Treatment and Management

Initial Management / Acute Concussion

​

Clinical Cornerstone:

• A comprehensive approach to managing concussion injury and any associated symptoms involves integrating education, self-care, conservative management, and specific interventions when necessary. This approach should be grounded in evidence-based practice, respectful of cultural nuances, and prioritize patient needs and values. It emphasizes professional collaboration and is continuously fine-tuned based on patient feedback and progress, ensuring a unified, empathetic, and efficient pathway.

• Clinical reason should be used to tailor clinical management to the patient’s individual needs and goals. Reassure patients that symptoms of mild concussions often improve within a month.

• In the event that a concussion is suspected in sport, immediate removal of the player from the field is indicated to avoid further potential injury.

Strategy Details

• Patient Education: Focus on patient understanding of the condition, implementing pain management strategies, and actively participating in the rehabilitation process. Clarify the biopsychosocial dimensions of pain, address underlying psychosocial factors, and underscore the importance of active participation in care and setting realistic expectations. Particularly for concussion patients, written/online information may be a valuable consideration to augment verbal information.

​

• Assurance regarding Light Activity: Education regarding early (24 to 48 hours post concussion) return to activity and the avoidance of arbitrary bed-rest. Clarify the importance of activity-to-tolerance/relative rest over bed-rest.
   

• Self-care: Minimize activities associated with a risk of sustaining a subsequent head injury, particularly during the initial management of a concussion. Monitoring for acute complications.
   

• Exercise: Introduce sub symptom-threshold aerobic exercise within 2 – 10 days. Address fear avoidance behaviours (hurt-vs-harm advice). Clarify the importance of activity-to-tolerance. Discuss incremental activity progressions and graduated return to exercise.
   

• Return to Work/School: Discuss incremental activity progressions and graduated return to work/school. Address fear avoidance behaviours (hurt-vs-harm advice). Return to work/school decisions should be made in the context of practitioner scope of practice and regional regulations.

  • Utilize techniques like Brief Action Planning to support self-management and promote regular movement and engagement in normal activities, including work. Incorporate strategies like goal setting/SMART goals.
     

• Return to Driving: Patients with concussion should be cautioned about driving within 24 hours post-injury. Consider and discuss the potential impact of any associated symptoms (fatigue/drowsiness, visual disturbances, auditory disturbances, slowed processing/cognition speed, dizziness, confusion, even anxiety/agitation/impulsiveness) on driving safety for the patient and for bystanders. Return to driving decisions should be made in the context of practitioner scope of practice and regional regulations.
   

• Return to Sport: Discuss incremental activity progressions and graduated return to exercise. Minimize activities associated with a risk of sustaining a subsequent head injury, particularly during the initial management of a concussion (e.g. minimize contact sports, promote mouthguard use in ice hockey). Consider the addition of neuromuscular training warm-up programs to help reduce risk of subsequent headache. Return to sport decisions are complex, and should be made in the context of practitioner scope of practice and regional regulations.