FROM MY PT SCHOOL NOTES · NEUROLOGY · UNIT 4 · CHAPTER 15
How should concussion symptoms and return to activity be managed?
Concussion care requires recognition of urgent danger signs, individualized assessment and a graduated return to usual activities. Persistent symptoms are multifactorial; one symptom or screen does not define the entire diagnosis.
Understand the clinical picture
Screen for medical danger before rehabilitation
A suspected concussion after a blow or jolt warrants prompt appropriate medical evaluation and protection from further head impact. Emergency signs include worsening severe headache, repeated vomiting, seizure, new weakness/numbness, worsening confusion, unequal pupils, slurred speech or difficulty awakening. Follow emergency procedures rather than completing exertion or vestibular testing.
The CDC’s current warning-sign guidance helps distinguish routine symptom monitoring from urgent escalation. Routine imaging may be normal in concussion; imaging is determined by medical decision rules and possible concern for more serious injury.
Think across symptom domains
Symptoms may involve headache/migraine, cervical pain, dizziness, balance, ocular tracking, light/noise sensitivity, exercise intolerance, attention, sleep and emotional health. No single finding proves a specific ‘concussion subtype.’
A focused examination can include neurologic and cervical screening, balance/gait, symptom response to safe exertion, vestibular and oculomotor assessment when indicated. VOMS is a symptom-provocation screening tool, not a stand-alone concussion diagnostic test; it can suggest reasons for additional assessment or referral. Avoid copying an original proprietary/attributed test sheet into the commercial notes.
Relative rest, then graded activity
The 2023 Amsterdam concussion consensus advises about 24–48 hours of relative, not strict, rest, while allowing basic daily activity and short, tolerable walks. Prolonged strict rest or isolation until all symptoms disappear is not recommended. Graduated low-risk aerobic activity can begin as tolerated with appropriate clinical oversight, and symptoms inform pacing.
Return to school/work and sport are not identical. Return to learning often begins relatively early with symptom-based accommodations. Return to sport uses a supervised stepwise process and appropriate medical clearance before activities at risk of another head impact; no same-day return after suspected sport-related concussion.
Know when specialist rehabilitation may help
For persistent dizziness, neck symptoms, headache or exercise intolerance, assess whether vestibular, cervical, exertional and other contributors warrant individualized targeted rehabilitation. Symptoms that are worsening or not resolving as expected—often around 2–4 weeks—merit reassessment and possibly specialist referral.
Treatment decisions should be based on clinical findings and tolerance, not automatically assigning every symptomatic patient the same vestibular exercises or prescribing unrestricted exertion.
Quick reference
| Immediately | Recognize danger signs and avoid further injury or risky activities |
| First 24–48 hours | Relative rest, basic daily activity and brief tolerable movement |
| As tolerated | Gradual return to school/work and supervised low-risk physical activity |
| Before contact or collision sport | Medical authorization and completion of a staged return-to-sport process |
What changes for PT?
For a person with dizziness after concussion, prioritize safety and identify whether cervical, vestibular, visual, exertional, headache or medical factors are contributing. Document what provokes symptoms and what a task requires. Avoid making a diagnosis from symptom severity alone.
Clinical reasoning case
A student athlete three days after concussion can walk 10 minutes with a mild, brief increase in symptoms but experiences dizziness while reading and turning their head. Should they be told to remain in a dark room without activity until all symptoms disappear?
Reasoning: No. Following medical assessment, use individualized relative activity, education and graded return to learning, with targeted evaluation of ocular/vestibular/cervical complaints and referral when appropriate. High-risk sport remains restricted until properly cleared.
Check your understanding
Why can return to school begin before an athlete is cleared for unrestricted sport?
Original uploaded sources: Concussion .pdf (2019 lecture); VOMS .pdf; Headache.pdf; Vision Therapy.pdf (older lecture material). Historical note: The original 2019 concussion lecture predates the 2023 Amsterdam consensus and newer CDC guidance. Compare with your own notes and current research, especially regarding rest, aerobic activity and graded return. These are independently organized PT-school companion lessons, not individualized medical care or emergency instructions.
