Concussion Basics The CDC estimates that there are 1.6-3.8 million concussions each year in the United States that resulted from sports or recreation injuries. Because concussions can have long-term health effects, it is imperative to identify and treat concussion immediately. Patients may need support in returning to school or work after a concussion, and athletes need guidance for how to safely return to play after they are fully recovered. Many patients benefit from working with skilled professionals to treat their symptoms and assist them in navigating their recovery so they can return to their life roles.  Saint Alphonsus Rehabilitation Services (STARS) offers a comprehensive concussion management program – from evaluations and testing to physical therapy, cognitive therapy and more. If you would like to discuss concussion symptoms, please contact: Kathy Smith – Neurological Case Manager at the Concussion Clinic: (208) 367-8962.

If you or your loved one needs immediate attention, please contact your local Emergency Department or your primary care physician.

Two of our Sports Medicine Providers, Dr. Jennifer Southard and Dr. Derek Kunz  are available to evaluate your concussion and to provide ongoing medical management. These professionals have additional concussion specialty training so you can be confident you are getting the best care.  Some clinics reserve spots for new concussion patients so accessing medical services is easy and quick.

Return to Learn Protocol

The Speech-Language Pathologist will provide direction for advancing through the levels. The patient must complete the full Return to Learn protocol before the Return to Play protocol can be initiated. The goal is to progress through the levels while maintaining a sub-symptom threshold as much as possible. Sub-symptom threshold – keeping cognitive activity below the level that triggers symptoms, such as headache, fatigue or other post-concussive symptoms.

Stage	Activity	Objective
1. No activity	Complete cognitive rest – no school, no homework, no reading, no texting, no video games, no computer work.	Recovery.
2. Gradual reintroduction of cognitive activity	Relax previous restrictions on activities, adding them back for short periods of time (5-15 minutes at a time).	Gradual controlled increase in sub-symptom threshold cognitive activities.
3. Homework at home before school work at school	Homework in longer increments (20-30 minutes at a time).	Increase cognitive stamina by repetition of short periods of self-paced cognitive activities.
4. School re-entry	Part day of school after tolerating 1-2 cumulative hours of homework at home.	Re-entry into school with accommodations to permit controlled sub-symptom threshold increase in cognitive load.
5. Gradual reintegration into school	Increase to full day of school.	Accommodations decrease as cognitive stamina improves.
6. Resumption of full cognitive workload	Introduce testing, catch up with essential work.	Full return to school. May commence Return-to-Play protocol.

      Source: Master CL, Gioia GA, Leddy JJ, Grady MF.

Return to Play Protocol

The patient should not return to athletics until allowed to do so by a physician experienced in the management of concussion.  The return to athletics should be gradual, should be monitored by a physician, and should proceed in a step-wise fashion as outlined below. The patient must be at each level for 24 hours without symptoms. If any post-concussion symptoms occur, the patient should drop back to the previous asymptomatic level and try to progress again after another 24-hour period has passed.

Stage	Activity	Objective
1. No activity	Symptom limited physical and cognitive rest.	Recovery.
2. Light aerobic exercise	Walking, swimming or stationary cycling keeping intensity <70% of maximum predicted heart rate.  No resistance training.	Increase heart rate.
3. Sport-specific exercise	Sport-specific exercise such as running drills.  No head impact activities.	Add movement.
4. Non-contact training drills	Progression to more complex training drills.  May start progressive resistance training.	Exercise, coordination and cognitive load.
5. Full-contact practice	Following medical clearance, participate in normal training activities.	Restore confidence and assess of functional skills by coaching staff.
6. Return to play	Normal game play.

Source: Adapted from Consensus Statement on Concussion in Sport 4^th International Conference on Concussion in Sport held in Zurich, November 2012. You can also learn more below: