, multicenter study is warranted. “I’d love to see more rigorous clinical research conducted, such as if certain screen activities, like gaming, might be worse than texting,” he says.
Screen Time and Post-Concussion Brain Rest
While each individual TBI patient’s injuries will be different, Dr. Schaller has general guidelines regarding screen-time usage in the first 48 hours after a concussion for people of all ages. As a basic rule of thumb, he recommends:
- Total brain rest (no screen time) initially after injury
- Limiting other activities that require learning or thinking
- Trying for 8-10 hours of sleep, with regular wake up and bedtime hours
- Gradual phasing in of screen time after 48 hours, provided symptoms haven’t worsened
Watch Children Carefully After Head Injury
Despite what many people think, kids aged 10 to 19 years old are more likely to sustain traumatic brain injuries than adults under the age of 65. Dr. Schaller warns that symptoms in children may not appear right away. In addition, sometimes kids don’t articulate clearly to adults around them about symptoms they are experiencing. Since the human brain is still developing well after a person turns 18, we should not take childhood or adolescent head injuries lightly. “When it comes to brain health, think of these young adults as fragile packages that need to be handled with care after any type of TBI,” he says.
What if a Concussion Isn’t Immediately Detected?
It isn’t always obvious that someone has experienced a concussion. Kids who bump their heads or experience whiplash (which can violently shake the head) may not initially be brought in for medical assessment. They may tell their parents, teacher or coach that they feel fine to seem brave. Or they and the adults they speak to may be incorrectly under the assumption that concussions require loss of consciousness. What’s more, many people aren’t aware that concussions don’t show up on the MRIs and CT scans done to rule out brain bleeds and aneurysms.
“Concussions don’t necessarily mean there are visible bruises or clear evidence of harm,” explains Dr. Schaller. “Delayed symptoms that aren’t initially attributed to a head injury may take more time to surface, like sleeping more or less than usual, fatigue, sadness or foggy thinking.”
Dr. Schaller notes that, luckily, the majority of the concussions he treats don’t result in permanent brain damage. But he adds that undiagnosed, untreated concussions can put an individual at risk of prolonged recovery and symptoms. “Another concern is something called second impact syndrome, a sudden and life-threatening condition that can happen when a concussed person sustains another TBI after not fully-recovering from the initial concussion,” he says.
Tools for Brain Health Testing, Monitoring, Concussion Diagnosis and Treatment
Over the last few decades, major advances in clinically effective brain-testing tools have helped concussion specialists like Dr. Schaller diagnose and treat brain injuries better than ever before. MAC Alliance specialists utilize technologies like ImPACT® and Cambridge Brain Sciences® neurocognitive testing, BrainScope® One-EEG head injury assessment, RightEye® infrared eye-tracking, Brain SPECT Scan 3D metabolic imaging and Sway Balance Systems® vestibular balance assessments. These tools allow medical professionals to quickly and accurately monitor brain function.
— reporting by Faith R. Foyil
[POST UPDATED 03/01/24]
