Concussion 5 Rs

Recognise – signs and symptoms

Remove - from work or play

Refer – to GP or medical professional

Rest – first 24-48 hours

Recover – gradual return to normal activity

*Sports: 21 days before full return to play.

Recognise

Concussion Signs and Symptoms

Concussion signs and symptoms are what someone could observe about you to determine if you have a concussion. These signs and symptoms are the brain’s response to the damage it has experienced.

Some immediate signs that a person has sustained a concussion include:

  • Appears dazed
  • Confused
  • Poor balance and lack of coordination
  • Answers questions slowly
  • Runs in the wrong direction
  • Forgets events that occurred before and after impact
  • Loses consciousness – but it is important to remember that a person can sustain a concussion without losing consciousness

A person may complain of:

  • Headache
  • Nausea and vomiting
  • Double or blurred vision
  • Confusion
  • Fatigue
  • Poor concentration
  • Memory problems
  • Sleep difficulties
  • Irritability
  • Sensitivity to noise and light
  • Ringing in ears

Warning Signs

If you have any of the following symptoms or your symptoms continue to worsen, go to your nearest hospital, medical centre or call Healthline on 0800 611 116.

  • Fainting
  • Seizure
  • Feeling extremely tired
  • Loss of balance or clumsiness
  • A headache that gets worse or is severe
  • Repeated vomiting
  • Feeling confused or agitated
  • Differences in your vision (trouble seeing)
  • Slurred speech
  • Feeling weak or numb

If in doubt, check it out!

Remove

If a concussion is suspected, remove yourself from the environment – the field of play or the work environment.

This is to avoid the risk of further knocks to the head and putting your brain under undue stress and pressure.

Refer

If In Doubt, Check it out!

Research shows that the right concussion advice and support leads to better outcomes and better recovery.

Make an appointment with your GP or medical professional is you suspect a concussion.

If you can’t get a nurse or doctor, or if you’re concerned about something call Healthline on 0800 611 116.

Health line is a free over-the-phone health service available 24 hours a day, 7 days a week.

 

How are concussions diagnosed?

Recognising the signs and symptoms of a concussion is crucial since concussions do not appear on imaging tests such as X-rays, CT scans, or MRIs. Additionally, there are no objective tests, like blood or saliva tests, that can confirm a concussion.

A doctor diagnoses a concussion through a thorough examination that involves observing signs of a concussion and gathering reports of symptoms from the patient following an impact to the head or body. These signs and symptoms indicate that the brain is injured and not functioning as it should.

These signs can vary from obvious to subtle, but even a single sign following a head injury should be reported to a medical professional.

 

Remember that you do not need to be knocked unconscious to experience a concussion. Symptoms can also develop over time, and everyone can experience different symptoms.

 

In New Zealand, GPs and some physios use the BIST (Brain Injury Screening Tool) to help them assess and manage a suspected concussion. This tool looks at physical, vestibular and cognitive symptoms experienced after the injury.

Rest

First 24 – 48 hours: Monitor and Rest

Rest your brain so it can heal.

The first step to recovery is to rest your brain so that it can heal. Rest for 24 – 28 hours depending on your symptoms.

 

Just like an injured muscle, an injured brain needs the chance to rest, recover, and then rebuild its strength.

Resting your brain does not need to be bed rest but demand on your brain should be reduced to ensure it has the energy to heal.

Choose your activities carefully to lighten to the load on your brain such as:

  • A gentle walk eg. 10 –15 mins.
  • Light everyday tasks – break tasks into small 10-minute bites
  • Avoid screentime as this is hard work for a healing brain
  • Reduce sound and visual stimulation
  • Do things slowly and rest to let your brain heal.
  • Stay connected with friends and family eg. Short phone calls

General Advice

SLEEP You may find you need to sleep more. This is a time when the brain can repair and restore itself. If taking a daytime nap, it is best to take one either late morning or early afternoon (for 20-30 minutes) so you don’t affect your night-time sleep patterns.

WORK AND STUDY You are likely to need a minimum of two days off work or school. Beyond that your healthcare provider will provide appropriate guidance.

DRIVING You should not drive for at least 48 hours after a concussion. You should not return to driving until any symptoms of dizziness have gone away, your concentration is good and sustained, you can react quickly to unexpected hazards, and your ability to judge distances is normal.

ALCOHOL AND RECREATIONAL DRUGS You should avoid alcohol, caffeine/energy drinks, and other recreational drugs until your symptoms are better. The brain can’t deal with these substances as well when it is injured. They can make your symptoms worse and slow down recovery.

TRAVEL If possible, you should avoid air travel for the next 24-48 hours.

PAIN RELIEF Use paracetamol or Panadol for headaches. Anti-Inflammatory pain relief such as ibuprofen, Naproxen, Voltaren (Diclofenac) or Nurofen (NSAIDs) may be used 48 hours after injury as advised by your healthcare practitioner for muscle pain or headaches.

Recover

After 24 – 48 Hours: Gradual Return to Normal

Just like a muscle, the brain needs to be worked to get stronger. Do this gently and gradually. Everyone recovers at different rates and has different symptoms so listen to your body.

Remember: Staying in a dark room is proven to negatively impact your recovery.

Rebuilding your brain’s energy and strength

Research has shown that people who do too much too soon AND those who do too little are slower to recover.

To understand how various activities impact you, rate your symptoms on a scale from 0 to 10.

  • Begin with short sessions of mental and physical activities, around 10-15 minutes, and gradually increase the duration and intensity. Use your symptom scores as a guide.
  • If an activity raises your symptom score by three points or more, it’s a sign you’ve overdone it.
  • Stop the activity and, when you try again, reduce your time (for example, finish 10 minutes earlier).
  • If the increase is less than three points, you can gradually extend the duration of that activity.

Remember:

  • resting and scaling back on activities are crucial for your brain's recovery.
  • Avoid pushing yourself too hard too quickly and be sure to take regular breaks.

 

Recovery scale info and examples

Concussion Information Kit

Concussion Advice and Support for Best Recovery

The Concussion Learning, Implementing and Recovery Tool (CLARITY) is an educational resource for those recovering from a concussion/mild traumatic brain injury. It is designed by clinicians and researchers working in concussion, with feedback from those with lived experience. 

Finally,

One of the most important things you can do during your concussion recovery is to maintain a positive attitude.

While it can be frustrating and challenging at times, having a positive mindset can help support your healing process.