From the Guidelines
Adolescents with a concussion should be immediately removed from activity and not allowed to return until evaluated by a healthcare professional.
Signs and Symptoms of Concussion
The signs and symptoms of a concussion in an adolescent include:
- Headache
- Nausea
- Impaired balance
- Difficulties concentrating
- Confusion
- Emotional lability
- Fatigue 1
Management of Concussion
The management of a concussion in an adolescent involves:
- Prevention of further injury
- Management of cognitive and physical activity/rest
- Instructions regarding return to play/recreation and school
- Clear clinician follow-up instructions 1
Monitoring Postconcussive Symptoms
Postconcussive symptoms should be monitored using a scale that assesses the severity of symptoms such as:
- Headache
- Nausea
- Dizziness
- Balance problems
- Sleeping more than usual
- Sensitivity to light
- Sensitivity to noise
- Feeling slowed down
- Feeling like “in a fog”
- Difficulty concentrating
- Difficulty remembering
- Trouble falling asleep
- More emotional than usual
- Irritability
- Sadness
- Nervousness 1
First Aid for Concussion
If an adolescent shows signs or symptoms of a severe head injury, such as loss of consciousness, worsening headache, vomiting, altered mental status, seizures, visual changes, swelling, or deformities of the scalp, EMS should be activated 1
From the Research
Signs and Symptoms of Concussion
- Concussions are common sport injuries, and are particularly common among children and adolescents involved in organized sports and recreational activities 2
- Symptoms of concussion can be subtle, and may be overlooked by athletes, coaches/trainers and parents 2
- Concussion symptoms often interfere with school, social life, family relationships, and athletics, and may affect the emotional well-being of the injured athlete 3
Management of Concussion
- Any child or youth who sustains a concussion should be removed from play immediately and medically evaluated as soon as possible 4, 2
- Cognitive and physical rest are recommended to allow symptoms to resolve 4
- Cognitive rest may require temporary school absence and/or a modified class work or homework load 4
- A full return to activity and/or sport is accomplished by using a stepwise program while evaluating for a return of symptoms 3
- Treatment for concussion should be individualized, based on predominant signs and symptoms, and can include subsymptom threshold aerobic exercise, cervical physical therapy, vestibulo-ocular rehabilitation, behavioral and cognitive psychotherapy, and some symptom-specific pharmacological therapies 5
Return to Play
- After symptoms have completely resolved at rest and a full return to school is achieved, the student can progress through a medically supervised, stepwise exertion protocol to return to play 4
- The reduction, not necessarily elimination, of physical and cognitive activity is the mainstay of treatment, and a full return to activity and/or sport is accomplished by using a stepwise program while evaluating for a return of symptoms 3