Have a child healing from a head injury? There's an app for that, and it may help doctors to improve concussion care.

In a pilot program that already has been expanded, a team of researchers from the University of Pennsylvania's Perelman School of Medicine and the Children's Hospital of Philadelphia recently used everyday technology - a computer application, along with portable movement and sleep monitors - to learn about patients' activity after a concussion.

The study's results, published online in September in JAMA Pediatrics, may lead to some changes in recommendations for the recovery period after a concussion.

"It's not 100 percent what we expected," said Christina L. Master, a Children's Hospital attending physician, associate professor of clinical pediatrics, and study coauthor.

Typical post-concussion symptoms can include headache, dizziness, and nausea. After a head trauma, metabolic and blood-flow changes can make the brain more vulnerable to further injury. So patients generally are advised to limit physical and cognitive activities.

The question is, how much rest is best?

"We need to learn better what the optimal time is," Master said.

The findings of the pilot suggest that the right balance during recovery from concussion may be resting one's brain but still getting some physical activity.

The researchers found that patients who spent more time reading, playing online games, watching television, or working on a computer reported more severe symptoms on the day they engaged in the activity and two days after. That was especially true of patients who started out with more severe symptoms.

However, more physical activity tended to correspond with fewer symptoms that day and the next two days, according to the study.

The majority of patients in the study - 68 percent - reported no symptoms by the end of the two weeks during which each was studied.

"If replicated, this could change how physicians care for their pediatric concussion patients," said Douglas J. Wiebe, study lead author and associate professor in Penn's department of biostatistics and epidemiology.

The study involved 34 patients 11 to 19 years of age.

Master said each participant was asked to carry an accelerometer to record movements and an iPod Touch loaded with an app that would ping them prompts at intervals during each day to report any symptoms they were feeling. They also completed activity questionnaires and summaries. In addition, they wore a device called an ActiGraph to monitor sleep.

The study's methods allowed the researchers to get immediate information about individual participants.

"This may be a really useful means to get real-time data from a patient," Master said.

The pilot did not include the first 48 to 72 hours after an injury because there was a lag before patients were referred to the study from a sports medicine clinic, according to Master.

However, she said a follow-up study already has been started that includes the immediate post-injury period.

The study comes at a time when concussion reports are on the rise, according to a data analysis by the Blue Cross Blue Shield Association. Pennsylvania and New Jersey had among the highest rates in the nation, according to the insurer, probably because of increased awareness of the long-term effects of head injuries rather than an increase in actual injuries.

In 10- to 19-year-olds, concussion diagnoses increased by 71 percent from 2010 through 2015.


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