|
in bed or in a darkened room is not advised and is associated with worse outcomes compared with relative rest.
It is important that individuals gradually return to their normal activities. Light physical activity is recommended in the acute stages post-injury( eg, 2-14 days). 2, 20 If concussion symptoms are triggered or worsened by physical or cognitive activity, the activity may be continued, provided the symptoms are mild and resolve within an hour. However, if symptoms per-
|
learning, sport and other activities) is highly valuable for concussed patients and their family members. A national child health poll conducted by the Royal Children’ s Hospital Melbourne in 2023 showed that one in three( 34 %) parents had no or very limited knowledge about concussion. 5 Lack of knowledge often increases parental anxiety, which itself has a significant impact on an individual’ s recovery. 22
Return to learn
|
Table 2. Return-to-learn strategy
Step Mental activity Activity at each step Goal
1 Daily activities that do not result in more than a mild exacerbation * of symptoms related to the current concussion.
Typical activities during the day( eg, reading) while minimising screen time. Start with 5-15 minutes at a time and increase gradually.
Gradual return to typical activities.
Increase tolerance to cognitive work.
|
Sport-related concussion makes up a large proportion of emergency presentations in older children and adolescents. |
||||||||||
|
sist beyond this time frame or intensify, it is advisable to discontinue the activity and allow for appropriate rest. 2
Currently, there are no pharmacological agents that modify concussion recovery; however, simple analgesics( non-opioid) may be used sparingly in the acute period for somatic symptom management( eg, headache). The recommended use of simple analgesia is limited to short-term relief and is to be avoided over extended periods.
Hypnotic and sedative medications should be avoided post-concussion. Poor sleep in the acute phase following a concussion(< 10 days) is associated with
|
Returning children and adolescents to school and learning is a primary goal in concussion management. GPs can help facilitate return to learn. A stepwise returnto-learn paradigm has been published by the CISG to guide this( see table 2). 2 Return to learn is a gradual process that increases cognitive load and allows for mild, brief symptom provocation. The return-to-learn strategy takes priority over the return-toplay strategy, although both can usually be implemented simultaneously. Most children and adolescents will progress through this process with little or no difficulty, however, if a child cannot progress through the |
Increase academic activities.
Return to full academic activities and catch up on missed work.
* Mild and brief exacerbation of symptoms is defined as an increase of no more than 2 points on a 0-10-point scale( with 0 representing no symptoms and 10 the worst symptoms imaginable) for less than an hour when compared with the baseline value reported prior to cognitive activity.
|
|||||||||||
increased risk of persisting symptoms. Evaluating and providing appropriate |
stages in a timely manner, then referral to a specialist with expertise in concussion |
Reproduced with permission from the Concussion in Sport Group and the British Journal of Sports Medicine 2 |
|||||||||||
management of sleep hygiene is vital for |
management is appropriate. |
||||||||||||
|
optimal recovery. 21
Further psycho-education regarding typical concussion recovery and the process of returning to activities( such as return to
|
Return to sport Similarly, a strategy for return to sport has also been published by the CISG( see |
table 3). 2 During the initial 24-48 hours it is both safe and highly recommended to commence light physical activity. This forms the initial stage of the six-stage |
return-to-sport strategy. It is recommended to commence sub-symptom threshold aerobic exercise early. 20 Individual children and adolescents will |
|||||