return to activity guidelines for children and

youth

is a brain injury and must be

taken seriously

a concussion

concussionmanagementconcussion

management

recommendations for return to contact sport after multiple concussions

concussion facts

•NO SAME DAY RETURN TO PLAY!•Ifpositiveneuroimagingfindings→Takeatleast3monthsofffromcontactsport.•If2concussionsin3months→Take6monthsofffromthetimeofmostrecentinjury.•If3ormoreconcussionsin1year→Take1yearofffromthetimeofthe mostrecentinjury.•Discussretirementfromcontactsportsafter3concussions,consideringnon-contact alternatives,especiallyifsymptomsareprolongedandaffectingperformance.

Thebiggest riskisgoingbacktoplaybeforethebrainhealsandgettinganotherconcussion!

Management Tips•Drinkwaterregularly•Getsubstantialrest(8-10hoursofsleep)•Donotskipmeals

•Wearsunglassesornoisecancellingheadphonesifsensitivetolightor

noise

return to activity Stage 1:...................... 1-2days Stage 2:....................... 7-10days Stage 3:....................... 7days Stage 4:....................... 7days Stage 5:....................... 3days

Fully back to game play in 4-5 weeks

return to school Stage 1:...................... 1-2days Stage 2:....................... 3-5days Stage 3:....................... 7-14days Stage 4:....................... 7days

Fully back to school in 2-4 weeks

Time in Each Stage/How long will it take for me to get through each stage? Averagetimeineachstageisbasedonresearchfrom

McMaster’sBacktoPlayStudy.

Note:Differentpeoplerecoveratdifferentratesdependingonmanyfactors,includingseverityofinjuryandprevioushealthhistory.Thesetimelinesaremeanttohelpsetexpectationsandtobeusedasaguide.Ifyouareworriedaboutthepaceofyourrecovery,contactaphysicianorbraininjuryspecialist.

Higher risk of prolonged recovery with:

•Multipleconcussions•Historyoflearningorbehaviourproblems•Historyofmigraines•Symptomsofamnesia,fogginessordizziness

But continue to exercise!

Formoreinformation,pleasevisitwww.canchild.ca

GOAL: Completehomeandleisureactivitiesastolerated,withoutanincreaseinthenumberorseverityofsymptoms.Nophysicalactivitiesofanyintensityforlongerthan5minutes,aslongastheseactivitiesdonotincreasesymptoms.

stage

1Short Phase of

Physical and Cognitive Rest with Symptom Guided Activity

24-48 hours

Beginnolaterthan2weekspostinjuryifsymptomsaredecreasing.GOAL: InadditiontoactivitiesaccomplishedinStage1,complete15-30minutesoflightphysicalactivitytwicedailywithoutworseningsymptomsforatotalof~1hourperday.LIGHT ACTIVITIES:Walking,stationarycycling,swimming,stretching.NOresistancetrainingorweightlifting.

stage

2 Light Exercise(No Contact)

GOAL: AbletocompleteactivityrequirementsforStages1and2,withtwoadditional30-minutesessionsofmoderatephysicalactivitydailywithoutworseningsymptomsforatotalof~2hoursperday.MODERATE ACTIVITIES:Skating,lightjogging,throwing.

stage

3Individual

Sport-SpecificActivity

(No Contact)

GOAL: AbletocompleteactivityrequirementsforStages1-3,withtwoadditional30-minutesessionsofmoderate/vigorousphysicalactivityfornomorethan3hoursperday.Bytheendofthestage,progresstofullteampracticewithNOCONTACT.Increaseskilllevelanddifficultyastoleratedwithoutworseningsymptoms.MODERATE/VIGOROUS ACTIVITIES: Beginresistancetrainingandgeneralsport-specificconditioningskillswithoneotherteammate.Throwing/passingaball,sport-specificdrills,andothernon-contactactivities.

stage

4Sport SpecificPractice with

Team(No Contact)

GOAL: AbletocompleteactivityrequirementsforStages1-4,participateinfullpracticeandtrainingactivitiesastoleratedwithoutworseningorcausingsymptoms.VIGOROUS ACTIVITIES: Running,cycling,jumpingjacks.Ifsymptomfree,youarereadytoreturntocompetition!

stage

5Sport-SpecificPractice with

Team(Contact)

Congratulations you have completed the Guidelines!

stage

6Return to FullActivity, Sportor Game Play

(Contact)

return to activity guidelinesSTAGES1-3oftheReturntoActivity(RTA)andReturntoSchool(RTS)guidelinesshouldprogresstogether,howeveryouthshouldreturn

full-timetoschoolactivitiesbeforeprogressingtoSTAGE4,and5oftheRTAguidelines

ConCuSSionAconcussionalsoknownasamildtraumaticbraininjury,changesthewaythebrainfunctions.Aconcussioncanbecausedbyadirectorindirecthit,blow,orforcetotheheadorbody.

SympTomS oF ConCuSSion• Headache• Dizziness,nauseaorvomiting• Sleepdisturbanceordrowsiness• Poorbalanceorcoordination• Visualproblems• Sensitivitytolightornoise• Mentallyfoggy• Difficultyconcentrating/ remembering• Emotionalchanges(anxiety, irritability,sadness)

Red FlAg SympTomSIfanyofthefollowingsymptomsdevelop,gototheemergencydepartmenttoseekfurthermedicaltreatmentimmediately.

• Increaseddrowsinessorcannot beawakened• Headachesorneckpainworsen• Persistentvomiting• Unequalpupilsize• Seizures• Confusionorshort-term memoryloss• Blurred/doublevision,slurred speech,orlossofmotorfunction• Changeinbehaviour(irritability, agitation,oraggression)

importantnotes

ANxIETY canbehighafterabraininjury.Manyyouthworryaboutschoolfailureandneedreassurancethataccommodationswillbetemporary.

DEPRESSIONiscommonduringrecoveryfrombraininjury,especiallywhenthechildisunabletobeactive.Depressionmaymakesymptomsworseorprolongrecovery.

Note:Differentpeoplerecoveratdifferentratesdependingonmanyfactors,includingseverityofinjuryandprevioushealthhistory.Thesetimelinesaremeanttohelpsetexpectationsandtobeusedasaguide.Ifyouareworriedaboutthepaceofyourrecovery,contactaphysicianorbraininjuryspecialist.

©CanChild,McMasterUniversity2018

if symptoms increase or return at any STAge, reduce activity by returning to the previous stage for 24 hours.

a SYMPTOM FREE WITHIN 48 HOURS AFTER INJURY B SYMPTOM FREE/SYMPTOMS DECREASE

WITHIN 1-4 WEEKS AFTER INJURY c SYMPTOMATIC FOR MORE THAN 4 WEEKS

WHICH SYMPTOM GROUP ARE YOU IN? orB ca

Takeatleast24hoursforeachstageasyoucompletetherestoftheguidelines.

Takeatleast2daysforeachstageasyoucompletetherestoftheguidelines.

Takeatleast1weekforeachstageasyoucompletetherestoftheguidelines.