What to do following an incident involving an impact or impulsive force to the body or head

A mild traumatic brain injury (mTBI) or concussion can occur in a variety of circumstances. Indeed, violent contact, a collision or a fall are risky situations, since they can cause a back and forth movement of the head or a jolt to the head.

If you think you have sustained a mild traumatic brain injury or a concussion, it is important that you watch for the appearance of symptoms.

For all health-related questions, you can contact Info-Santé 811 at any time.

After an incident that may have caused an mTBI/concussion, the absence of immediate symptoms is not always a reliable indicator. It is important to watch for the appearance of symptoms for a period of 24 to 48 hours during which:

• you can do activities of daily living (e.g., light physical activities such as walking or housework, intellectual or learning activities at home, reading, interacting with family and friends)
• you must limit screen time to the strict minimum (e.g., to what is necessary for school work, if you are a student)
• you must avoid participating in activities that make you breathless or during which you could be injured (collision, fall, contact)
• you must watch carefully for any possible changes in your state of health and the appearance of signs and symptoms
• you can ask for help from your loved ones to carry out more complex activities and tasks

If you do not develop symptoms of mTBI/concussion within 24 to 48 hours after the incident, and only if this is the case, you can gradually resume all your intellectual or learning, physical and sports activities.

If you develop symptoms of mTBI/concussion within 48 hours following the incident, you should quickly consult a doctor or a health professional who has received training in concussion management (specialized nurse practitioner, physiotherapist) at a medical clinic or hospital emergency department. You will receive a diagnosis and the appropriate support.

Active rest period

After an incident that caused an mTBI/concussion, rest for one to two days. Be careful, resting does not mean doing nothing! To promote recovery, it is important to keep doing your activities during this active rest period, but to do them slowly and progressively:

• do simple activities that make you feel good, like listening to soft music or audiobooks
• limit screen time as much as possible for the first two days
• stay in touch with friends and family and avoid isolation;
• do light physical activities that do not increase your symptoms. You should be able to speak without shortness of breath during these activities. Take breaks as needed
• avoid activities that require a lot of concentration, reflection or memory and physical activities that make you breathless or during which you could injure yourself

Other recommendations

Other recommendations apply if you have symptoms of mTBI/concussion:

• drink water to stay well hydrated
• eat healthily and according to your appetite
• get enough sleep at night
• avoid alcohol, energy drinks and drugs
• avoid prolonged isolation in the dark and in silence
• avoid wearing sunglasses indoors and earplugs
• avoid driving if you have severe symptoms

Your pharmacy can inform you about over-the-counter medications that could relieve your symptoms. Observe the recommended doses.

If symptoms have diminished

If, after a 48-hour rest, your symptoms have diminished:

• progressively return to your activities (intellectual or learning, physical and sports)
• consider documenting your symptoms and your return to activities using the tools available. A follow-up sheet (in French only) is available on the website of the Institut national d’excellence en santé et en services sociaux (INESSS), on the page Mild traumatic brain injury: advice for gradually resuming intellectual, physical and sports activities.

If symptoms worsen or appear

If, after a 48-hour rest, your symptoms worsen or new symptoms appear:

• maintain a level of activity that does not exacerbate your symptoms
• consider documenting your symptoms and your return to activities using the tools available. A follow-up sheet (in French only) is available on the website of the INESSS, on the page Mild traumatic brain injury: advice for gradually resuming intellectual, physical and sports activities.

If, at any time, you are worried or have questions about your state of health, call Info-Santé 811 or make an appointment with a healthcare professional.

After an incident involving an impact or impulsive force to the body or head, in the presence of symptoms of mTBI/concussion, consult a doctor or a health professional who has received training in concussion management (specialized nurse practitioner, physiotherapist). They will ask you about the circumstances of the incident and your symptoms in order to assess the situation. When you see the qualified health professional, it is important to bring the monitoring sheet (in French only) that you started after the incident with you. It can be used, in particular, to document the incident, especially if there were no witnesses or if you do not remember the exact circumstances. It is also helpful for the transmission of information between the people concerned. For events involving a risk of concussion during school, sports, or leisure activities, the follow-up monitoring sheet adapted to these contexts (in French only) can be completed.

If applicable, they will diagnose an mTBI/concussion.

They will provide you with the relevant and proper information to manage the coming days, including the necessity of adopting good behaviours.

They will issue the required certificate(s) regarding absence from work, absence from school or non-participation in physical and sports activities, if necessary.

They will let you know if a medical follow-up is required and if an attestation is needed for returning to work or school or participating in sports.

During the consultation, it is important that you be accompanied by someone close to you. This person will receive the same information as you but may be in a better position to understand and memorize it because, with an mTBI/concussion, it is highly likely you will not be able to do so. If needed, this person could also transmit the information more accurately to those who will help and support you over the coming days.

After the active rest period, you can gradually resume your usual activities, at your own pace. The monitoring sheet (in french only) will help you to follow strategies for resuming intellectual or learning, physical and sports activities. You can use it to record your progress. A progressive return to activities prevents complications, respects your capacity to recover and helps maintain social ties.

Intellectual or learning, and physical activities can be resumed at the same time, provided they do not cause, or few, symptoms.

Experiencing mild symptoms during the activity is normal. It is also normal for your symptoms to increase a little during or after the activity. However, they should diminish in less than an hour afterwards.

If symptoms worsen, take a break and wait for them to return to the same intensity as before the activity. Then, do the activity again, but for a shorter time or with less intensity.

The pace of the progressive return must be adapted to each individual and take into account their prior level of activity and the targeted level.