Ask a Physiotherapist: Concussion Rehabilitation and Management- What Every Parent Should Know.

Paediatric Concussion: The basics every parent should know!

‘Concussion’ is a word and a condition that is generating considerable concern and worry amongst parents, and justifiably so. It refers to a condition that can have severe, long term consequences, is increasingly prevalent in today’s world and can often remain silent and undiagnosed. However, if diagnosed, managed and treated efficiently and effectively, concussions can be ‘fixed’, long term consequences avoided, and the return to daily activities occurring safely.
Concussion refers to a mild traumatic brain injury. It can result from a direct blow to the head or any injury that causes the brain to shake quickly back and forth in the skull. Although pediatric concussions as a result of sport injuries is rising at an annual rate of 15%, parents should be aware that kids can get a concussion from any injury that involves a hit to the head, or the shaking of the brain in the skull. The severity of a concussion can vary, and while some symptoms are quite visible, others are less so. But one thing is true, concussion is of growing concern in youth populations, with an incidence rate of 400 cases per 100,000 for girls and 700 per 100,000 for boys in Canadian emergency department visits.

How do I know if my child has a concussion?

Signs and symptoms of concussion may not be immediately apparent. After a potential concussion, it is important to closely monitor your child for the next few hours to watch for symptoms to present. There is no need to wake your child up during the night, or check for dilated pupils, unless they lost consciousness or suffered prolonged amnesia post concussion. Common signs and symptoms include (but not limited to):

  • Headache or a feeling of pressure in the head
  • Temporary loss of consciousness
  • Confusion or feeling as if in a fog
  • Amnesia surrounding the traumatic event
  • Dizziness or “seeing stars”
  • Ringing in the ears
  • Nausea
  • Vomiting
  • Slurred speech
  • Delayed response to questions
  • Appearing dazed or fatigued

Concussions can be difficult to recognize in infants and toddlers because they may not be able to describe how they feel. Nonverbal clues of a concussion may include:

  • Listlessness and tiring easily
  • Irritability and crankiness
  • Loss of balance and unsteady walking
  • Crying excessively
  • Change in eating or sleeping patterns
  • Lack of interest in favorite toys

What do I do if I suspect a concussion?

 If you expect your child has suffered from a concussion, it is important to seek medical advice in the first 48 hours post concussion. If your child loses consciousness, 911 should be called immediately. Your child must not resume any onerous physical activity until cleared by their doctor. A plan to return to school and sport needs to be decided by health care providers. The brain is quite sensitive to re-injury after a concussion, so returning to everyday activities must be gradual, planned, and monitored.

What happens after a concussion?

For the first 7- 10 days post concussion, rest is critical. This includes physical and cognitive rest- no sports, no computer, no reading etc. Typically, a child must be free of all symptoms for 24 hours (with no medication) before any activity can be resumed. When a child has been cleared to return to activity, it must be attempted gradually. Light exercise, including swimming or stationary biking at a low intensity is a good place to start. When the child is able to perform light activity with no symptom reproduction, they can move on to sport specific training, then non contact practice, contact practice and then normal game play. It is very important to seek medical advice prior to engaging in physical activity, as returning too soon can cause irreversible damage to the brain and a reoccurrence of symptoms. Doctors often refer children with a concussion to physiotherapy. Physiotherapists are able to guide the return to sport and school, and can monitor the safe return to normal activities. Physiotherapists are trained to rehabilitate a patient post concussion, once they have been medically cleared.
Once a patient is cleared by a doctor and there is no risk of a brain bleed or second impact syndrome, physiotherapy is recommended to not only help guide a safe return to normal activities, but to also address soft tissue dysfunction that may have occurred as a result of the concussion. Often a neck injury is coupled with a concussion due to the likelihood of whiplash due to the mechanism of injury. Soft tissue injury to the neck, such as muscle tightness, strain and muscle guarding, can cause concussion-like symptoms to occur, therefore physiotherapy treatment for the neck is beneficial to the rehabilitation from a concussion.
Currently, many health care practitioners and clinicians are engaging in research to better understand concussion, to manage the symptoms, and to rehabilitate a patient optimally. The field is growing, as the prevalence of concussion is on the rise, approximately 30,000 concussions among 12 to 19 year olds are diagnosed annually in Canada. The increase in knowledge surrounding youth and concussions is evident in Canadian health care, and the treatment available is starting to be more accessible.
A concussion is a brain injury, and should be treated as one. The process of rehabilitation from a concussion needs to be catered to the individual, and it is important to seek medical and other health professional advice. Proper, safe, and monitored rehabilitation will mean your child can resume all their activities safely and effectively. Precautions need to be taken when children engage in sports that have a high incidence of concussion (contact sports) but parents need not be unduly fearful. With preventative practices, good and quick diagnosis, and professional rehabilitation, concussions can be managed and patients need not suffer long-term consequences.
– Charlotte Anderson
Registered Physiotherapist
At ALPHA Health Services, Charlotte Anderson and Jennifer Harvey focus on concussion rehabilitation and management. They both have extensive knowledge, and training in concussion intervention. Charlotte is currently completing her PhD at The University of Toronto, with a focus on concussion management, intervention, and education. For more information, please email, or to book a consultation click here.

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