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Updated: Nov 15, 2025
A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
Association of Self-Paced Physical and Cognitive Activities Across the First Week Postconcussion With Symptom
Jingzhen Yang1, Keith Owen Yeates, Junxin Shi
1Center for Injury Research and Policy (Drs Yang and Sullivan and Mss Hautmann and Asa), Biobehavioral Health Center (Dr Taylor), Biostatistics Resource (Dr Shi), and Research Information Solution and Innovation (Mr Bailey), The Abigail Wexner Research Institute, at Nationwide Children's Hospital, Columbus, Ohio; Departments of Pediatrics (Drs Yang, Taylor, Pommering, MacDonald, and Cohen) and Sport and Internal Medicine (Dr Tiso), The Ohio State University College of Medicine, Columbus; Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (Dr Yeates); Divisions of Sports Medicine (Drs Pommering and MacDonald) and Emergency Medicine (Dr Cohen), Nationwide Children's Hospital, Columbus, Ohio; Discipline of Children's Studies, National University of Ireland, Galway (Dr Sullivan); Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington (Dr Xun); Injury Prevention Research Center and Department of Epidemiology, University of North Carolina at Chapel Hill (Ms Singichetti); Department of Psychology, New York University, New York (Dr Lu); and Division of Arts and Sciences, NYU Shanghai, Shanghai, China (Dr Lu).
Objective:
To examine the association of objectively measured, self-paced physical and cognitive activities across the first week postconcussion with symptom resolution in youth.
Setting:
Emergency department or concussion clinics.
Participants:
Youth aged 11 to 17 years with physician-confirmed concussion.
Design:
Prospective cohort with repeated measures.
Main Measures:
Days from injury to symptom resolution, based on daily ratings by youth on the Post-Concussive Symptom Scale. Physical and cognitive activities were assessed using an ActiGraph and a Narrative Clip, respectively.
Results:
A total of 83 youth participants were included (n = 54 [65%] males; mean age = 14.2 years, SD = 1.9). While self-paced daily physical and cognitive activities increased across the first week postinjury, daily postconcussion symptoms decreased. Increased daily step count was associated with an increased likelihood of early symptom resolution (hazard ratio [HR] = 1.17; 95% confidence interval [CI], 1.02-1.34). However, this association was not statistically significant after adjusting for acute postconcussion symptoms and other covariates. Greater school attendance time was associated with earlier symptom resolution (adjusted HR = 1.14; 95% CI, 1.02-1.27).
Conclusion:
Self-paced physical and cognitive activities across the first week postinjury alone neither hastened nor prolonged concussion recovery. Youth with concussion may have some latitude to determine their activity levels.
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