Patient Education

A concussion is a mild traumatic brain injury caused by a bump, blow, or jolt to the head or body that makes the brain move rapidly back and forth inside the skull. This sudden movement stretches and stresses brain cells, creating chemical changes that temporarily affect how the brain works. **Common causes:** • Falls — the leading cause across all ages • Sports and recreation (football, hockey, soccer, basketball, rugby, cycling) • Motor vehicle crashes • Bumps, blows, or hits to the head during play **Important facts:** • A concussion can happen without a direct hit to the head — a hard hit to the body can jolt the brain too. • Most people never lose consciousness. You do not need to "black out" to have a concussion. • Symptoms usually appear right away but can develop or worsen over the first 24–48 hours. • Brains heal differently — recovery is gradual, and pushing too hard too soon can slow it down. **Why it matters:** A second hit before the brain has healed can be dangerous. That's why it's so important to recognize a concussion early, rest, and follow a step-by-step return to activity. With proper care, most people recover fully within a couple of weeks.

Symptoms can show up immediately or develop over hours to days. Check in regularly for the first few days, because symptoms can change over time. **Physical symptoms:** • Headache or "pressure" in the head (the most common symptom) • Nausea or vomiting • Dizziness or balance problems • Blurred or double vision • Sensitivity to light or noise • Fatigue, drowsiness, or feeling "sluggish" **Thinking / cognitive symptoms:** • Feeling "foggy," groggy, or slowed down • Difficulty concentrating or remembering • Trouble following conversations • Confusion or repeating questions **Emotional symptoms:** • Irritability or easily frustrated • Sadness or crying more than usual • Anxiety or nervousness • Feeling "more emotional" **Sleep changes:** • Sleeping more or less than usual • Trouble falling asleep or staying asleep **In young children who can't describe symptoms, watch for:** • Appearing dazed or stunned • Crying more than usual or changes in behavior • Loss of balance, unsteady walking, or vomiting • Tiring easily or listlessness • Loss of new skills (e.g., toilet training) **Keep a daily log:** Note which symptoms are present and how strong they are each day. Bring this to follow-up visits — improving scores are one of the best signs of recovery.

Recovery starts with brief rest, then a gradual return to everyday life. The goal is to stay active enough to heal without making symptoms worse. **First 24–48 hours — relative rest:** • Rest the body and the brain, but you do not need to stay in a dark room all day. • Limit intense thinking and screens, but light conversation and easy activities are fine. • Stay hydrated, eat regularly, and keep a normal sleep schedule. • Have someone check on you periodically. **After the first days — ease back in:** • Start with short, easy activities and see how you feel. • If an activity makes symptoms clearly worse, stop, rest, and try again later or at a lighter level. • Gradually reintroduce reading, screens, light chores, and short walks. • Break tasks into smaller pieces and take breaks before symptoms build up. **Pacing — the key idea:** • "Symptom-limited" means you can do an activity as long as symptoms don't spike. • A small increase in symptoms (1–2 points) during activity is okay if they settle back down within an hour. • Avoid the "push-and-crash" cycle — doing too much, then crashing for a day or two. **Things to avoid early on:** • Contact sports or any activity with head-injury risk • Heavy exertion or weightlifting until cleared • Driving if you have dizziness, slowed reactions, or trouble concentrating **When to progress further:** Move forward only when you can do daily activities with mild or no symptoms, and always follow your healthcare provider's guidance.

Returning to learning is a priority and should come before returning to sports. The brain has to handle thinking and concentration again before it handles physical exertion. **Communicate early:** • Tell the school nurse, counselor, and teachers about the concussion as soon as possible. • Ask your healthcare provider for written accommodations. • Identify a point person at school (often the nurse or counselor) to check in with the student. **Stage 1 — Light cognitive activity (at home):** • Short periods of reading, homework, or screens as tolerated. • Stop if symptoms rise; rest and retry. **Stage 2 — Part-time school with accommodations:** • Half-days or a shortened schedule. • Frequent breaks in a quiet space. • Reduced workload and extended deadlines. • Excuse from gym, recess contact, and high-stakes tests. **Stage 3 — Nearly full schedule:** • Attend most classes with breaks as needed. • Begin making up missed work gradually. • Limit to one major test or project per day. **Stage 4 — Full return to school:** • Full schedule, normal workload, no accommodations needed, and symptoms are minimal. **Helpful accommodations:** • Reduced screen time; printed handouts instead of tablets • Preferential seating away from noise and bright lights • Extra time, breaks, and a quiet "reset" space • Sunglasses or a hat for light sensitivity • Permission to leave class if symptoms flare **Red flags that mean pull back:** • Symptoms clearly worsening during the school day • Needing to nap for hours after school most days • Falling behind despite accommodations Work with the school team and your provider — recovery is not perfectly linear, and adjustments are normal.

Athletes should never return to play the same day a concussion is suspected. A step-by-step return-to-play (RTP) progression begins only after the athlete is back to full school activities and symptom-free at rest. **Before starting RTP:** • Full recovery of symptoms at rest • Back to a normal school/workload with no accommodations • Cleared by a licensed healthcare provider • Successful completion of light cognitive and physical activity without symptoms **The 6-step return-to-play progression:** Move to the next step only when the current step is symptom-free. Each step usually lasts at least 24 hours. 1. Symptom-limited light activity — daily activities, light walking. 2. Light aerobic exercise — stationary bike or walking at a pace that raises heart rate mildly. 3. Sport-specific exercise — running drills or skating (no head-impact risk). 4. Non-contact training drills — more complex drills, passing, resistance training. 5. Full-contact practice — normal training after medical clearance. 6. Return to play — normal game competition. **If symptoms return at any step:** • Stop the activity and rest until symptom-free again (at least 24 hours). • Resume at the previous successful step. • Contact your healthcare provider if symptoms keep coming back. **Key reminders:** • "If in doubt, sit them out." Never play through symptoms. • A second concussion before full healing can be serious and prolong recovery. • Younger athletes often take longer to recover — be patient. • Helmets do not prevent concussions; they protect against skull fractures. Your provider's clearance and the school's athletics protocol guide the final decision.

Most concussions can be managed with rest and follow-up care. But some symptoms can signal a more serious brain injury. Know the red flags — if you see any of them, go to the nearest emergency department or call 911 right away. **Go to the ER immediately for any of these:** • One pupil larger than the other • Drowsiness or inability to wake up • Worsening headache that does not go away or gets severe • Slurred speech, weakness, numbness, or decreased coordination • Repeated vomiting or nausea • Unusual behavior, confusion, restlessness, or agitation • Loss of consciousness (passed out), even briefly • Convulsions or seizures (shaking or twitching) • Clear fluid or blood draining from the ears or nose • Skull swelling, deformity, or a deep cut on the head **For infants and toddlers, also watch for:** • Bulging soft spot, repeated vomiting, or won't stop crying • Refusing to eat, unusual irritability that won't settle • Cannot be comforted or won't wake up **When to call your provider (non-emergency but prompt):** • Symptoms aren't improving after 7–10 days • New symptoms appear after the first few days • Symptoms get worse when returning to activity • You're unsure whether it's safe to return to school, work, or sports **Trust your instincts:** If something feels wrong or the person is declining, seek emergency care. It is always better to be checked.