Initial Steps for Concussion Recovery

What does “cognitive rest” mean?

According to the Centers for Disease Control and Prevention (CDC), rest and careful management of physical and cognitive exertion are the keys to recovery. Cognitive activity includes heavy concentration or focus, visual stress, memory, reasoning, reading or writing (e.g., texting, television, video games, computer use, homework, classwork, job-related activity).

Until a full recovery is achieved, your child or teen may need adjustments to home and school activities.


1.  First 24 – 48 hours after Injury: REST! 

  • Avoid activities that require concentration and attention. No school, work, driving, or outside-the-home activities, such as restaurants, shopping, movie theaters, sideline game attendance, group gatherings like church, etc.
  • Avoid visually stimulating activities. No texting, computer use, video games, watching TV, reading, or homework.
  • Avoid physical activities. No jogging, running, jumping, spinning, “horse play”, bike riding, skateboard, or other sports/physical activities.


  • Start with low volume audio activities (audio books, listening to music or TV), then add short periods of visual activity if it does nor trigger symptoms.
  • Add visual activities without screens first, like drawing, painting, crafts, Legos, model building, baking, and board games.
  • Then add visual activities with screens like TV, computer, iPad, and texting with dim screens and enlarged font.
  • Progress to adding short periods of reading and homework and gradually increase time spent on these activities as tolerated.
  • Add low-intensity aerobic exercise like walking outside, walking on a treadmill, riding a stationary bike, and stretching. Growing research suggests low-intensity safe exercise can help improve symptoms and decrease recovery time after concussion.

It is strongly recommended that individuals with a concussion refrain from any rotational/high velocity activities while recovering (and up to six months after clearance).
These activities include, but are not limited to:

  • Water tubing / boarding
  • Trampolines
  • Bungee jumping
  • Diving
  • Swinging / spinning
  • Skiing / snowboarding
  • Snow tubing / sledding
  • Amusement park rides
  • Any other activity that causes acceleration / deceleration or rotational motion to the head or neck


We now know that early return to school (with adjustments to decrease provoked symptoms) may help speed concussion recovery. Once the physician determines that it is safe for your child or teen to resume academic activities, adjustments may be recommended based on the patient’s exam to help them pace through the school day. It is important that the student and parent(s) discuss these recommended adjustments with the school nurse and/or guidance counselor before returning to classes to ensure the transition back to school is as smooth as possible. Examples of School Adjustments (which vary based on symptoms) may be:

  • Rest breaks as needed
  • Extra time to complete homework and tests
  • Reduced reading, enlarged font, or audio books
  • Avoidance of Smart Board or computer lab
  • Avoidance of noisy environments (lunchroom, group passage in halls, bus transportation)
  • Early passage in halls, etc.


Eat healthy meals three times per day.  Do not skip meals, as the brain needs energy to heal.  Low blood sugar may trigger headaches, so carry healthy snacks with you too.
Drink more water! Impairment of cerebral vasculature after concussion results in decreased blood flow to the brain.  This makes the brain more sensitive to dehydration and can worsen symptoms, so make sure to drink 8 cups of water per day.


There is a lack of scientific data to support the usage of supplements for the reduction of post-concussive symptoms or for the prevention of future concussions (ex. such as fish oil, butterbur, feverfew, coenzyme-Q, magnesium, curcumin, grape seed and green tea extract).  Eating a well-balanced diet should include all the necessary vitamins and minerals for a healthy recovery.


Establish a regular sleep routine.  Go to bed early, at the same time each night, and try to arise at the same time each morning.
Create a quiet, dark place for sleep.  Eliminate distractions from the bedroom, including televisions, iPads, computers, and cell phones.
Decrease daytime naps if they are interfering with a regular bedtime, or having difficulty staying asleep.