Blog Detail

Last week’s blog discussed special considerations for head injuries in our children, and some of the things needed to keep in mind if your child ever suffers a head injury. This week we will discuss recovery.  The road to recovery for my daughter was pretty simple, but a little challenging to navigate. As I mentioned in the last blog, symptoms can be ambiguous and difficult for the child to describe, so I really had to put on my investigator hat to dig deep and find out how she was doing.  

Recovery is Much More Favorable in Children When a Concussion is Handled Appropriately Immediately After Injury.

In general, children take longer to heal from a concussion, and expected full recovery is around 4 weeks.  However, if the immediate injury is handled inappropriately, the recovery process can be lengthened, or the current injury made much worse.  

With my daughter’s injury, the school did a great job.  They removed my daughter from the gym class activity, sent her to the nurse’s office for evaluation, and we were notified immediately.  Had the PE teacher sent my daughter back to the activity, she would have been at risk for a much more serious, life-threatening injury called Second Impact Syndrome.  I believe I have Michigan’s Concussion Legislature to thank for this.  It requires athletes, coaches and parents to complete annual concussion training before participation in any organized athletic activity.  It also requires that the student be removed from participation if a concussion is suspected, and requires written permission from a qualified healthcare provider to return to said activity.

In the Beginning, Rest is Best.  

We kept her home from school for a couple of days, and took advantage of timing (it was about to be Christmas break at school, and she was due for a week off).  In the not-too-distant past, it was recommended that concussion patients be woken up every few hours to re-assess their status, and essentially be kept in a cocoon while they were still experiencing symptoms.  Picture the patient in a dark room for 24 hours a day while they are encouraged to sleep as much as possible and not allowed to do anything to pass the time. It was discovered with further research that these techniques were not beneficial, and in fact could potentially slow recovery.  Could you imagine lying in a dark room for hours on end? I would go crazy! We also now have assessment tools and “red flags” to be aware of in the first few days following injury. These signs and symptoms alert us to the fact that urgent (or emergent) medical evaluation is warranted. These list of red flags can be found on the Pocket Concussion Recognition Tool 5.

Overall in the beginning stages of recovery, I’ve found that rest is best.  In my personal experience, the first 72 hours following injury seem to be critical (I have no evidence to support this – It’s strictly anecdotal based on 10 years of concussion experience).  Outcomes tend to be more favorable when symptoms are kept at bay and the opportunity for significant rest is allowed in this window of time. In the medical community, we know that in the concussed patient, physical and mental exertion can bring back symptoms, worsen current symptoms, and overall delay the healing process.  This means that things like running on the playground, jumping, doing math, reading, screen time and other things that active young children do should be limited at first. In general, I limited these activities as best I could with my daughter. It wasn’t perfect (try keeping an active 6-year-old quiet for the whole day), but overall the rule of thumb was to have her avoid activities which worsen current symptoms or bring on new ones.  She was symptom-free by Day 3, reporting “zeros” for headache, visual blurriness and dizziness. Her re-assessment showed that she normalized her cognitive function and reported no concussive symptoms.

Recovery Needs to Be Slower In Children

A child’s brain is a delicate thing.  When injured, it not only has to carry out the healing process, but it also has to continue growing and developing.  This can take an immense amount of bodily resources, and sometimes it takes longer than most of us would like. The absolute most important component of concussion recovery is that your child make a complete recovery.  That means that they should be allowed to gradually return to activities over time, and be guided by their tolerance to those activities.  This requires time, patience and diligence.

Return to Learn First

This is where we as parents need to keep our priorities straight.  As much as we would love to send our kids back to sports once their symptoms have gone, we would be making a big mistake.  Our ability to learn is much more important in the short and long-term. It’s important that we give our recovering children the opportunity to have their mental capacity and cognitive function challenged in a controlled environment first before they progress to physical activity.  At this stage, gym class and recess are off-limits The concussed child may require a half-day at school, other accommodations such as low lights or temporary excuses from homework, rest breaks, etc. Allow this if needed, as catch-up work can be completed later. A “return to learn” protocol can be found below:

Table 2

Graduated return-to-school strategy

(Source:  https://bjsm.bmj.com/content/51/11/838)

Gradually Return to Physical Activities Once They can Tolerate School Well.

It’s really best to have someone a team of professionals over-seeing your rehab process (Physician, Athletic Trainer, Physical Therapist).  This will give you the best results and the highest-quality care. In general, the return to physical activity and sport should be gradual in the same fashion as returning to school.  But, it should only begin once the child’s performance at school has normalized, catch-up work has been completed, and they feel like their old self again. In terms of the nuts and bolts and “how-to” of returning to sport, this should always be guided by your sports medicine team.  Here is an example of a gradual return to sport protocol that your team is likely to use. (Source:https://bjsm.bmj.com/content/51/11/838)

Table 1

Graduated return-to-sport (RTS) strategy

• NOTE: An initial period of 24–48 hours of both relative physical rest and cognitive rest is recommended before beginning the RTS progression.
• There should be at least 24 hours (or longer) for each step of the progression. If any symptoms worsen during exercise, the athlete should go back to the previous step. Resistance training should be added only in the later stages (stage 3 or 4 at the earliest). If symptoms are persistent (eg, more than 10–14 days in adults or more than 1 month in children), the athlete should be referred to a healthcare professional who is an expert in the management of concussion.

If Symptoms Do Not Improve

It’s always best to see a professional to manage your child’s concussion.  If you suspect a concussion, don’t play games. Get them evaluated by a Physician or Certified Athletic Trainer.  This will ensure that you get the proper day-by-day steps for a successful recovery. Generally, if symptoms don’t begin to improve within a few days, your child may require further intervention such as Physical Therapy to aid in their recovery.  This principle assumes no red flags were present at the initial time of injury, and are not present in the first 72 hours following injury. If red flags become apparent, a trip to the Emergency Room is required.

If you think you or your child can benefit from Physical Therapy to guide your recovery, please see us on the web at http://stayactiveup.com/center-dizziness-balance/, or call our Fair Avenue Clinic at (906)-226-0574.