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CRM: Acute Management
Concussion Recognition & Management
Module 5 Management

Acute Management

doctor shows young man chart
The stages of concussion recovery depend on where the patient is in the continuum of symptom recovery. Your job as the licensed health care professional is to understand symptoms, and be aware of whether they do or do not exist.

The initial approach is to get symptoms to resolve as quickly as possible. For your patient, it can be comparable to treating the flu — taking care of it involves simple steps: hydrate, adjust activity levels, pay attention to symptoms, get help, and get as much rest as he or she chooses.

Rest versus Activity

The cornerstones of concussion management are physical and cognitive rest, followed by a gradual Return to Activity program. (4th International Conference on Concussion in Sport, Zurich) This will be discussed in greater detail later in this module.

Specifically, it’s essential to limit mental and physical activity in the first 24–48 hours, just to be safe. (4th International Conference on Concussion in Sport, Zurich) However, be aware that strict rest for five days following an injury offers no additional benefit over the usual one to two-day rest. (Thomas, 2015) It has been shown that children who did two days of nothing actually fared better than children who did five days of nothing.
Thomas, DG et al. Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial. Pediatrics. 2015. 135(2): 1-11.
young woman in jeans asleep, face down on bed

Listen to Your Body

Mention of any specific health care facility or organization in the videos reflects an individual’s specific experience and is not intended as an endorsement from this site.


Here is an example of a symptom log your patient can use as a daily diary / log of symptom triggers:

Date

Time of Day

Symptom

What were you doing
when it occurred?

How bad was it
on a scale from 1 to 10?

May 5
Early afternoon
  • Headache
  • Fatigue
  • Dizziness
Reading on a computer
About a "6"


multi-colored pills spilling from bottle

Precautions for the Licensed Health Care Professional

At an early stage, discuss with the patient and parents your views on over-the-counter medications. Warn your patient about self-medicating. Tell the patient not to take over-the-counter drugs, use alcohol, or take other drugs without input and approval from you, because inappropriate use of these items could worsen the symptoms.

Because it’s difficult for children to reduce activities (they want to do something), suggest specific, simple, symptom-based alternatives to replace behaviors that may prove too much at this stage of recovery. This will help ensure the patient doesn’t engage in behaviors that will worsen symptoms, such as spending too much time looking at screens or trying to read text.

Alternative activities should limit physical exertion and visual strain; exclude heavy-duty problem solving or anything requiring prolonged cognitive exertion; and also be activities that help the patient avoid emotional over-stimulation.


Early Precaution List for Concussion Patients

athlete walking
  • Listen to your body. If an activity bothers you or causes symptoms, don’t do it!

  • You don’t have to sit on a couch. You do have to be mindful of what you’re doing.
    • Go for a walk.
    • Play a simple board game.
    • Take a "spa" bath with pleasant smells, soft music, and other relaxing features.
    • Give yourself a manicure.
    • Listen to recorded books or quiet music.
    • Do the dishes.
    • Arrange flowers.
    • Interact with a pet.

  • No contact sports. In fact, most sports are out, especially strengthening or training sports, like weightlifting. Weightlifting involves abrupt movements and quickly increases intracranial pressure, which may make your symptoms worse.
  • No driving. Symptoms of concussions impair your reaction time. It’s not unusual for a young person recovering from a concussion to drive too soon and get into a car wreck.

  • Don’t get on any wheels. Skateboards, bikes, and other rolling things are out.

  • Don’t climb. Keep your feet on the ground. Roofs, trees, trampolines, playground equipment, etc. are not for you, at least for now.

  • Reduce visual activities, such as reading and computer use.
    • Avoid prolonged reading of textbooks. (The length of your assignments should be reduced.)
    • As for using a computer or other device with a screen, it’s up to you to monitor yourself and stop before you trigger symptom issues.

  • Take sick leave or take time off. If you’re not going to school and / or not taking part in sports, then you shouldn’t be working at a part-time job, either.

  • Be patient with these restrictions. They won’t last forever. They all depend on reducing and eliminating symptoms. You can log your progress in a diary.

  • Take control of your recovery! Stick to the management plan, and you will get better. "Cheating" on the plan (doing too much too soon) will delay recovery. It’s up to you.

Module 5 Management

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