Lingering Concussion Symptoms

Lingering Concussion Symptoms

The initial treatment for a concussion is rest — both mental and physical. It is important to allow for sufficient brain rest so that the brain is able to heal. For specific instructions on what your child can and cannot do while rest is prescribed, review the Return to Learn program.

Most children who suffer concussions will heal spontaneously, within one month of their injury. However, about 20 percent of children will go on to suffer symptoms for an extended period of time — beyond one month.

If concussed patients overexert themselves immediately after their injury, they are often more at risk of having prolonged recovery times.

While research has demonstrated that rest immediately after a concussion can help the brain recover from injury, research has also shown that resting too long after a concussion can get in the way of recovery.

  • Q&A About Prolonged Recovery After a Concussion

    Parent: How much rest is too much rest?

    Christina L. Master, MD: Rest is the most important treatment for a concussion.

    Matthew Grady, MD: At some point in time, rest becomes too much rest. In our adolescent populations, we advocate rest for only a few weeks at the most, depending on the severity of the injury. If an individual can be back in school in two or three days, that's ideal. If the injury is more severe, it may take them more than a few weeks to get back to full school.

    In a subset of patients who have prolonged symptoms, usually about 10 percent of adolescent concussions, rest is no longer a benefit for them. And so, as a general guideline, after the three- to four-week mark, we're going to have individuals do activities, regardless of symptoms. And at that point, we're thinking of this more as rehab rather than as a rest for spontaneous recovery.

    In general, schoolwork functions as cognitive rehabilitation, and so we like to get students into schoolwork as quickly as possible during the rehabilitation phase. In individuals with prolonged symptoms, who are unable to do schoolwork, then occasionally we have to do additional therapies. At that point, speech therapy, which specifically works on memory, is one of the additional therapies we may add. For individuals with eye tracking problems that do not respond to this particular therapy, occasionally we'll add vision therapy.

    In individuals with prolonged concussions, mood disorders are common. In general, we'll look for mood disorders for people with prolonged concussion symptoms. If they have mood disorders, then they will be referred to the appropriate specialist. However, we do know that allowing people to be physically active and doing aerobic activity and getting them back to school sooner reduce the number of mood symptoms that we see, and so we like to keep them as active as possible during the rehab phase.
Transcript Transcript

Symptoms beyond one month

Typically, if symptoms last longer than one month, your child will require active rehabilitation to aid in their recovery. Common symptoms that seem to linger include:

  • Vestibular system deficits (brain’s ability to visually track and focus and maintain balance)
  • Exercise continues to induce physical symptoms (headache, nausea)
  • Cognitive deficits (memory issues, attention deficits and challenges in problem solving)
  • Alterations in mood (irritability, sadness and depression)

If these symptoms persist, they can affect school performance and hinder interactions with family and friends.

A thorough evaluation by your child’s healthcare team will determine what specific deficits are causing lingering symptoms so that an appropriate treatment plan can then be made. Specific rehabilitation therapies for concussion with persistent symptoms beyond one month include:

  • Vestibular therapy with balance and eye movement exercises
  • Aerobic rehabilitation to increase tolerance for exercise
  • Vision therapy may help improve visual stamina for certain children who have specific visual problems after concussion 

Sadness and depression

If your child suffers from alterations in mood, such as sadness, depression and/or personality changes, it is important to understand that these feelings are very common when someone is suffering the long-term effects of a brain injury. These feelings can be especially pronounced in adolescents.

Parents and caregivers should pay close attention to changes in mood and discuss with the child’s healthcare team ways to support patients through counseling, therapy or support groups, such as the REACH program at CHOP.

Visit After the Injury to learn more.