I've heard that in addition to physical rest, cognitive rest is just as important in recovering from mild tbi. but exactly what is cognitive rest? I've heard of athletes such as sidney crosby and lindsey vonn having to lie in a dark room all day free from stimuli. is this what cognitive rest is? can you be actively doing things around the house and still be resting your brain?

When I first got my PCS I realised I needed to rest, and thought 'hey this is a good opportunity to do a load of reading on medical issues for work that I've been meaning to do for a while' and sat out in my garden reading very complicated books for a week, in between watching action films and playing computer games.

This is not cognitive rest! I didn't understand the difference between cognitive and physical rest, and that there are things that can work your brain very hard while your body is at rest. In my experience things which tire out your brain are

(a) anything that is complex for it to understand (like complex medical textbooks I was reading)

(b) anything that requires it to keep track of lots of different things at the same time or quickly switch attention from one thing to another - this would include most fast-moving console computer games, situations where you have to try to, say talk to someone whilst your brain is also listeniing to other conversations or the tv in the background

(c) anything which puts pressure on your brain to respond quickly, eg people asking things of you in a demanding way (I get this a lot at work) or action films/music videos etc which are designed to keep changing scenes and hitting you with loud noise and bright colours so your brain is constantly having to reorientate and pay attention.

C is the biggy for me since my brain will tend to rise to the challenge whether I want it to or not, my processing speeds up and I am able to cope with the demands being made of me.... but then the effort brings my symptoms back afterwards. I work in mental health with a lot of desperate people and I have had to work periods without patient contact because my brain couldn't cope with all the demanding requests they kept making of me.

Lying in a dark room all day free of stimuli may well be helpful and if you are able to do it by all means give it a try. Personally I'm not capable of doing that as the boredom would drive me insane - instead I have tried to do things which interest me, but which don't make too many demands of my brain. These include watching nature or certain types of history programmes, reading books which aren't too difficult to understand and when I felt a bit better going to watch a quiet game of cricket or visiting a historic site where there aren't too many people around. It depends on what you're interested in and what your brain can tolerate, but if your symptoms get worse afterwards that will mean it was too much.

The only physical activity I could do was walk, slowly, preferably outside.

I downloaded a lot of guided relaxation and meditation podcasts and listened to those. I also listened to nature sounds (rain, waves, etc) while lying in a dark room. It gave me something gentle to focus on.

I also found coloring to be helpful. At the beginning, I had to do very simple pictures where I didn't have to think too hard about what color to make things. Now I'm able to do some slightly more complex designs.

I second the coloring! I have a gigantic stack of papers I've colored... After the first few weeks of "zombiness" I couldn't stand to sit around and do nothing.

Also, I have found that it helps to return to familiar books if you can read (or movies if you can stand to watch them). If I read an old favorite, it occupies my time without my having to think much since I've already read it before. I can also play a favorite movie on my computer and listen to it with the screen turned away so the visuals don't bother me.

Trying to read or watch something new is often too taxing for my brain. Besides, with my memory nowadays, the old stuff often seems new - just easier to understand.

I find the sound of water very relaxing. Rain is simply amazing.

Cognitive rest has been very difficult for me. Now that I can (finally!) read some and spend some time on my computer, I'm having to learn all sorts of new boundaries.

Talking, concentrating, reading, listening, all of it.

I enjoy the ability to watch a good movie again and again without knowing the next move. I will recognize the situations but not be able to remember what happens next. The Bourne Trilogy is a good example.

I find that I am much more likely to be visually overwhelmed with a High Definition flat screen. Surround sound can also be too much for me.

Once you understand how the brain actually blends things together to make them easier to process, it makes sense that we have a difficult time. Our brains often lack this ability to blend and fade images together, especially when they are so vivid as in Hi Def.

I agree with Mark's observation about HDTV - I think it provides too much input to the brain (at least for me). I've basically stopped watching all television/movies until I get better. Some things that have helped me reduce my overall daily "intake" of stimulation include:

- Adding curtains to my bedroom to create a darker environment (before I had semi-useless blinds only)

- Placing a time limit on phone calls (30 mins max, preferably 5-10 mins). Before I would occasionally talk for an hour - I think this contributed to setbacks

- Less time on the computer (say, 20 mins instead of two hours). This is a hard one for me, as the computer is a nice distraction and a link to the outside world. But it's a necessary sacrifice

- Keeping conversations light and short

- Keeping emails short and to the point

- More naps - even non-sleeping ones. I think having some periodic shutdown time helps my brain slow down from the day's stimulation

- Less reading. When I started to feel better initially, I started reading a lot more. I think this was overly taxing for my brain. Now I just skim the newspaper, reading the occasional article, and read short sections (sometimes just a few pages) of the book I'm reading

- Meditation. I don't always do this, but I find 10-20 mins of meditation daily is a good way to slow everything down and promote the "relaxation response"

- For now, short slow walks in the pool in my building instead of short walks outside - less stimulation indoors

It's hard to give up all these things and to be so monastic in my day-to-day life, but I figure my priority at the moment is to heal. First I need to get better; then I can start to add activities back in.