Physical Therapy for Kids Recovering from Concussions

Innovative Approaches to Pediatric Concussion Recovery Through Physical Therapy

May 13, 2025

Understanding the Importance of Physical Therapy in Concussion Management for Kids

Concussions are a common mild traumatic brain injury affecting children, often resulting from falls, sports impacts, or jarring blows to the head. While most pediatric concussion symptoms resolve within a few weeks, ongoing symptoms like dizziness, headaches, and visual disturbances can interfere with daily activities and school performance. Physical therapy has emerged as a critical component in managing these symptoms, tailoring interventions to address specific impairments such as vestibular dysfunction, ocular-motor issues, and neck stiffness. This article explores how physical therapy supports kids through recovery, the assessment processes involved, and effective treatment strategies that enable safe return to normal activities.

Initial Steps and Monitoring Post-Concussion

Vigilant Monitoring: Watch for Symptom Changes & Seek Urgent Help

What steps should be taken immediately after a child sustains a concussion?

The first response after a childhood concussion involves ensuring the child stops any physical activity immediately. Rest—both physical and mental—is crucial during this initial phase. The child should be kept in a quiet environment, avoiding activities that increase brain load, like screen time, loud noises, or vigorous play.

Close monitoring of symptoms is essential. Parents and caregivers should watch for any signs of deterioration, including worsening headaches, confusion, dizziness, vomiting, or loss of consciousness. Prompt management of severe symptoms requires urgent medical attention.

Supporting recovery includes ensuring the child gets plenty of sleep, staying well-hydrated, and maintaining a balanced diet. Caffeine intake should be limited, and light, consistent sleep schedules should be maintained to facilitate healing.

Monitoring symptoms

Caregivers should regularly check on the child for any changes in their condition. Persistent or worsening symptoms such as increased headache, difficulty concentrating, or new neurological signs should trigger immediate medical evaluation.

It is advisable to keep a symptom diary, noting the severity and frequency of symptoms to inform healthcare providers. If any sudden or severe symptoms appear—including double vision, seizures, or severe drowsiness—urgent medical intervention is necessary.

Guidance on activities and rest

Initially, physical and cognitive activities should be minimized. The child should avoid sports, vigorous exercise, and academic burdens for at least 24–48 hours, or longer if symptoms persist.

As symptoms improve, a gradual reintroduction of activities is recommended. Light activities such as walking may be permitted early on, but only after clearance from a healthcare professional.

During recovery, it’s vital to balance rest with gentle activities to prevent deconditioning without risking symptom exacerbation.

When to seek medical attention

Medical evaluation should be sought within 24 to 48 hours post-injury to confirm diagnosis and receive guidance. Continued or worsening symptoms warrant further assessment.

Signs indicating the need for urgent medical care include severe headache, repeated vomiting, confusion, seizures, double vision, or inability to stay awake.

Monitoring vigilantly during the recovery period helps ensure the child’s safety and supports optimal healing. Medical professionals can provide personalized advice on resuming school and sports activities once they deem it safe.

Proper initial management and diligent observation are vital steps in helping children recover effectively from a concussion and minimize the risk of complications.

Duration and Expectations of Recovery in Pediatric Concussions

Recovery Timeline: From Days to Several Weeks

How long does full recovery typically take for a child after a concussion?

Most children recover from a concussion within a few days to four weeks. The initial rest period usually lasts for 24 to 48 hours, during which physical and cognitive activities are limited to prevent symptom worsening. After this phase, children gradually resume light activities like walking, and their progress is closely monitored by healthcare providers.

A structured, stepwise protocol guides return to sports and other activities, with each stage lasting at least 24 hours and only advancing if symptoms do not increase. Typically, full recovery and safe return to sports occur over three weeks, but factors such as injury severity, age, and pre-existing health conditions can extend this timeline.

In some cases, symptoms may persist beyond four weeks, requiring further evaluation and specialized treatment. Persistent symptoms may include ongoing dizziness, headaches, or cognitive difficulties, and they often necessitate a multidisciplinary approach for effective management.

Comprehensive Evaluation and Treatment Planning in Pediatric Concussions

Personalized Assessment and Targeted Therapy for Pediatric Concussion Assessment procedures form the cornerstone of effective pediatric concussion rehabilitation. Physical therapists and healthcare providers perform detailed evaluations that include examining the neck and cervical spine for mobility restrictions, muscular tightness, and underlying injuries. Balance assessments are also crucial, often utilizing tools like the Balance Error Scoring System (BESS) to identify stability issues.

A key component involves assessing the vestibulo-ocular system, which controls eye movement and balance, through specialized tests such as the Vestibular Ocular Motor Screen (VOMS). This screening helps detect symptoms like dizziness, visual disturbances, and gaze instability. For example, eye tracking exercises, head movements focusing on objects, and visual convergence tasks are used to identify dysfunctions.

These assessments also include symptom severity ratings and specific tests like the Buffalo Concussion Treadmill Test to evaluate exertion tolerance. The information gathered directs the development of personalized treatment plans targeting the child's unique impairments, such as vestibular therapy for dizziness and balance problems or eye exercises for visual tracking issues.

Recognizing the importance of a team approach, multidisciplinary professionals—such as neurologists, occupational therapists, and neuropsychologists—collaborate to optimize recovery. They combine physical and cognitive assessments to create comprehensive, individualized rehab strategies.

In addition to physical and vestibular evaluations, concussion education plays a vital role in treatment planning. It involves teaching children and caregivers to recognize symptoms early, understand the importance of reporting issues promptly, and follow a safe, gradual return-to-activity protocol. Education strategies often include in-person counselling, online modules, and materials explaining the recovery principles of Recognize, Remove, Report, and Relax.

Overall, tailored assessments and thorough education strategies ensure that interventions are specific, effective, and supportive of safe recovery pathways for children recovering from concussion.

The Role of Multidisciplinary Care and Return-to-Activity Protocols

Team Approach & Stepwise Return: Safely Re integrating Children into Activities A comprehensive approach to concussion management involves a team of specialists working together to support the child's recovery. This multidisciplinary team typically includes sports medicine physicians, physical therapists, occupational therapists, neuropsychologists, ophthalmologists, and other healthcare providers. Each professional addresses specific aspects of the injury, such as vestibular function, vision, cognitive abilities, and emotional well-being.

Having an integrated team ensures that the child's diverse needs are thoroughly assessed, which leads to personalized treatment plans. For example, physical therapists might focus on balance and neck mobility, while neuropsychologists address cognitive and emotional recovery. This collaborative effort not only optimizes symptom resolution but also enhances the safety of the return-to-school and sports activities.

Monitoring the child's progress throughout recovery is vital. Regular check-ins and symptom assessments help to ensure that activities are reintroduced safely and that any signs of symptom worsening are promptly addressed. This vigilance reduces the chances of prolonged symptoms or re-injury.

Gradual reintroduction to activities is foundational in concussion recovery. Children start with rest and light cognitive tasks, then slowly advance to low-intensity physical exercises. Each stage lasts at least 24 hours, and only if symptoms do not worsen can they move to the next level. Exercises often include light aerobic activity, progressing to sport-specific drills without contact, and finally, full participation in sports.

Evidence-based return-to-play guidelines are designed to minimize risks and ensure demands are only increased when the child is ready. These protocols typically consist of sequential steps: starting from symptom-limited activity, then controlled exertion, followed by more intense physical activity, and eventually full competition. Throughout, careful symptom monitoring is essential. If symptoms recur, the child is advised to revert to previous stages.

Employing these systematic strategies helps foster complete recovery, preventing long-term complications. It emphasizes safety and individualized pacing, ensuring children can re-engage in activities with confidence that they are fully recovered.

Supporting Long-Term Recovery in Children

Effective recovery from a pediatric concussion hinges on early intervention, personalized physical therapy, patient education, and a carefully structured return-to-activity plan. Multidisciplinary care ensures that all aspects of a child's health are addressed, from vestibular and ocular-motor functions to emotional well-being. With professional guidance and tailored exercises, children can safely return to school, sports, and play, minimizing the risk of long-term effects. Education and awareness among families, schools, and healthcare providers play a vital role in promoting safe practices and timely recovery, helping children reclaim their active and healthy lives.