Follow Up Management
- The cornerstone of recovery from a concussion injury is physical and cognitive rest (at least 24-48 hours)
- Rest allows the brain time to recover
- During this time there should be no school, sport, television, reading, computer or gaming
- The rest period should continue until all symptoms resolve. This period of recovery should be supervised by a Medical Doctor
Return to play
- A concussed player must not be allowed to return to school or return to play before having a medical clearance
- Children must successfully return to school first before they return to play
- Players should be returned to play through a graduated program (see step wise program below)
Return to Play Program
- Rest until symptoms resolve. Once asymptomatic, proceed to step 2.
- Light aerobic exercise such as walking or stationary cycling
- Light, non-contact training drill (e.g. running, ball work)
- Non-contact training drills (progression to more complex training drills and start light resistance training)
- Full-contact training – only after medical clearance by Doctor
- Return to competition (game play)
- There should be 24 hours allowed (or longer) for each stage.
- Players should be symptom-free during the program. If they develop symptoms at any stage, they should drop back to the previously symptom-free level and try to progress again after a further 24-hour period of rest.
- If the player is symptomatic for more than 10 days, a review by a medical doctor and expert in the management of concussion, is highly recommended.
- Children require an extended return to play program with a longer rest period (48hours) and recommended minimum of 14 days before returning to full contact sport (after medical clearance).
Management of Children (5-17 years)
Children and adolescents take longer to recover from concussion.
Children require a different approach to managing concussion as their brains are still developing and they need to continue learning. Concussion may impact on the child’s cognitive ability to learn at school.
The primary goal in the management of children following concussion is return to school or learn rather than return to sport. This is the critical difference between the management of adults and children with concussion.
It is reasonable for a child to miss a day or two of school after concussion but an extended absence is uncommon.
Once symptoms have decreased and the child is able to complete thinking tasks without exacerbating symptoms, a gradual return to school is advised.
Medical clearance is required before the child may return to school.
Return to School Program
The child will progress through the return to school program provided there is no worsening of symptoms. If any particular activity worsens symptoms, the child should abstain from that activity until it no longer causes symptoms to worsen. Use of computers and internet should follow a similar graduated program, provided it does not worsen symptoms. This program should include communication between the parents, teachers and medical doctor and will vary from child to child. The modified school program should consider;
- Extra time and a quiet room to complete assignments and tests
- Avoidance of noisy areas such as assembly halls, sporting events and music classes
- Frequent breaks during class, homework and tests
- No more than one exam per day
- Shorter assessments
- Repetition/ memory cues
- Use of a helper or tutor
- Later start times, the use of half days or attendance only at core subjects
Children are not to return to play or sport until they have successfully returned to school / learning.