Post Concussion Instructions

Monsignor Bonner and Archbishop Prendergast Post Concussion Home & School Instructions

Following a concussion, rest is the key.The student-athlete should not participate in any high risk activities (e.g., sports, physical education, riding a bike, etc) or other physical activities that increase his/her normal heart rate. Limit activities that require a lot of lengthy mental activity (such as homework, schoolwork, job-related activities, extended video game playing or cell phone use) as this can make the symptoms worse. Get good sleep; no late nights or sleepovers. Take naps if tired. The student-athlete will need help from parents, teachers, coaches, and athletic trainers to help manage their activity level. They should not drive until cleared by a physician.

Returning to School

1. Inform the teacher(s), school nurse and administrator(s) about your child’s injury and symptoms. You might want to share a copy of these instructions with them.
2. Students who experience symptoms of concussion often need extra help to perform school-related activities and may not perform at their best on classroom. Rest breaks during the school day can also be helpful. As symptoms decrease during recovery, the extra help can be removed slowly.

Parents and school personnel should watch for:

1. Increased problems paying attention or concentration
2. Increased problems remembering or learning new information
3. Longer time needed to complete tasks or assignments
4. Greater irritability, less able to cope with stress
5. Increase in symptoms (e.g., headache, tiredness) when doing schoolwork

Returning to Sports & Recreation

1. Your son/daughter should NEVER return to sports participation or active recreation with ANY symptoms, including practices and games.
2. Be sure that the Physical Education teacher and all coaches are aware of the injury
3. It is normal for the child to feel frustrated because they cannot return to sports right away. With concussion, full recovery is essential to prevent long term issues.
4. After the athlete is cleared for participation they MUST complete a gradual progression back to activity that is supervised by the certified athletic trainers.
5. No return to Gym or activity until the child is seen by an appropriate allied health care professional. They should be seen by a Sports Medicine Specialist, not just a pediatrician. If you do not know of a Sports Medicine Specialist the certified athletic trainers can recommend one.

The child is only allowed to begin his/her progression back to activity after he/she has been cleared by the Sports Medicine Specialist and a note has been given to the certified athletic trainers.

6. Return to Play – Return to play protocol following a concussion follows a stepwise process (see below). With this stepwise progression, the athlete should continue to proceed to the next level if asymptomatic at the current level. Generally, each step should take 24 hours so that an athlete would take approximately one week to proceed through the full rehabilitation protocol once they are asymptomatic at rest and with provocative exercise. If any post-concussion symptoms occur while in the stepwise program, then the patient should drop back to the previous asymptomatic level and try to progress again after a further 24-hour period of rest has passed. An athlete should not return to play on the same day.

Graduated Return to Play Protocol
Rehabilitation Stage Functional Exercise at Each Stage of Rehabilitation
Objective of Each Stage
1. No Activity Complete physical and cognitive rest Recovery
2. Light Aerobic Exercise Walking, swimming or stationary cycling keeping intensity, 70% MPHR; no resistance training Increase HR
3. Sport-specific Exercise Skating drills in ice hockey, running drills in soccer; no head impact activities Add Movement
4. Non-contact Training Drills Progression to more complex training drills, eg. passing drills in football and ice hockey; may start progressive resistance training. Exercise, coordination, and cognitive load
5. Full Contact Practice Following medical clearance, participate in normal training activities Restore confidence and assess functional skills by coaching staff
6. Return to Play Normal game play


It’s OK to: There is no need to: DO NOT:
Use Tylenol for headaches
Use ice pack for headaches
Eat a light diet
Sleep-but can wake up once overnight if concerned
Check eyes with flashlight
Test reflexes
Wake the child repeatedly overnight
Drink alcohol
Take advil, motrin, aspirin, naproxen or other NSAID

Serious Signs to Watch For. 

Please watch carefully for any of the following serious signs and symptoms. The best guideline is to note symptoms that worsen, and behaviors that are a change in your son/daughter. If you observe any of the following signs, call your doctor or go to your emergency department immediately.

  • Headaches that worsen Look very drowsy, can’t awaken Can’t recognize people/places
  • Unusual behavior change Seizures Repeated vomiting
  • Significant irritability Increasing confusion Loss of consciousness
  • Slurred speech Weakness/numbness in legs/arms Neck pain

[*Adapted from ACE Care Plan “Heads Up: Brain Injury in Your Practice” (2007); National Athletic Trainers’ Association Position Statement: Management of Sport-Related Concussion (2004)]


The Healthplex

Steven Collina, MD, David Webner, MD, Kevin Duprey, DO & Arjun Ramparsad, MD

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Eric Lake, DO & Robert Cabry, Jr., MD

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510 W. Darby Rd., Havertown, PA 19083



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Media, PA   l9063


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Nemours Dupont Pediatrics – Bryn Mawr

Mark Riederer, MD

825 Old Lancaster Road, Suite 250

Bryn Mawr, PA 19010



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Stephen Stache, MD

 650 Carnegie Blvd., Suite 220A

Malvern, PA   l9355