RETURN
RETURN TO
STUDY/WORK
STUDY/WORK
RETURN TO
SPORT
SPORT
SPORT
GUIDELINES
GUIDELINES
EMERGENCY
CONTACTS
CONTACTS
RETURN TO STUDY/WORK
RESTING THE BRAIN
To avoid exposing the recovering brain to excessive cognitive activity a student/employee may benefit from a phased return to school work/university studies/employment.
Following a concussion some people find they have a reduced attention span and difficulty processing information. Some may find that tasks involving even low-levels of concentration, can make their symptoms worse. During this recovery-period the student may need some accommodations made to their “normal” workload.
Upon return to school/college/work it is important to emphasize to pupils, parents and teachers that the goal for the student is not to “catch up” but rather ensure that he/she can tolerate the school environment.
The speed of progression back to normal work is extremely variable and individual, with rate of progression determined by symptoms. Some individuals may require modifications to their day and others may not. The graphic below gives some suggestions on how to progress through a ‘return-to-study’ process. Some may be able to bypass this entirely or slot in at later stages.
When attempting to return to school or employment following a concussion, difficulties may be encountered with concentration and memory, fatigue and sleep, and with emotions. Each section details helpful modifications that can be made if these problems occur.
PROBLEMS THINKING/REMEMBERING
If the individual is experiencing difficulty thinking clearly, concentrating or feeling slowed down, consider the following actions:
Decrease assignments/homework
Allow extra time for assignments
Provide written instructions
Demonstrate understanding verbally rather than in writing
Consider using a computer/recorder to take notes
FATIGUE/SLEEP
If the individual is experiencing tiredness, no energy, headaches and dizziness, consider the following actions:
Allow time to see school nurse
Provide rest breaks
Allow extra time to travel between classes
If sensitive to light pull blinds/allow sunglasses
Don’t replace PE with extra work
EMOTIONAL
If the individual is experiencing feelings of sadness, irritability or anxiety, consider the following actions:
Provide someone to discuss issues with
Provide a quiet place if individual is feeling overwhelmed
Maintain social activities and interactions
GRADUATED RETURN-TO-SCHOOL STRATEGY
This is a 4-stage process to return to full-time school work (Berlin Concussion Consensus Statement 2016). The rate of progression through each stage is highly variable and individual, with some people able to return to school immediately without needing accommodations and others requiring a more prolonged period.
| Stage | Aim | Activity | Goal of each step |
|---|---|---|---|
| 1 | Daily activities that do not give the child symptoms | Typical activities of the child during the day as long as they do not increase symptoms (e.g. reading, texting, screen time). Start with 5-15 minutes at a time and gradually build up | Gradual return to typical activities |
| 2 | School activities | Homework, reading or other cognitive activities outside of the classroom | Increase tolerance to cognitive work |
| 3 | Return to school part-time | Gradual introduction of schoolwork. May need to start with a partial school day or with increased breaks during the day | Increase academic activities |
| 4 | Return to school full time | Gradually progress school activities until a full day can be tolerated | Return to full academic activities and catch up on missed work |
A complete return to school work should be made before attempting to return to sport.
RETURN TO SPORT
RESTING THE BODY
Once a full return to study/employment has been made – the athlete should begin a graduated ‘return-to-sport strategy’.
Check to see if your sport has its own specific guidelines for returning to play.
Having observed the recommended rest period for a specific sport and when symptom free, athletes/players should work through a 6-stage process of gradually increasing exercise/skill intensity before returning to play.
A suitably qualified health professional can guide you through this strategy.
The ‘return-to-sport strategy’ has 6 steps where the final step is a full return to competitive sport. Adults should take at least 1 day between each step progressing only if symptom free, whereas athletes/players under the age of 20 should take at least 2 days between each step.
If any concussion symptoms occur while in the stepwise programme, then the athlete should rest until symptoms settle. The following day (once the athlete/player is symptom free again) the strategy should be commenced at the last stage where no symptoms were experienced and progressed as before from that stage.
This is the 6-stage return-to-sport strategy, which details activities and goals for progressing to the next stage (Berlin 2016 Concussion Consensus).
| Stage | Aim | Activity | Goal of each step |
|---|---|---|---|
| 1 | Symptom-limited activity | Daily activities that do not provoke symptoms | Gradual reintroduction of work/school activities |
| 2 | Light aerobic exercise | Walking or stationary cycling at slow to medium pace. No resistance training | Increase heart rate |
| 3 | Sport-specific exercise | Running or skating drills. No head impact activities | Add movement |
| 4 | Non-contact training drills | Harder training drills e.g. passing drills. May start progressive resistance training | Exercise, coordination and increased thinking |
| 5 | Full contact practice | Following medical clearance, participate in normal training activities | Restore confidence and assess functional skills by coaching staff |
| 6 | Return to sport | Normal game play |
Here are some practical examples on how this return-to-sport strategy can be applied to common sports.
| Stage | Aim | Boxing | Gaelic Football | Hockey |
|---|---|---|---|---|
| 1 | Symptom-limited activity | Normal activity/school work | Normal activity/school work | Normal activity/school work |
| 2 | Light aerobic exercise | Slow jog/ static cycle for 20mins | Slow jog/ static cycle for 20mins | Slow jog/ static cycle for 20mins |
| 3 | Sport-specific exercise | Boxer skipping/shadow boxing | Running drills on pitch | Running drills on pitch |
| 4 | Non-contact training drills | Punching bags/ strenuous exercise | Start weight training/ drills with ball | Passing drills |
| 5 | Full contact practice | Light sparring – full protective head gear | Small-sided game – normal play | Small-sided game – normal play |
| 6 | Return to sport | Full Sparring | Normal match play | Normal match play |
The Sports Concussion Assessment Tool – SCAT5 has been developed to aid qualified healthcare professionals in the diagnosis and management of concussion. It may be useful to print this off and take it with you to your doctor/school nurse/physiotherapist.
This website includes a form that provides a summary of your concussion symptoms, mechanism of injury and progression through to a full return-to-sport. It may be helpful for you and your doctor to complete this form as a record of your concussion and a summary of events/symptoms should onward specialist referral be required.
SPORT SPECIFIC GUIDELINES
Some sports offer specific guidelines for the period of rest required before undertaking a ‘return-to-play’ protocol and returning to competition. These may also vary according to the age of the player.
Where guidance exists specifically for a sport, or where a sport has its own recommendations, please follow the links provided.
FOOTBALL
GAA
RUGBY
BOXING
HORSE RIDING
HOCKEY
Please note this list may not be exhaustive and is based on the links that were available at the time of publication.
EMERGENCY CONTACTS
Royal Victoria Hospital
274 Grosvenor Road,
Belfast, BT12 6BA
Phone: 028 9063 2250
Children’s Hospital (Royal Site)
274 Grosvenor Road,
Belfast, BT12 6BA
Phone: 028 9063 3755
Mater Hospital
45-54 Crumlin Road,
Belfast, BT14 6AB
Phone: 028 9074 1211
Ulster Hospital
Upper Newtownards Road,
Dundonald, BT16 1RH
Phone: 028 9048 4511
Lagan Valley Hospital
39 Hillsborough Road,
Lisburn, BT28 1JP
Phone: 028 9266 5141
Downe Hospital
2 Struell Wells Road,
Downpatrick, BT30 6RL
Phone: 028 4461 3311
Antrim Area Hospital
Bush Road,
Antrim, BT41 2RL
Phone: 028 9442 6262
Causeway Hospital
4 Newbridge Road,
Coleraine, BT52 1HS
Phone: 028 7034 6086
Craigavon Area Hospital
69 Lurgan Road,
Portadown, BT63 5QQ
Phone: 028 3833 4444
Daisy Hill Hospital
5 Hospital Road,
Newry, BT35 8DR
Phone: 028 3083 5000
Altnagelvin Area Hospital
Glenshane Road,
Londonderry, BT47 6SB
Phone: 028 7134 5171
South West Acute Hospital
124 Irvinestown Road,
Enniskillen, BT74 6DN
Phone: 028 6638 2000
