What patient education is recommended for managing concussions?

Patient Education for Concussion Management

Systematic education should be offered early to patients within the first 4 weeks after concussion, including information about symptoms, management, restitution, and self-care to prevent persistent postconcussive symptoms. 1

Key Components of Concussion Education

Immediate Post-Injury Information

• Warning signs of more serious injury requiring immediate medical attention
• Description of expected course of symptoms and recovery timeline (typically 7-10 days, though some may take weeks to months) 1
• Instructions on monitoring postconcussive symptoms
• Prevention of further injury

Activity Management Guidelines

1. Initial Rest Period (First Several Days):

   • Observe more restrictive physical and cognitive activity during the first several days after concussion 1
   • Complete physical and cognitive rest until symptoms begin to improve

2. Gradual Return to Activity:

   • Resume a gradual schedule of activity that doesn't exacerbate symptoms
   • Close monitoring of symptom expression (number and severity)
   • Return to full activity only when premorbid performance is achieved and patient remains symptom-free at rest and with increasing physical exertion 1

3. Return to Play Protocol (for athletes):

   • Follow stepwise progression:
     • No activity, complete rest until asymptomatic
     • Light aerobic exercise (walking, stationary cycling)
     • Sport-specific training
     • Non-contact training drills
     • Full contact training (after medical clearance)
     • Game play 1
   • Progress to next level only if asymptomatic at current level
   • If symptoms recur, drop back to previous asymptomatic level and try again after 24 hours 1

School/Work Accommodations

• Guidance on returning to school/work with appropriate accommodations
• Instructions for teachers and administrators to modify workloads to avoid symptom exacerbation 1
• Clear follow-up instructions with healthcare providers 1

Special Considerations

For Persistent Symptoms (>10 days)

• Approximately 10-15% of concussion patients experience persistent symptoms 2
• For symptoms persisting beyond 4-6 weeks, referral for specialized assessment and interventions may be needed 1
• Consider an active rehabilitation program with progressive reintroduction of non-contact aerobic activity that doesn't exacerbate symptoms 1

Psychosocial Support

• Assess the extent and types of social support available to patients
• Emphasize social support as a key element in recovery 1
• Address emotional and psychological aspects of recovery

Improving Patient Education Effectiveness

• Provide written materials in addition to verbal instructions
• Electronic clinical practice guideline handouts have been shown to improve short-term outcomes 3
• Concussion-specific educational materials are preferred by patients over standard discharge instructions 4

Common Pitfalls to Avoid

1. Returning to activity too soon:

   • Never allow return to play/activity while symptomatic at rest or with exertion 1
   • "When in doubt, sit them out" approach is safest 1

2. Inadequate symptom monitoring:

   • Teach patients to recognize and report all symptoms
   • Use validated symptom scales when possible 1

3. Overprotection vs. underprotection:

   • Avoid prolonged inactivity beyond the initial rest period
   • Balance rest with gradual return to activity to prevent deconditioning

4. Ignoring risk factors for prolonged recovery:

   • Closely monitor patients with risk factors for persistent symptoms
   • These may include history of previous concussions, certain demographics, or specific injury characteristics 1

By providing comprehensive education that covers these aspects, healthcare providers can help patients better manage their concussion recovery and potentially reduce the risk of persistent symptoms or complications.