What patient education should be provided for a patient with a concussion?

Patient Education for Concussion

Patients with concussion must understand that complete physical and cognitive rest for 24-48 hours is essential, followed by gradual return to activities under medical supervision, with strict avoidance of same-day return to play or sports. 1, 2

Understanding What a Concussion Is

• A concussion is a traumatic brain injury that disrupts normal brain function temporarily, causing a complex metabolic process in the brain that requires time to heal 1, 3
• Most concussions do not involve loss of consciousness, and normal CT or MRI scans do not rule out concussion 1
• The brain enters a vulnerable period after concussion where it has a lower threshold for reinjury and may suffer worse damage if hit again before recovery 3, 4

Warning Signs Requiring Immediate Emergency Care

Seek emergency medical attention immediately if any of these red flag symptoms occur: 1, 2

• Loss of consciousness lasting more than 30 seconds 1
• Severe or progressively worsening headache 1
• Repeated vomiting 1, 2
• Altered mental status or increasing confusion 1
• Seizures or convulsions 1
• Visual changes or double vision 1
• Swelling or deformities of the scalp 1, 2

Expected Symptoms and Recovery Timeline

• Common symptoms include headache, dizziness, nausea, fatigue, difficulty concentrating, confusion, emotional changes, and sensitivity to light or noise 1, 4
• Most patients (80-90%) recover within 7-10 days to one month, with typical recovery around 10-14 days 1, 2, 5
• Adolescents typically require longer recovery times than college or professional athletes and need more conservative management 1, 2, 5
• Approximately 10% of patients experience symptoms beyond 3 months and require specialist referral 2, 5

Rest Protocol: First 24-48 Hours

During the initial 24-48 hours after injury, strict rest is mandatory: 1, 2, 5

Physical Rest Requirements:

• Stay home from school or work 1, 2, 5
• Avoid all sports and physical exertion 1
• No exercise, running, or strenuous activities 1

Cognitive Rest Requirements:

• Limit or avoid screen time (television, computers, phones, video games) 1
• Avoid reading, even for leisure 1
• Minimize cognitively demanding activities 1
• Avoid loud music or headphones if sound sensitivity is present 1
• Wear sunglasses if light sensitivity is significant 1
• Avoid driving if reaction times are slowed 1

Critical caveat: Prolonged rest beyond 48 hours can actually worsen outcomes and delay recovery, so gradual activity resumption is essential 1, 2, 6

Gradual Return to Activity After 48 Hours

After the initial 24-48 hour rest period, begin slowly increasing activities as long as symptoms do not worsen: 1, 2

• Resume activities gradually, monitoring symptom number and severity closely 1, 2
• If symptoms worsen during any activity, immediately stop and return to the previous symptom-free level for 24 hours before trying again 1, 2, 5
• For symptoms persisting beyond 4 weeks, active aerobic exercise below symptom threshold can help reduce symptoms 1, 2

Return to School Guidelines

Academic accommodations are essential during recovery: 1, 2

• Work with teachers and school administrators to reduce workload and avoid symptom exacerbation 1
• Request extended time for tests and assignments 1, 2
• Take frequent breaks during the school day 2
• Consider shortened school days or temporary leave if needed 1, 2
• Avoid taking standardized tests during recovery, as scores may not reflect true ability 1
• Gradually increase academic demands as symptoms improve 2

Important: Students may physically appear well, leading teachers to underestimate difficulties—clear communication with school staff is critical 1

Return to Sports Protocol

Athletes must never return to play on the same day of injury, even if symptoms resolve: 1, 2, 5, 3

Six-Step Progression (Minimum 24 Hours Per Step):

1. No activity: Complete rest until asymptomatic at rest 1, 2, 3
2. Light aerobic activity: Walking or stationary cycling at low intensity 1, 2, 3
3. Sport-specific exercise: Running drills without contact 1, 2, 3
4. Non-contact training drills: More complex drills, may start progressive resistance training 1, 2, 3
5. Full-contact practice: Normal training activities after medical clearance 1, 2, 3
6. Return to play: Normal game activity 1, 2, 3

If any symptoms return at any stage, stop immediately and drop back to the previous asymptomatic level for 24 hours before attempting to progress again 1, 2, 5

Medical Clearance Requirements

• Evaluation by a healthcare professional experienced in concussion management is required before returning to sports 1
• Athletes must be completely symptom-free both at rest and with increasing physical exertion before full return to play 1, 2, 5
• Medical clearance is mandatory before returning to contact sports 1

Risk Factors for Prolonged Recovery

• History of previous concussions increases risk of another concussion and predicts longer recovery 2, 7, 3
• Pre-existing conditions (mood disorders, learning disabilities, ADHD, migraines) can complicate recovery 3
• Multiple concussions may require consideration of retirement from contact sports 1, 2, 7

Prevention of Future Concussions

• Helmets reduce skull fractures and bleeding but have not been proven to reduce concussion rates 2, 3
• Mouthguards protect teeth but lack evidence for preventing concussions 2, 3
• Rule enforcement and fair play are the most effective prevention strategies 3
• Report all symptoms immediately—never try to "tough it out" 1, 2, 7

Key Pitfalls to Avoid

• Never minimize symptoms or rush back to activities—this increases risk of prolonged dysfunction and potential catastrophic injury 7, 3
• Do not take medications to mask symptoms in order to return to play faster—athletes must be symptom-free without medication 1
• Avoid prolonged strict rest beyond 48 hours—this can worsen outcomes and delay recovery 1, 2, 6
• Do not assume normal imaging means no concussion—concussion is a clinical diagnosis with typically normal CT/MRI 1