Source: AAFP 2012
Cognitive rest: No texting or playing video games. Limit TV and computer use. Decrease schoolwork. Avoid any activities that require attention or concentration.
Physical rest: Avoid any physical activity that exacerbates symptoms (e.g., aerobic exercise, lifting weights, household chores, sexual activity). Image the patient if there is a severe or worsening headache, persistent vomiting, or seizures.
Medications / Interventions: Medication choices and interventions are the same for those without concussions. Wear sunglasses for photophobia. Wear earplugs or noise canceling headphones for phonophobia. Take medications to alleviate specific symptoms (e.g., NSAIDs, acetaminophen, or amitriptyline for persistent headaches; sleep aids, anxiolytics, SSRIs for depressive symptoms). Avoid meds that may mask post-concussive symptoms. Avoid NSAIDs if there is a potential for intracranial bleeding.
Transition back to school: Work with school personnel to enable slow integration. Consider forgiving missed assignments, giving more time to complete tests and schoolwork, giving standard breaks and rest periods as needed, decreased school work, distraction-free work areas, and a note taker.
No standardized testing during the recovery period.
Monitor carefully for 2 to 3 months after concussion for scholastic difficulties
Graded return to play: When the patient is symptom-free and medication-free, go through a graded return to play protocol.
Each of the following steps should take 24 hours:
- Nonimpact aerobic exercise
- Sport-specific exercise (nonimpact drills)
- Non-contact training drills
- Full contact practice
- Return to normal play
“Patient must be symptom-free and medication-free before starting return-to- play protocol. If any symptoms develop, activity should be stopped immediately; 24 hours after symptoms resolve, protocol may resume at the last step for which the athlete was asymptomatic.”
http://www.aafp.org/afp/2012/0115/p123.html