REAP suggests the following timeframe
Family Team*
Help child understand he/she must be a "honest partner" in the rating of symptoms
- Impose rest – healthcare provider-guided rest, if a HCP is involved.
- Check in on symptoms periodically – especially monitor sleep/energy and emotional symptoms.
- Return child to school, communicate with school RN/health tech/teacher so the school can help student manage symptoms and provide academic supports.
- Continue to check in on symptoms weekly, monitor if symptoms are improving.
- Continue to check in on symptoms and increase/decrease stimulation at home accordingly.
- Continue to check in on symptoms weekly.
- Continue to check in on symptoms and increase/decrease stimulation at home accordingly.
School Team / Physical
Coach/AT/School Nurse
(Assign 1 point person to oversee / manage physical symptoms)
- REMOVE from high risk physical play at recess/ PE and any physical activity that risks further injury to the brain/head to prevent Second Impact Syndrome.
- Assess physical symptoms weekly, use objective rating scale.
- Monitor visits to school clinic. If symptoms at school are significant, contact parents to coordinate a plan of action.
- A school that uses an electronic concussion flag system may put the flag up.
- Continue to assess symptoms weekly.
- School Nurse: Continue to monitor visits to school clinic. Work with student to manage symptoms by taking "pacing" and "strategic rest" breaks so student can be at school daily for full days. See ADJUST/ACCOMMODATE section.
- Continue with all assessments weekly.
- School Nurse: Continue to monitor visits to school clinic. Work with student to manage symptoms by taking "pacing" and "strategic rest" breaks so student can be at school daily for full days. See ADJUST/ACCOMMODATE section.
- Once a concussion has been "cleared", schools
that use an electronic concussion flag system can
put down the flag.
School Team / Academic
Teachers, School Psychologist, Counselor, Social Worker, School Nurse
(Assign 1 point person to oversee and manage academic and emotional symptoms)
- REDUCE (do not eliminate) all cognitive demands.
- Meet with student to create academic adjustments for cognitive/emotional reduction.
- Educate all teachers on the symptoms of concussion.
- See ADJUST/ACCOMMODATE section.
- Continue to evaluate symptoms weekly and slowly increase/decrease cognitive and academic demands accordingly.
- Continue academic adjustments, as needed.
- Monitor for downstream emotional (depression/anxiety) sequelae
- Continue to evaluate symptoms weekly and increase/decrease cognitive and academic demands accordingly.
- Continue academic adjustments, as needed.
- Assess if longer term academic accommodations are needed (may need to consider a 504 Plan beyond 4+ weeks).
- Continue to monitor for emotional (depression/anxiety) sequelae
Healthcare Provider Team
MD / DO / NP / PA / AT / PT / OT / SLP
- Assess and diagnose concussion.
- Assess for head injury complications, which may require additional evaluation and management.
- Recommend return to school with academic adjustments once symptoms are improving and tolerable, typically within 48 to 72 hours. Do NOT hold students out of school until they are totally "symptom-free."
- Educate student/athlete and family on the typical course of concussion and the need for rest with gradual re-integration of "activity" (school, home and social stimulation, light cardio exercise under the supervision of HCP, outpatient PT and/or parent).
- Monitor that symptoms are improving throughout Week 1 – not worsening in the first 48 to 72 hours.
- Continue to consult with school and family teams.
- Follow-up medical check including: comprehensive history, neurologic exam, detailed assessment of mental status, cognitive function, gait and balance.
Schools have increasing levels of support for students who struggle academically. Allow schools to go through their process; do not write prescriptions for 504 Plans or IEPs. See SPECIAL CONSIDERATIONS.
- Continue to consult with school and home teams.
- Consider referral to a Specialty Concussion Clinic if symptoms are especially problematic
or long. - It is best practice that a medical professional be involved in the management of each and every concussion, not just those covered by legislation.
*Family should sign a Release of Information so that School Team and HCP Team can communicate with each other as soon as possible.
Don’t be alarmed by symptoms – symptoms are the hallmark of concussion. The goal is to watch for a slow and steady improvement in symptoms over weeks.
It is typical for symptoms to be present for up to three to four weeks.
If symptoms persist at Week 4+, see SPECIAL CONSIDERATIONS.