Today, concussions are one of the hottest topics of conversation in sports and fitness. Research studies continue to come out with new and improved guidelines for prevention, rehabilitation and diagnoses of concussions. The media has engaged in endless documentaries, movies and shows advertising to the public key messages that health care professionals are trying to get across. While most parents and coaches understand the importance of physical rest following a concussion, many are still out of the loop on the importance of cognitive rest. Cognitive rest is loosely defined as the cessation of activities that stimulates your brain. For the first 24-48 hours following a concussion, this is critical.
Health Care professionals typically advise the child or parent to go home, rest and if symptoms progress to go to the hospital. Many of us lack the ability to, quite literally, do nothing for an entire day. With TV, cellphones, inability to take time off work/school and our need to be doing something at all times, this creates a recipe for disaster when trying to recover from a concussion. This is one of the reasons why concussion sufferers under the age of 25 are often sent through a two week program, as opposed to the typical seven-day rehab. The first week, an often overlooked or not prescribed portion of the rehabilitation, is the Return to Learn (RTL). Most concussion protocols the media report on are from sports athletes who can return in 6-10 days typically. For a child, this extra week of return to mental activity, followed by a week of physical activity is believed to be crucial for long term health of the sufferer. It is also vital because it is believed that children who incur a brain injury are twice as likely as other children to have a second brain injury within six months, so we must ensure that they are fully healed.
Return to Learn Protocol (CTSQ, 2014)
NOTE: The RTL approach consists of 6 stages that should be separated by a minimum of 24 hours without symptoms before proceeding to the next step. Furthermore, throughout this process, there should be no physical activity. If there are symptoms, you do not progress to the next step and wait 24 hours to complete that same step again.
Step 1 = Cognitive rest
-no reading, homework, computer, video games or smartphone
Step 2 = Gradual reintroduction of cognitive activity
-Gradually integrate cognitive activities for short periods of time
Step 3 = Homework before school attendance
-Able to perform homework
-When the student is beginning to react well to 30 minutes of light mental
activity, consider returning to school
Step 4 = School re-entry
-Partial day of school attendance, homework
Step 5 = Reintegration into school
-increase to full day of school
Step 6 = Return to learn, full cognitive workload
-Return to school, including tests and exams, catch-up work, etc
Return to Play Protocol Initiated
What does this mean for parents?
If your kid is still going to school, but they stopped playing their hockey or basketball for the week, you have only done half the job. RTL and Return to Play (RTP) are both part of the rehabilitation process for youth and modifications to their school and sport lifestyle should be made.
Article Written By: Steven Warsh
B.SC KIN, B.SC SPECIALIZATION AT
Corporation des Thérapeutes du Sport du Québec (CTSQ). 2014. Concussion Management Guidelines for Certified Athletic Therapists in Quebec. Montreal, Quebec. http://www.academiedelathlete.ca/wp-content/uploads/2014/04/CTSQ-FINAL-ENGLISH.pdf