What to Do After a Concussion: Rehabilitation and Care

Concussions are complex injuries that require a broad base of assessment tools to fully understand.

A common disorder in children and adolescents, concussions can have long-term consequences, affecting a person’s ability to function physically, cognitively, and psychologically. Up to 3.8 million concussions, or mild traumatic brain injuries (mTBIs), occur annually in the U.S. Due to their widespread and serious nature, it’s vital for rehabilitation professionals and athletic trainers to understand what to do after a concussion and the important role they play in helping their patients return to normal.

Recommended course: Tools for Concussion Assessment & Management

Defining concussions

The World Health Organization (WHO) describes a mTBI as “an acute brain injury resulting from mechanical energy to the head from external physical forces.” Symptoms can include one or more of the following:

• Confusion or disorientation
• Loss of consciousness for 30 minutes or less
• Post-traumatic amnesia for less than 24 hours
• Other transient neurological abnormalities include: focal signs, symptoms, or seizure, as well as a score on the Glasgow Coma Scale between 13 to 15 a half hour after an injury (or later upon presentation for healthcare)

What to do after a concussion: The road to recovery

While many individuals who sustain a concussion return to full function within 7 to 10 days, up to 30% of individuals may remain symptomatic for longer. They may also experience significant functional limitations due to their injury.

For most patients, the road to recovery requires the expertise of a multidisciplinary team, ranging from nurses and neurologists to physical and occupational therapists to teachers and athletic trainers. Rehabilitation professionals are particularly critical during this recovery time as they guide the patient’s return to normal activities.

First steps after a concussion

Gathering a structured history is a vital first step in developing a relationship with a patient and gaining a clear understanding of their injury, as well as determining the level of risk for persistent symptoms.

The principal goals of the history are fourfold:

• Determine the mechanism of injury
• Identify the initial and ongoing symptoms
• Establish what medical management has been issued
• Note any risk or prognostic factors that may contribute to a prolonged recovery

Systems check

Following a complete patient history, it’s important to screen all major body systems for symptoms that may not be related to concussion directly, or conditions that may require additional medical referral.

Top of the list are the cardiopulmonary, endocrine, gastrointestinal, hematologic, integumentary, musculoskeletal, and neurologic systems. Other areas to consider include:

• Vision
• Sensory and perceptual processing
• Functional cognition
• Attention
• Memory
• Executive function
• Insight/awareness
• Emotions
• Sleep

What to do after a concussion diagnosis: Tools, tests, and measures

A concussion is a complex injury. It requires a broad base of assessment tools to fully understand each patient’s clinical presentation.

The Post-Concussion Symptom Scale (PCSS) and Graded Symptom Checklist (GSC) are symptoms checklists recommended by the American Academy of Neurology. They can be self-administered and utilized as a means of tracking symptoms and patient progress.

• The PCSS rates 22 common symptoms post-concussion using a 7-point Likert scale ranging from 0 (no symptoms) to 6 (severe symptoms)
• The GSC also rates symptoms on a 7-point Likert scale from 0 to 6 with a specific focus on the first hours and days after injury and is used more commonly by athletic trainers, who are often the first responders immediately postinjury

Based on a broad assessment of self-reported symptoms, a clinician may choose to examine the effects of specific symptoms further. The Dizziness Handicap Inventory (DHI) and the Neck Disability Index (NDI) are symptom-­specific screening tools that may assist in streamlining the assessment process.

Concussion prognosis and next steps

Next, it’s important to identify what activity or stimulus is triggering the symptom. Common activities may include reading, screen time, or scrolling on the computer. Even activities as simple as walking in busy environments, riding in a car, or exercising might be triggering.

Evaluation and intervention

Regardless of the cause, multiple variables influence the complexity of a concussion, creating a significant overlap in underlying symptom pathology. By assessing the patient’s symptoms, a rehabilitation professional can individualize the examination to determine the best course of care.