Less than 3 weeks to first day of college and she has a concussion!

Parents Forum
1

I am keeping her super quiet (she is not happy), but it is so much more important that she heal quickly and I have read that trying to do too much too soon can delay recovery time by 500%.

On Saturday she was hit in the back of the head by a falling product shelf (with heavy items on it) at work. She works in a small hardware store. We suspected a concussion several hours later (ER said inconclusive) but Monday I took her to the pediatrician and she agreed yes concussion.

Friday we are going to Children’s of Philadelphia (she is still 17) to see a specialist. She is feeling much better but I still think she needs to rest as much as possible so she can heal as quickly as possible. The timing! OMG

2

Oh, poor kid! Best of luck to her, and to you.

3

Sounds like you are doing everything right for her. Hope she is back to 100% before she heads to college. If there are any lingering effects, you should alert the Health Department on campus.

4

As a parent who endured a couple of concussions during the school year, I understand your worry. Sending sympathy!

I’m going to guess she’ll be fine in 3 weeks, especially if she can rest. When you go to CHOP, make sure the doc gives her a list of dos and don’ts (including those that involve sleep, alcohol use, etc) as well as a list of warning signs that she may be pushing it and specific instructions on what to do if those occur.

Ime, concussion or not, your guidance on this will be heavily discounted while the advice of a medical professional might be valued and heeded, even if they are the same!

5

Listen to your doctor of course, but also check this out for current concussion management.

INITIAL STEPS

After an initial concussion the individual should subscribe to REST, not just physical rest, but COMPLETE and UTTER rest.

NO TV
NO Texting
NO Computers
NO Radio
NO Bright Lights
NO Loud Noises
NO Reading
COMPLETE brain rest, in other words, SLEEP!

SCHOOL AGED INDIVIDUALS

Rest should be continued until all signs and symptoms have resolved. Rest in this demographic should and would include exclusion from school. When trying to learn the brain is working, thus not resting. Even if the kid went to school the bright lights, the loud noises and the exercise the brain needs to just navigate the hallways is enough to impede progress in resolving this injury. As a reminder, it may be good to take the cell phone, computer and video game systems from the kids. They should return to school when all signs and symptoms have resolved.

RETURN TO ACTIVITY (including Physical Education)

Current graded return to play guidelines for athletes that have sustained a concussion. This particular model was adapted from the 3rd International Conference on Concussions held in Zürich in 2008, and I have since modified adding one step.

-No activity, only complete rest, proceed to step two only when symptoms are gone.
-Return to school/academics (1/2 day at first), again no moving on until a full day of school can be completed.
-Light aerobic exercise such as walking or stationary cycling. Monitor for symptoms and signs. No resistance training or weight lifting.
-Sport – specific activities and training (eg. skating in hockey). No contact or risk of contact.
-Drills without body contact. May add light resistance training and then progress to heavy weights. The time needed to progress from non-contact to contact exercise will vary with the severity of the concussion and player.
-Begin drills with body contact.
-Game play.
As stated above each step should be only attempted if there is NO signs or symptoms as they relate to the concussion.

It is also important to realize that a concussion or head injury, in general, will not resolve in a typical linear fashion. Meaning that “on day one you have this and by day 7 you should be here,” as is common with other general orthopedic injuries.

The head is mysterious and responds differently for each individual person. Set-backs will be common and should be expected. When they do occur you should regress to the previous step in this process and begin again.

The general rule of thumb is 24 hours at each phase.

Be mindful and remember that if you suspect a head injury/concussion that you should consult a medical professional, preferably one that has experience with concussions and return-to-play.

https://theconcussionblog.com/current-concussion-management/

6

Make sure to get documentation from the doctor to take to the school (Office for Disabilities or in some schools, a dean). She should get accommodations like extra time, reduced course load, even single room if still needed.

This may heal quickly.

Taking away all distractions can create anxiety which is also not good.

If she is not having trouble looking at screens or lights, that is a good sign. Headache, nausea are other signs.

If it hit her in the neck, there are many neurological receptors in the neck which, if affected, can cause dizziness and malaise. So consider that.

Imaging does not pick up concussion so no one can diagnose objectively. They have to go by history and symptoms.

7

I hope your DD gets well soon! Thanks to all the other posters for info on concussions. Fortunately we have not had to deal with one, but it is good to be prepared.

8

Don’t forget to file a worker’s comp claim. At a min they have to pay for medical bills.

9

^^although they might also require her to use their docs…

Worth checking out, but perhaps not the outcome you’d want.

10

@compmom each day she feels a bit better, she got hit on the back top of the head. She is still a tad sensitive to sound and is a bit light headed upon standing up from sitting/laying down. But the nausea is better and the headache. She said a little TV was okay but the commercials gave her a bit of a headache so she moved onto folding some clothing to pack in her go to college bag. Good idea on the note – I will get something from CHOP Friday.

11

@gpo613 we did file a claim; and I talked to the case manager. DD has a history of AVM and I used that to insist on the Children’s of Philadelphia doctor and they said OK

12

Sorry she has to deal with this during a transition. Best of luck to her!

13

If commercials give her a headache she should go back to no tv.
I would definitely contact the Dean of Students/Disability office and ask what they need to get accomodations for extra time if needed. She may possibly want to drop a class.

14

One of my kids had coil embolization for fistulas. Feel free to PM me. She has also had concussions.

It would seem that a knock on the top back of the head wouldn’t interact with the AVM but glad she is going to a good hospital for evaluation.

Young people heal well, in fact amazingly.

15

We have been through this. It can be a long road to recovery. If it is shorter and less frustrating, great. But our journey was long and bumpy.

Go ahead and register now with college disabilities office. If you don’t need accommodations, great, but better for student to have them in place.

16

Not to alarm you, but make sure your daughter herself knows that head injuries can cause problems many weeks after they occur and that she should be aware of how she’s feeling and not ignore symptoms for any reason, including thinking that they’re not related to the head injury.

17

I second that. Mine finally admitted to still having a constant low-level headache 9 weeks after her concussion. She needed another six weeks of PT to get her eyes back to working in concert.

18

As a mom to a daughter with a couple of concussions… please be so vigilant in following orders. You can not rush back or you can go all the way back to step one over and over. My daughter suffered a major concussion that a year and a half later still has some residual effects. She almost had to be taken out of school second half of senior because migraines, insomnia, speech issues, memory issues etc remained. They still sneak up time to time but thankfuthabkfully they are 95% under control. Tv, moving around too much, texting, all of that can be too much exertion during this recovery period. Praying for your daughter and you too!

19

PM’ed you

20

@bopper. “After an initial concussion the individual should subscribe to REST, not just physical rest, but COMPLETE and UTTER rest.

NO TV
NO Texting
NO Computers
NO Radio
NO Bright Lights
NO Loud Noises
NO Reading
COMPLETE brain rest, in other words, SLEEP!”

New studies are questioning some of that advice.

‘Broad restrictions on nearly all physical and cognitive activity following a concussion are not evidence-based and may result in iatrogenic harm to patients, according to a widely praised paper in the March 5 JAMA Neurology.

Recommendations for “total rest,” “cognitive rest” or “cocooning” became widespread as clinicians sought to avoid the risk of a second mild traumatic brain injury (mTBI) in a sports-related setting, according to the Viewpoint paper by researchers at the University of California, Los Angeles (UCLA) and the University of Queensland in Brisbane, Australia.

But, they wrote, the pendulum has swung too far, to the point where children and adults are being told to avoid routine mental activity ranging from reading or watching television to texting or checking email.

“The reality is that total restriction of brain activity is not ideal, even for an injured brain,” the paper states.

Yet such recommendations continue to be made by practitioners who do not specialize in the treatment of concussion, said one of the authors of the paper.

Amaal Starling, MD, assistant professor of neurology at the Mayo Clinic in Scottsdale, AZ, said she hoped that the paper might help to reduce the number of concussion patients referred to her clinic whose recovery has been impeded by recommendations for total rest… individuals had been prescribed cocoon therapy, and our multidisciplinary team is trying to undo the harm it caused and get these people back into life,” Dr. Starling told Neurology Today.“

Authors of another study noted that “People in the absolute rest phase after concussion often experience depression," “In the case of concussion, cutting people off from their social circle when we say ‘no screen time’ – particularly the young generation with their cell phones and iPads – they will just get more depressed and anxious. So maybe we need to rethink current rehabilitation strategy.”