Management and treatment of mild TBI and Concussion

Provide education and reassurance to the family. This should include the following information which is available here:

• Warning signs of more serious injury
• Description of injury and expected course of symptoms and recovery
• Instructions on how to monitor postconcussive symptoms
• Prevention of further injury
• Management of cognitive and physical activity/rest
• Screen time and playing video games should be limited to 30 minutes, 2-3 times a day
• Instructions regarding return to play/recreation and school
• Clear clinician follow-up instructions

• Health care professionals should counsel patients to rest for the first 1-2 days only
• Then, gradually increase activity. Sometimes symptoms increase. If they increase by more than 20-30%, decrease activity slightly.
• Early graduated exercise increases recovery speeds 
• Return to full activity and sport when they return to pre-morbid performance if they have remained symptom-free at rest and with increasing levels of physical exertion. We recommend no contact sport for at least 21 days following the injury.

• Recovery from concussion can be challenging, especially when a young person loses contact with their friends. 
• Social support has proved useful in promoting the recovery of persons with mTBI, particularly those with cognitive deficits 
• Emphasize the importance of friends and social support when talking to patients, caregivers, and educators. 

To assist children returning to school after mTBI, medical and school-based teams should counsel the student and family regarding the process of gradually increasing the duration and intensity of academic activities as tolerated, with the goal of increasing participation without significantly exacerbating symptoms 

• Return-to-school protocols should be customized based on the severity of postconcussion symptoms. Most people should be back at school 1-2 weeks following the injury.
• For students with prolonged symptoms (> 4 weeks) that interfere with academic performance, assessment of the educational needs of that student should be performed (done through the QPRS mTBI and Complex Concussion Clinic) in order to determine the student’s need for additional educational supports 
•  Postconcussion symptoms and academic progress in school should be monitored collaboratively by the student, family, health care professional(s), and school teams
• For students who demonstrate prolonged symptoms and academic difficulties despite an active treatment approach, health care professionals should refer the child for a formal evaluation by a specialist in paediatric mTBI 

Common problems after a concussion include headache, dizziness, blurry vision, sleep disturbance, and cognitive problems. Specific recommendations can be found here.