STEP 1:
Immediately after the incident, you should remain awake for two to three hours and be continually monitored. You should NOT DRIVE or be left alone as the onset of symptoms are not always immediate following the injury. After 3 hours, you may sleep for 2-3 hour increments. Someone should wake you every 3 hours and ask simple questions to ensure a more severe brain injury hasn't occurred. Signs of a more severe brain injury include:
- Severe headache with sudden onset
- Slurring
- Inability to be woken up
- Repeated vomiting
- Rapid deterioration of symptoms
Even if you feel fine, you should seek an appointment with your NUCCA practitioner or another health care professional that has experience with post-concussion management as soon as possible.
STEP 2:
Complete physical and cognitive REST is critical; rest in a dimly lit room with minimal stimulation. Absolutely no driving, screen time, reading, homework, excessive environmental stimulation or physical activity.
When you no longer exhibit symptoms for at least 24 hours, you can move on to the next step.
If, after 4-5 days, you are still symptomatic with complete rest, return to your NUCCA chiropractor for re-evaluation. The underlying neck injury needs to be assessed and addressed, and other exercises may facilitate the recovery; this should be monitored very carefully with your practitioner.
STEP 3:
You are now allowed to engage in light cognitive activity. You should still be resting for the majority of the day, but you can attempt to read a book or do homework for a maximum of 30-45 minutes/day in total. If symptoms occur during or in close proximity to the cognitive activity, this is considered a failed step and you need to go back to Step 2 for a minimum of 24 hours. If no symptoms occur during the light activity, the following day you can proceed to Step 4.
STEP 4:
You are now ready for a half-day of work or school to reacclimatize yourself to the environment. You may sit and observe, but no tests, physical activity, manual labour, driving or heavy equipment usage. If any symptoms arise while at school, work or later in the day, return to Step 3 for the following 24 hours. If no symptoms occur, progress to Step 5 the next day.
STEP 5:
This step involves precisely the same recommendations as Step 4, but you may attend work or school for the full day with restrictions. Some accommodations should still be made during this step; these include allowing for frequent breaks, no tests or intense thinking, have another student take notes, engage in 50-70% of your normal workload, avoid over-stimulating environments, crowds, loud noises, or jostling in crowded hallway. If any symptoms occur, return to Step 4. If no symptoms occur, you may proceed to Step 6.
STEP 6:
Slowly start removing restrictions and prepare for a full return to school or work as tolerated. It is recommended that you lift one restriction per 24-hour period, and once again, if no symptoms occur, continue to lift one restriction until a full return can be tolerated.
STEP 7:
You are now ready for a full return to work or school with no restrictions. Driving is permitted, but physical activity should be kept to light walking or gentle range of motion exercises until you have fully reintegrated your normal daily activities. At this stage, another evaluation should be done by your NUCCA chiropractor to begin the process of returning to full physical activity or sports. For more information about your concussion and recovery, contact our office and one of our NUCCA practitioners would be happy to assist with your concussion management.
Do you still have questions regarding the management of a concussion? Visit the FAQs to learn more or send us a message, we'd happily answer your questions.
