Concussion Patient Education: Key Components
Educate patients and families that concussion recovery requires an initial 24-48 hours of strict rest followed by gradual, symptom-guided return to activities—not prolonged complete rest, which can actually worsen outcomes and delay recovery. 1, 2
Immediate Post-Injury Instructions (First 24-48 Hours)
Complete physical and cognitive rest is essential only for the first 24-48 hours after injury, including staying home from school, avoiding all sports and physical exertion, and limiting screen time, reading, and cognitively demanding activities. 3, 2, 4
Warn patients and families about red flag symptoms requiring immediate emergency evaluation: loss of consciousness, severe or worsening headache, repeated vomiting, altered mental status, seizures, visual changes, or scalp deformities. 3
Emphasize that prolonged rest beyond 3 days can be harmful—studies show that inactivity beyond the initial 72-hour period may worsen self-reported symptoms and contribute to depression, physical deconditioning, and protracted recovery. 1, 5
Gradual Return to Activity Protocol (After Initial Rest Period)
After 24-48 hours, patients should begin a gradual, stepwise increase in both cognitive and physical activities that does not significantly exacerbate symptoms, with close monitoring of symptom number and severity. 1, 2
If symptoms worsen during any activity level, patients should drop back to the previous asymptomatic level for 24 hours before attempting to progress again—this is critical to prevent setbacks. 1, 3
For patients with symptoms persisting beyond 4 weeks, active aerobic rehabilitation below symptom threshold actually reduces postconcussive symptoms and should be offered as part of treatment. 1
Return to School Education
Students require academic accommodations during recovery, including reduced workload, extended time for tests, frequent breaks, and modified schedules based on symptom severity. 1
Return to school should be gradual and customized, with medical and school-based teams collaboratively monitoring symptoms and adjusting accommodations on an ongoing basis until academic performance returns to preinjury levels. 1
For students with prolonged symptoms beyond 10-14 days interfering with academics, formal evaluation for educational supports under federal statutes (Individuals With Disabilities Education Act §504) should be pursued. 1
Return to Play Protocol
Athletes must follow a strict 6-step progression, with each step taking a minimum of 24 hours: (1) no activity/complete rest, (2) light aerobic exercise (walking, stationary cycling), (3) sport-specific training without contact, (4) non-contact training drills, (5) full contact practice after medical clearance, and (6) return to game play. 1, 3
Athletes must be completely symptom-free both at rest and with increasing levels of physical exertion before progressing through each stage and ultimately returning to full activity. 1, 3
Never allow same-day return to play, even if symptoms resolve—this is an absolute contraindication due to the postconcussive vulnerability period when the brain has a lower threshold for reinjury. 1, 3, 6
Expected Recovery Timeline
Most patients (80-90%) recover within 10-14 days to one month, with average spontaneous recovery around 10-14 days when assessed by symptom resolution. 3
Adolescents typically require longer recovery times (7-10 days or more) than college or professional athletes and should be managed more conservatively. 3
Approximately 10% of patients experience persistent symptoms beyond 3 months, and 5-20% may have symptoms at 12 months—these patients require referral to a concussion specialist. 3
Psychosocial Support and Education
Assess and emphasize social support (emotional, informational, instrumental, and appraisal) as a key element in education of caregivers and educators, as social support promotes recovery, particularly in those with cognitive deficits. 1
Educate all stakeholders—athletes, parents, coaches, school administrators, teachers, and healthcare providers—about concussion recognition and management, as education remains the most important component of improving care. 1, 6
Important Caveats and Risk Factors
History of previous concussions increases risk of sustaining another concussion and predicts longer recovery times—patients with multiple concussions require more conservative management and longer rehabilitation programs. 1, 3, 6
Pre-existing conditions complicate diagnosis and management: mood disorders, learning disorders, ADHD, and migraine headaches all affect recovery trajectory and require specific attention. 6
Female athletes have higher reported concussion incidence than males in sports with similar rules, and youth athletes are more susceptible to catastrophic injury and have more prolonged recovery. 6
Prevention Education
Rule changes and enforcement play the key role in reducing concussions—helmets reduce skull fractures and bleeding but have not been consistently shown to reduce concussion incidence or severity. 1, 6
Mouthguards reduce dental trauma but lack clinical evidence for reducing concussion rates—they should be recommended for dental protection, not concussion prevention. 1, 6
Secondary prevention through appropriate return-to-play management is critical—premature return increases risk of repeat concussion, prolonged symptoms, and potentially long-term neurological sequelae. 6