Concussion Management Return To School Guidelines

CONCUSSION MANAGEMENT
Return to Activity Guidelines for Children & Youth
These guidelines should be followed in discussion with a physician or brain injury clinician.
STEP 1: No Activity and Complete Rest
NO physical activity if symptomatic

Which symptom group are you in: BLUE, PURPLE, or GREEN?
SYMPTOM FREE
WITHIN 1 WEEK
SYMPTOM FREE
WITHIN 1 - 4 WEEKS
SYMPTOMATIC FOR
MORE THAN 4 WEEKS
Rest for 1 more week

after symptom free
Rest for 1 more week

after symptom free
Begin STEP 2
(4 weeks after injury)
Begin STEP 2
Begin STEP 2
DO NOT progress to
STEP 3 until symptom free
and cleared by a physician
or brain injury clinician
Take at least 24 hours for

each step as you complete
the rest of the guildelines
Take at least 1 week for

Take at least 1 week for

*Get clearance from a physician or brain injury clinician before beginning STEP 2
STEP 2: Light Exercise
If symptoms return, rest for at least 24 hours
and then go back to the previous step

NO resistance training or weight lifting
10-15 minutes light exercise, maximum twice a day
e.g., walking, stationary cycling, light jogging, freestyle swimming
STEP 3: Individual Sport-Specific Activity
NO body/head contact, spins, dives, jumps, high speed stops, hitting a baseball with a bat,
or other jarring motions
20-30 minutes general conditioning, maximum twice a day.
e.g., skating, running, throwing
STEP 4: Sport-Specific Practice with Team, NO CONTACT
NO checking, heading the ball, tackling, live scrimmages

Begin activities with one other teammate and then by the end of this step progress to
full team practice, with NO contact.
e.g., ball drills, shooting/passing drills, or other non-contact activities
Begin resistance training and beginner level sport-specific skills. Increase skill level over time.
*Get clearance from a physician or brain injury clinician before beginning STEPS 5 and 6
CONCUSSION MANAGEMENT
Return to School Guidelines for Children & Youth
These stages are designed to strike a balance between the importance of returning to school
and brain recovery. Work with your school to put these recommendations into place.
STAGE 1: Brain Rest - NO SCHOOL
No school for at least one week

Lots of cognitive rest (NO TV, video games, texting, reading)
When symptom free, move to STAGE 2
*If symptoms persist past 2 weeks, move to STAGE 2
STAGE 2: Getting Ready to Go Back
Begin gentle activity guided by symptoms (walking, 15 minutes of screen time twice
daily, begin reading). If symptoms worsen, reduce activity.
*If symptoms persist, stay in this stage for a maximum of 2 weeks and discuss
moving to STAGE 3 with your physician or brain injury clinician
STAGE 3: Back to School/Modified Academics
This stage may last for days or months depending on rate of recovery
Go to bed early and get lots of sleep. Have a quiet retreat space in school
Academic Modifications:
Timetable/attendance: Start by going for one hour, half days or every other day
Curriculum: Attend less stressful classes, no tests, homework in 15 minute blocks
up to a maximum of 45 minutes daily
Environment: Preferential seating, avoid music class, gym class, cafeteria, taking
the bus, carrying heavy books
Activities: Limit screen/TV time into 15 minute blocks for up to 1 hour daily
*If symptoms persist past 4 weeks A recovery Individualized Education Plan
(IEP) may be needed
STAGE 4: Nearly Normal Routines
Back to full days of school, but can do less than 5 days a week if needed
Complete as much homework as possible and a maximum of 1 test per week
STAGE 5: Fully Back to School
Gradually return to normal routines including attendance, homework, tests and

extracurricular activities
SYMPTOMS OF CONCUSSION
STEP 5: Sport-Specific Practice with Team and CONTACT
Participate in normal training activities. If no symptoms, you are ready to return to competition!
STEP 6: Return to Activity, Sport or Game Play

Reference: McCrory P, Meeuwisse W, Johnston K et al. Consensus Statement on Concussion in Sport: The 3rd
International Conference on concussion in Sport Held in Zurich, Nov 2008. Journal of Athletic Training 2009; 44(4):434-448.
www.canchild.ca
CanChild, McMaster University
Sleep disturbances or drowsiness Sensitivity to light or noise

Headache
Mentally foggy
Nausea and vomiting Difficulty concentrating/ remembering
Poor balance or coordination
Irritability
Dizziness
Sadness
Visual problems
Nervousness

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CONCUSSION MANAGEMENT

Return to Activity Guidelines for Children & Youth

STEP 1: No Activity and Complete Rest

NO physical activity if symptomatic

Rest for 1 more week

Rest for 1 more week

Take at least 24 hours for

Take at least 1 week for

Take at least 1 week for

STEP 2: Light Exercise

If symptoms return, rest for at least 24 hours

and then go back to the previous step

STEP 3: Individual Sport-Specific Activity

STEP 4: Sport-Specific Practice with Team, NO CONTACT

NO checking, heading the ball, tackling, live scrimmages

Return to School Guidelines for Children & Youth

STAGE 1: Brain Rest - NO SCHOOL

No school for at least one week

STAGE 2: Getting Ready to Go Back

STAGE 3: Back to School/Modified Academics

STAGE 4: Nearly Normal Routines

STAGE 5: Fully Back to School

Gradually return to normal routines including attendance, homework, tests and

STEP 5: Sport-Specific Practice with Team and CONTACT

STEP 6: Return to Activity, Sport or Game Play

Sleep disturbances or drowsiness Sensitivity to light or noise

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