What are the follow-up instructions and patient education for managing post-concussion syndrome?

Patient Education and Follow-Up Instructions for Post-Concussion Syndrome

Patients with post-concussion syndrome should follow a structured rehabilitation protocol that includes initial rest for 24-48 hours followed by a gradual return to activities that doesn't exacerbate symptoms, with close monitoring of symptom expression throughout recovery. 1, 2

Initial Management (First 24-48 Hours)

• Observe more restrictive physical and cognitive activity during the first several days after concussion 1
• Avoid activities that exacerbate symptoms 1
• Monitor for warning signs requiring immediate medical attention:
  • Worsening headache
  • Increased drowsiness
  • Inability to recognize people or places
  • Repeated vomiting
  • Unusual behavior
  • Seizures
  • Weakness or numbness in arms/legs

Gradual Return to Activity (After Initial Rest Period)

Cognitive Activities

• Resume cognitive activities gradually without significantly exacerbating symptoms 1
• Start with short periods (15-30 minutes) of light cognitive activity
• Increase duration and intensity as tolerated
• Avoid activities requiring intense concentration until symptoms improve
• Limit screen time (computers, phones, TV, video games) as these may worsen symptoms 1
• Consider using sunglasses for photophobia 1
• Avoid loud music or use of headphones if phonophobia is present 1

Physical Activities

Follow this stepwise progression 1, 3:

1. No activity, complete rest until asymptomatic
2. Light aerobic exercise (walking, stationary cycling)
3. Sport-specific or activity-specific training
4. Non-contact training drills
5. Full contact training (after medical clearance)
6. Return to full activity/competition

Important: Progress to next level only if asymptomatic at current level. If symptoms recur, return to previous asymptomatic level and try again after 24 hours 1, 3

Return to School/Work Instructions

• Customize return-to-school/work protocols based on symptom severity 1
• Consider temporary accommodations:
  • Shortened days
  • Reduced workload
  • Extra time for assignments/tests
  • Breaks as needed during the day
  • Avoidance of noisy environments (cafeterias, assemblies)
• Monitor symptoms and academic/work performance collaboratively with school/workplace 1
• Adjust accommodations as symptoms improve 1

Specific Symptom Management

Headaches

• Over-the-counter pain relievers as directed by healthcare provider
• Identify and avoid headache triggers
• Consider referral for persistent headaches

Sleep Disturbances

• Maintain regular sleep schedule
• Practice good sleep hygiene
• Avoid caffeine and electronic screens before bedtime

Balance/Dizziness Issues

• Consider vestibular rehabilitation for persistent balance problems 1, 3
• Avoid activities that might lead to falls or further injury 3

Visual Symptoms

• Oculomotor vision treatment for persistent visual symptoms 1, 3
• This can improve visual symptoms and reduce headache and fatigue 3

Emotional/Psychological Symptoms

• Psychological treatment has shown positive effects on overall burden of post-concussion symptoms 1, 3
• Consider referral if experiencing persistent anxiety, depression, or irritability

Warning Signs for Follow-Up

Seek immediate medical attention if experiencing:

• Worsening symptoms
• New neurological deficits
• Significant mood changes
• Inability to return to previous level of functioning despite following recommendations

Follow-Up Appointments

• Schedule follow-up appointments as directed by your healthcare provider
• Bring a symptom diary to track progress
• Report any new or worsening symptoms

Important Cautions

• Avoid driving until cleared by healthcare provider, as reaction times may be slowed 1
• Avoid alcohol and recreational drugs during recovery
• Do not take sleep aids without consulting your healthcare provider
• Never return to high-risk activities while still symptomatic 1

Long-Term Considerations

• Most post-concussion symptoms resolve within 3-6 months 4
• For persistent symptoms beyond 4 weeks, consider referral for specialized evaluation 1
• Interdisciplinary coordinated rehabilitation may be beneficial for persistent symptoms 1, 3
• Prolonged rest beyond the initial 24-48 hours can be detrimental and delay recovery 2, 5

Remember that each concussion is unique, and recovery times vary. The key is to balance rest with gradual return to activity without exacerbating symptoms.