How do I get back to sport/play? Criteria Toward Clearance
While 70% of concussions will resolve WITHIN 28 days, it's not possible for a healthcare professional to predict the length of time or the course of recovery from a concussion. In fact, a healthcare professional should never tell a family that a concussion will resolve in X number of days, because every concussion is different and each recovery timeframe is unique. The best way to assess when a student/athlete is ready to start the step-wise process of “Returning to Sport/Play” is to ask these questions and make sure all these criteria are met:
Is the student/athlete 100% "back to baseline" symptoms at home?
- Use a Symptom Checklist (there is a Symptom Checklist in the REAP APPENDIX). All symptoms should be back to the pre-concussion “baseline” symptom level (the student does not need to have "zero" symptoms; they need to be back to baseline symptoms).
- Look at what the student is doing. At home, your child should be acting the way they did before the concussion, doing chores, interacting normally with friends and family.
- Symptoms should not return when the child/teen is exposed to the loud, busy environment of home/
social, mall or restaurants.
Is the student 100% "back to baseline" symptoms at school?
- The student should be handling school work at the same level as before the concussion.
- Use the Teacher Feedback Form (there is a Teacher Feedback Form in the REAP APPENDIX) to see what teachers are noticing.
- Watch the student doing school work; they should be able to complete homework the same as they did before the concussion.
- In-school tests and school workload should be where they were pre-concussion; academic "adjustments" should be generously provided in the beginning of a concussions and weaned back as soon as they are no longer needed (no medical input needed to add in more academic work). However, not all make-up work needs to have been made up prior to clearance of the concussion.
- Symptoms should not return when the student is exposed to the loud, busy environment of school.
Academic adjustments can be happening simultaneous to the Graduated Return to Sport/Play steps 1, 2 and 3 but all the academic criteria mentioned above must be met PRIOR to a HCP approving the start of the Graduated Return to Sport/Play steps 4, 5 and 6.
If the school or HCP has used neurocognitive testing, are scores "back to baseline" or at least reflect normative average and/or historical baseline functioning?
If an athletic trainer (AT), physical therapist (PT) or occupational therapist (OT) is involved in the concussion rehabilitation, does the AT, PT or OT feel that the student has reached his/her objective goals and been discharged from any therapies?
If the student has been visiting with the school nurse/health tech/AT weekly, are symptoms "back to (historic report of) baseline"?
Have student-initiated visits to the school clinic for symptoms ceased?
- Perform serial administrations of the Symptom Checklist
Is the student off all medications used to treat the concussion?
- This includes over-the-counter medications such as ibuprofen, naproxen and acetaminophen, which may have been used to treat headache or pain.
If the answer to any of the questions is "NO," stay the course with management and continue to repeat:
REA Framework Diagram
- R - Remove/Reduce (Blue Circle)
- REMOVE physical activity
- REDUCE home and cognitive demands
- E - Educate (Purple Circle)
- EDUCATE: Let the symptoms direct the interventions
- A - Adjust/Accommodate (Green Circle)
- ADJUST/ACCOMMODATE: home/social and school activities
The diagram shows three overlapping circles (blue, purple, and green) representing the REA framework components working together.
... for however long it takes for the brain cells to heal!
The true test of recovery is to notice a steady decrease in symptoms while noticing a steady increase in the ability to handle more rigorous home, social and school demands.
PARENTS and TEACHERS – try to add in more home/social and school activities to test out those brain cells. It is safe to test out the recovery of the brain cells by allowing your child to go to a movie or allowing your student to attempt a quiz. You do not need to wait until a child/student has been “medically” cleared back to sport before you start adding back in home and school expectations. In fact, getting all the way back to pre-concussion home and school demands MUST come before the approval to even start the Graduated Return to Sport/Play steps. So try it!
Once the answers to the questions above are all “YES,” turn the page to the PACE page to see what to do next!