Background It is unclear whether physical rest and cognitive rest recommendations aid recovery in youth who sustain a concussion, in part because adherence to these recommendations is unknown.

Methods We tested ecologic momentary assessment to enable measuring cognitive and physical rest/exertion and symptoms in real time in recently concussed youth. Subjects, enrolled in clinic, wore an accelerometer and carried an iPod Touch, that randomly gave prompts to complete a symptom/activity survey app several times each day between clinic visits. Clinical data were also obtained.

Results We monitored 34 patients age 11–17 years (18 female, 16 male); 75% were followed for 10 days (range 5–21). Mean symptom score was 22.89 (range = 0–68, max = 132). The total number of EMA reports obtained was 1072. The median number of texts sent/day was 20–49, median electronic gaming hours/day was 0.5, median homework hours/day was 0, and median step count/day was 2684. On the 130 days that were school days, subjects did not go to school on 78 days (60%), went a partial day on 36 days (27.7%), and went a full day on 16 days (12.3%). The median hours slept/night was 9.7 (range = 0–23), and the median minutes spent napping/day was 0 (range = 0–370). The median total hours slept (overnight+nap) was 10.0. We found that 32% of subjects were symptom free (score ≤8) after 7 days, 52% were symptom free after 14 days, and 71% were symptom free after 2 months. Interestingly, 29 (76%) became asymptomatic but then became symptomatic again within 2 weeks. Only 14 eligible patients declined participation for reasons including time constraints and feeling too sick.

Conclusions It is feasible to monitor concussed youth to determine the timeline to symptom resolution and adherence to physical and cognitive rest recommendations. This protocol can enable randomised trials to determine the role of cognitive and physical rest in recovery.