Pillar Four: Conservative Treatment (Physical/Cognitive Rest)
Along with teachers, coaches, school nurses and administrators, parents play a crucial role in a child's treatment and recovery from a suspected concussion.
Parents and athletes should remember that a concussion, no matter how 'mild' it may seem, is a traumatic brain injury. Immediately after a concussion, even the most basic physical or mental tasks can make symptoms worse.
In the first few days after concussion parents therefore need to make sure their child get lots of rest and limits physical exertion and activities of daily living, including attendance at school (as recommended by the Child-SCAT3)
Because a concussion impacts the brain's cognitive functions (e.g. those that involve thinking, concentrating, learning, memory, and reasoning), limiting an athlete's scholastic and other cognitive activities, at least initially, gives the brain time to heal and speeds recovery.
Experts recommend taking a common sense approach involving a few days off from school, followed by a gradual return to a full school day ("return to learn") and social activities, which is symptom-limited (e.g. done in a way that does not make symptoms worse, and discontinuing an activity if symptoms get worse or reappear). [1,4]
Physical rest
While strict bed rest is not necessary, most experts recommend broad restrictions on physical activity in the first few days after a concussion.
Physical rest means:
- no sports;
- no weight training;
- no cardiovascular training;
- no PE classes;
- no chores that result in perspiration/exertion;
- no sexual activity; and
- no leisure activities such as bike riding, street hockey, and skateboarding that risk additional head injury or make symptoms worse.
Cognitive rest means:
- Time off from school or work;
- No homework;
- No reading;
- No visually stimulating activities, such as computers, video games, texting or use of cell phones,
- Limited or no television;
- No trips, social visits in or out of the home;
- No driving; and
- Increased rest and sleep.
Return to Learn
While an athlete must be 100% symptom-free before a return to sports (Pillar Five) , he or she does not need to be 100% symptom-free to return to school. (In fact, a growing number of concussion experts are now recommending an early return to school to avoid the social isolation and other problems that can result from an extended school absence)
Because concussion may still be affecting their thinking, ability to remember (especially new information), and organization, however, parents and school personnel (e.g. school nurse, school psychologist or a neuropsychologist, and teachers) should work together to help student-athletes to "return to learn" by adjusting their academic workload (taking time off from school to going partial days), and making other appropriate academic accommodations), for student-athletes who are still exhibiting cognitive problems.
Persistent symptoms
In the 10-15% of cases in which concussion symptoms persist for 10 days or longer, management by a team of health care providers with experience in sports-related concussions is recommended; in those that fall outside the usual 1- to 3-week recovery window, academic accommodations will need to stay in place longer.
