Brain Injury Prevention, Support for Survivors and Families
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HeadsUp! is a programme of the
ComaCARE Trust

Tel: +27 (0)860 110 111
(ComaCARE & HeadsUP!)


Simelela Centre Site B Day Hospital
Khayelitsha Hub

Tel: +27 (0)81 725 4547

We offer workshops for boys and
men, training for coaches, teachers
and learners, and injury
management and support for
survivors and families.

What Is A Concussion?

A concussion is a type of brain injury that changes the way the cells in the brain normally work. A concussion is caused by a bump, blow or jolt to the head. Concussions can also occur from a fall or blow to the body that causes the head and brain to move rapidly back and forth. Even what seems to be a mild bump to the head can be serious. Recognition and proper management of concussions when they first occur can help prevent further injury or even death. While some research shows that the young brain can be resilient, it may also be more susceptible to the chemical changes that occur in the brain after a concussion. These changes can lead to a set of symptoms affecting the individual’s cognitive, physical, emotional and sleep functions.

Children and adolescents are among those greatest at risk for concussion. The potential for a concussion is greatest during activities where collisions can occur, such as during physical education (PE) class, playground time or school based sports activities. However, concussion can happen at any time a student’s head comes into contact with a hard object, such as a floor, desk, or another student’s head or body. Proper recognition and response to concussions when they first occur can prevent further injury and help with recovery. Most concussions occur without loss of consciousness. Remember, you can’t see a concussion and some people may not experience and/or report symptoms until hours or days after the injury. If a concussion is suspected, seek medical attention immediately.

To help recognise a concussion, you should watch for the following two things:

  • A forceful blow to the head or body that results in rapid movement of the head, and
  • Any change in the person’s behaviour, thinking or physical functioning.

If an individual has a concussion their brain needs time to heal. A repeat concussion that occurs before the brain recovers from the first – usually within a short period of time (hours, days or weeks) – can slow recovery or increase the likelihood of having long-term problems. In rare cases, repeat concussions can result in brain swelling, permanent brain damage, and even death. This more serious condition is called second impact syndrome.

Signs and Symptoms

Because you cannot see a concussion you need to be aware of the signs and symptoms. These can show up right after an injury or may not appear or be noticed until hours or days after the injury. Be alert for any of the following signs or symptoms. Also, watch for changes in how the student is acting or feeling, if symptoms are getting worse, or if the student just "doesn’t feel right".

Observed symptoms:

  • Appears dazed or stunned
  • Is confused about assignment or position
  • Forgets sports plays
  • Is unsure of game, score or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows mood, behaviour or personality changes
  • Can’t recall events prior to hit or fall
  • Can’t recall events after hit or fall
  • Repeats questions

Symptoms reported by patient

  • Headache or ‘pressure’ in the head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy or groggy
  • Concentration or memory problems
  • Confusion
  • Does not ‘feel right’
  • Difficulty thinking clearly
  • Being irritable, sad, more emotional than usual, nervous
  • Numbness or tingling
  • Fatigue or feeling tired
  • Sleeps more or less than usual
  • Has trouble falling asleep
  • Drowsy

Action Plan

If you suspect someone has a concussion, remove them from the activity they were doing and seek medical attention. Do not try to judge the severity of the injury yourself.

Seek medical attention right away. A health care professional experienced in evaluating for concussion can determine how serious the concussion is and when it is safe for the person to return to normal activities, including physical activity and school.

Help them take time to get better. After a concussion the brain needs time to heal. You may need to limit activities during the recovery period. Exercising or activities that involve a lot of concentration such as studying, working on the computer or playing video games may cause concussion symptoms (such as headaches or tiredness) to reappear or get worse. After a concussion, physical and cognitive activities (such as concentration and learning) should be carefully managed and monitored by a health care professional.

Take the time to learn more about concussions. Talk about potential long-term effects and the dangers of returning too soon to normal activities (especially physical activity and learning/concentration). Knowledge of a concussion’s potential effects on a student, and appropriate management of the return-to-school process, is critical for helping students recover from a concussion.

What to Look for After a Concussion / Returning to School

  • Increased problems paying attention or concentrating
  • Increased problems remembering or learning new information
  • Longer time needed to complete tasks or assignments
  • Difficulty organising tasks
  • Inappropriate or impulsive behaviour during class
  • Greater irritability
  • Less ability to cope with stress or more emotional

Services and accommodations for students may include speech-language therapy, environmental adaptations, curriculum modifications and behavioural strategies.

Students may need to limit activities while they are recovering from a concussion. Exercising or activities that involve a lot of concentration such as studying, working on the computer or playing video games may cause concussion symptoms (such as headache or tiredness) to reappear or get worse.

Students who return to school after a concussion may need to:

  • Take rest breaks as needed
  • Spend fewer hours at school
  • Be given more time to take tests or complete assignments
  • Receive help with schoolwork and/or
  • Reduce time spent on the computer, reading or writing

It is normal for students to feel frustrated, angry or even sad because they cannot return to recreation or spors right away, or cannot keep up with their schoolwork. A student may also feel isolated from peers and social networks. Talk with the student about these issues and offer support and encouragement. As the student’s symptoms decrease, the extra help or support can be removed gradually.

Danger Signs

In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull. Be alert for symptoms that worsen over time. The person should be seen in an emergency department right away if s/he has:

  • One pupil (the black part in the middle of the eye) larger than the other
  • Drowsiness or cannot be awakened
  • A headache that gets worse and does not go away
  • Weakness, numbness or decreased coordination
  • Repeated vomiting or nausea
  • Slurred speech
  • Convulsions or seizures
  • Difficulty recognising people or places
  • Becomes increasingly confused, restless or agitated
  • Unusual behaviour
  • Loss of consciousness (even a brief loss of consciousness should be taken seriously)