INITIAL STEPS – UPDATED August 2019
After an initial concussion the individual should subscribe to REST, not just physical “rest”, but cognitive rest.
- REDUCED TV
- REDUCED Texting
- REDUCED Computers
- REDUCED Radio
- NO Bright Lights
- NO Loud Noises
- LIGHT Reading
- MONITORED and GRADED activity below a threshold that elicits signs/symptoms
RELATIVE brain rest, in other words, SLEEP is OK!
SCHOOL AGED INDIVIDUALS AND RETURN TO LEARN
“Rest” should be continued until all signs and symptoms have resolved. Rest in this demographic does not mean complete removal from school; using the Concussion Oversight Team at the school temporary adjustments should be used. When trying to learn the brain is working, thus not resting. Even if the kid went to school the bright lights, the loud noises and the exercise the brain needs to just navigate the hallways is enough to impede progress in resolving this injury. As a reminder, it may be good to take/heavily monitor: cell phone, computer and video game systems from the kids. They should return to normal school day when all signs and symptoms have resolved.
RETURN TO ACTIVITY (including Physical Education)
Current graded return to play guidelines for athletes that have sustained a concussion. This particular model was adapted from the 4th International Conference on Concussions held in Zürich in 2012, and I have since modified adding one step.
- No physical activity, only rest, proceed to step two after full evaluation by medical professional with experience in concussion (24-48 hours).
- Begin Return to Learn and graded return to school; include walking and sub-symptom threshold activity up to 20 min/day.
- Light aerobic exercise such as power walking or stationary cycling increasing heart rate to 50-70% of MHR. Monitor for symptoms and signs. No resistance training or weight lifting.
- Sport – specific activities and training (eg. skating in hockey); sprints, calisthenics increasing heart rate to 80-90% of MHR for 10 minutes total over 20 minute time frame. No contact or risk of contact. May begin weight training.
- Begin drills with body contact including practices in sport that keep the individual protected from uncontrolled contact. This should be the stage where the individual is assessed for return to the demands of the sport.
- Clear Return to Learn.
- Game play.
As stated above each step should be only attempted if there is NO NEW signs or symptoms or they are not exacerbated as they relate to the this concussion incident.
It is also important to realize that a concussion or head injury, in general, will not resolve in a typical linear fashion. Meaning that “on day one you have this and by day 7 you should be here,” as is common with other general orthopedic injuries.
The head is mysterious and responds differently for each individual person. Set-backs will be common and should be expected. When they do occur you should regress to the previous step in this process and begin again.
The general rule of thumb is 24 hours at each phase.
Be mindful and remember that if you suspect a head injury/concussion that you should consult a medical professional, preferably one that has experience with concussions and return-to-play.