Concussion management extends beyond the initial event and physical recovery and involves many non-sport aspects that are important for ensuring proper healing.
When a concussion occurs during sports, the first thing to do is make sure that the athlete receives a proper medical evaluation and diagnosis. An accurate diagnosis is the critical first step for concussion management. A medical professional will assess the individual’s symptoms, medical history, and perform a thorough neurological and physical examination to diagnose the concussion and rule out more severe injuries.
Recommended course: Concussion Management: A Comprehensive Evidence-Based Approach for the Physical Therapist
Post concussion syndrome management: cognitive and physical rest
Following a confirmed concussion diagnosis, the athlete should transition into the rest phase of recovery. Rest is essential for allowing the brain to heal itself after a concussion. Both cognitive and physical rest are required.
Cognitive rest helps the brain recover by reducing cognitive exertion. Overexertion during cognitive tasks may lead to worse concussion symptoms and a longer recovery time. After a concussion, athletes should avoid activities that strain the brain like reading, limit screen time, and refrain from engaging in mentally demanding tasks. Cognitive activities should resume gradually, ceasing them if symptoms reappear or worsen.
In addition to limiting direct strain on the brain, the athlete should limit physical exertion as well to help their body recover. Introduce light physical activity gradually and in alignment with how the athletes feels during the recovery phase.
Concussion symptom management: cognitive, vestibular, and vision
After a period of rest, athletes enter the cognitive and vestibular and vision rehabilitation phase of recovery. As concussion symptoms improve, gradually reintroducing normal cognitive and physical activities can facilitate recovery.
Cognitive rehabilitation is an integral part of recovery that can help athletes experiencing post-concussion symptoms like memory loss and difficulty concentrating. Professional help can be beneficial to help athletes overcome cognitive obstacles associated with concussion recovery. However, it is important to remember if these worsen or persists to seek medical attention.
After a concussion, some athletes experience issues with blurred vision, balance, and/or dizziness. Many times, the patient describes these symptoms vaguely as lightheadedness. But they can represent a more serious issue: that the concussion symptoms are still present and worsened by specific activities or triggered by environmental factors like light.
It’s important to recognize that these symptoms reflect some of the more severe effects of concussions. Be aware of when they occur and develop a plan to address them with specialized healthcare professionals.
Return to school post concussion
For most athletes following a concussion, resuming normal activities like school tends to facilitate quicker improvements. When athletes return to school after a concussion, either temporary adjustments or accommodation or both are made for them. Adjustments could include:
- Reduced workload
- Extended deadlines
- Modified assignments to accommodate ongoing cognitive limitations
Adjustments are informal changes to schoolwork that occur within the one to three weeks following a concussion. Accommodations are more formal and may require a 504 plan if symptoms persist. Accommodation is only done when concussion symptoms last more than three weeks and appear that they might affect learning and/or testing.
An accommodation may include school modifications, which are permanent changes to the affected individual’s educational plan and require an individualized education program (IEP). This is rare and should only be implemented with professional academic advisement under a physician’s care.
Whether adjustments and /or accommodations are warranted after a concussion, the NCAA requires that all schools develop a return to learn (RTL) policy and procedure to support athletes and facilitate return to the classroom (Runyon et al., 2020).
Return to play concussion protocol
Most athletes want to quickly return to sport play following a concussion. Before this, however, they must first demonstrate a gradual return to regular daily activities that includes progressively reintroducing cognitive and physical tasks while monitoring for symptom recurrence. Once symptoms have resolved and the athlete’s physician has cleared them to play, they can enter a resume-to-play protocol.
After a concussion and during transition to resume play, many athletes experience issues that must be addressed and include:
- Psychological stress: Concussions can lead to emotional and psychological changes, such as mood swings, anxiety, and depression. Providing psychological support and access to counseling can help athletes cope with the ongoing challenges related to their recovery.
- Sleep disturbances: Difficulty sleeping after a concussion is common. Implementing strategies to help improve sleep quality can support the recovery process.
- Nutrition and hydration: A well-balanced diet and proper hydration are essential for overall performance and support the body’s healing processes, including brain recovery.
Community involvement
Proper healing and recovery following a concussion requires the cooperative involvement of the people around the athlete. Building a strong and informed support system can help manage the emotional and practical aspects of recovery.
Educating the athlete, their family, friends, and teachers about concussions is vital to ensure a supportive environment and proper management. Support from family, friends, and social networks can significantly impact an individual’s recovery.
Long-term concussion management
Regular follow-up appointments with healthcare providers are important to track and monitor the recovery progress and to adjust the management plan as needed. In cases where symptoms persist beyond the expected recovery period, a long-term management plan may be required to address ongoing challenges. Documenting the initial injury and its management may be necessary for legal or insurance purposes, especially if the concussion was the result of an accident.
Explore more information on legal concussion guidelines set by CDC here.
These non-sport aspects of concussion management focus on physical, cognitive, and emotional recovery and include a strong network of loved ones and professionals to support athletes during and after recovery.
References
- Runyon, L. M., Welch Bacon, C. E., Neil, E. R, & Eberman, L. E. (2020). Understanding the athletic trainer’s role in the return-to-learn process at National Collegiate Athletic Association Division II and III institutions. Journal of Athletic Training, 55(4), 365-375. 10.4085/1062-6050-116-19
