D. Healthy Living · Healthy Living

Concussions: Signs, Symptoms and a Healthy Recovery

D1.1 A1.2 A1.3About 45 minutes

Learning goals

I can describe the signs and symptoms of a concussion.
I can tell the difference between a concussion symptom and a red flag that needs emergency help.
I can describe strategies that support a healthy recovery, including the return-to-school and return-to-sport steps.

Words to know

concussion
A brain injury caused by a hit to the head, face, neck or body that makes the brain move quickly inside the skull. It changes how the brain works for a while.

sign
Something other people can see, such as a blank stare or trouble with balance.

symptom
Something the injured person feels or notices, such as a headache or feeling "in a fog".

red flag
A sign or symptom that could mean a more serious injury. Call 911 right away.

relative rest
Resting for the first day or two while still doing gentle everyday things at home, with limited screen time.

medical clearance
A note from a doctor or nurse practitioner saying the person is ready to go back to full-contact practice and games.

second impact syndrome
A rare but very dangerous swelling of the brain that can happen if a person gets another concussion before the first one has healed.

"I'm fine. Just put me back in."

It's the last period of a hockey game. Jordan gets checked into the boards and gets up slowly, blinking. On the bench, Jordan says, "I'm fine. Just a bit dizzy."

Is Jordan fine? Today you'll learn how to recognize a concussion and how a person recovers safely. The Grade 8 curriculum asks you to describe the signs and symptoms of concussions, as well as strategies that support healthy recovery.

Remember from Grade 7

In Grade 7 (in the Active Living unit) you learned how to lower the risk of concussion: heads-up play, proper equipment, following rules, and reporting. This year you'll go further: what a concussion looks and feels like, and what healing looks like.

What happens in a concussion

Your brain is soft and floats inside your skull. A hit to the head, face or neck, or a hit to the body that makes the head whip quickly, can make the brain move and twist inside the skull. This can stretch and stress brain cells and change how the brain works for a while.

Three important facts:

Most concussions happen without being knocked out.
A concussion can't be seen on an X-ray or a regular brain scan. It's diagnosed by a doctor or nurse practitioner from the signs and symptoms.
Signs and symptoms can show up right away or hours (even a day or more) later.

A hard blow can make the brain move inside the skull and strike the inside of it. (Simple diagram, not to scale.)

Type	Examples
Signs (what others see)	Lying still after a hit, slow to get up, holding the head, blank or vacant look, balance problems or stumbling, seeming confused or not knowing the score or time, a cut or injury to the face
Physical symptoms (what the person feels)	Headache or pressure in the head, dizziness, nausea, blurry vision, sensitivity to light or noise, feeling tired or low on energy
Thinking symptoms	Feeling slowed down or "in a fog", trouble concentrating, trouble remembering
Emotional symptoms	More emotional, irritable, sad, nervous or anxious
Sleep changes	Sleeping more or less than usual, trouble falling asleep

A person does not need to have all of these. Even one can mean a concussion.

Red flags: call 911

Call 911 right away if, after a hit, the person has any of these:

neck pain or tenderness
double vision
weakness, tingling or burning in the arms or legs
a severe headache, or one that keeps getting worse
a seizure or convulsion
loss of consciousness (being knocked out)
getting more drowsy, confused or hard to wake
vomiting
becoming more and more restless, agitated or combative

If there could be a neck injury, don't move the person. Wait for help.

If you suspect a concussion: Recognize, Remove, Refer

Recognize the signs and symptoms.
Remove the person from the game or activity right away. They don't go back in that day, even if they feel better. "When in doubt, sit them out."
Refer: the person should see a doctor or nurse practitioner as soon as possible. They shouldn't be left alone at first, and they shouldn't ride a bike or drive.

In Ontario, Rowan's Law requires amateur sport organizations to remove athletes with a suspected concussion immediately and to follow a return-to-sport plan. The law is named after Rowan Stringer, a teenage rugby player from Ottawa who died in 2013 after a second hit before her first concussion had healed. Rowan's Law Day is the last Wednesday in September.

Healing well: strategies that support recovery

A brain needs time and care to heal, just like a sprained ankle.

First 24 to 48 hours: relative rest. Gentle activities at home, like short walks around the house, reading a little, or quiet time with family. Limit screen time. Complete bed rest in a dark room for days is no longer recommended.
Then increase activity slowly. Light activity, such as walking, can help recovery as long as it doesn't make symptoms clearly worse.
Sleep well, drink water, and eat regular meals.
Avoid alcohol, cannabis and other substances, and anything with a risk of another hit.
Manage feelings. Missing school, friends and sport can be frustrating or sad. Talking about it, breathing exercises and keeping some routine help.
Return to school before sport. A student goes back to school full-time before going back to full-contact practice or games.
Most young people feel better within a few weeks, but every concussion is different. If symptoms last, the doctor may suggest more help.

Return-to-School steps (Parachute Canada, 2024): relative rest, then some schoolwork at home, then school with supports, then full-time school. Move to the next step as symptoms allow.

Return-to-Sport step	What it looks like
1. Daily activities and relative rest	Gentle everyday activities at home
2. Light, then moderate aerobic exercise	Walking, then a stationary bike or light jog
3. Individual sport-specific activities	Skating or shooting drills alone, no chance of a hit to the head
4. Non-contact training drills	Harder practice drills with no contact; needs full-time school and medical clearance first
5. Full-contact practice	All practice activities and physical education
6. Return to sport	Games and competition

Parachute Canada's Return-to-Sport strategy (2024). At least 24 hours at each step. If symptoms get worse, go back to the previous step.

Worked example

Let's check Jordan

Jordan got checked into the boards, got up slowly, and says, "I'm fine. Just a bit dizzy." On the bench Jordan asks a teammate what period it is. What should happen?

Look for signs: slow to get up, confused about the period. These are signs.
Listen for symptoms: dizziness is a symptom.
Check for red flags: no neck pain, vomiting or knocked out mentioned. If any of these appear, call 911.
Remove: Jordan should not go back in, even if Jordan feels better in ten minutes.
Refer: Jordan should see a doctor or nurse practitioner, not be left alone, and start relative rest.

Jordan likely has a suspected concussion. Jordan should sit out for the rest of the game, tell the coach and a parent, and be checked by a doctor or nurse practitioner.

Worked example

Let's plan a healthy return

Aisha was diagnosed with a concussion from a fall while snowboarding. Two days later her headache is milder. She wants to snowboard on the weekend because "I feel almost normal." What should she do?

Where is she? After the first 24 to 48 hours of relative rest, she can start light activity and some schoolwork, as long as symptoms don't get clearly worse.
School first: she needs to get back to full-time school before full-contact or high-risk activity.
Step by step: she moves through the return-to-sport steps, at least 24 hours each, and needs medical clearance before step 4.
Why it matters: another hit before the brain heals can make recovery much longer and, rarely, cause second impact syndrome.

Not this weekend. Aisha can go for gentle walks, rest, and slowly add schoolwork. Snowboarding comes back only after full-time school, the return-to-sport steps, and medical clearance.

Hands-on activity

Make a concussion card

You need: an index card or paper, a pencil, and a phone or tape (optional).

On one side, write Recognize, Remove, Refer and list five signs or symptoms in your own words.
Add the red flags and the words CALL 911 in big letters.
On the other side, sketch the four Return-to-School steps as stairs.
Practise with your grown-up: they act out being hit by a ball and show one sign (for example, rubbing their head and looking confused). You name the sign and say what to do.
Keep the card in your sports bag, or take a photo of it.

What to look for: correct signs and symptoms, the red flags, and "don't return the same day". Practising what to say helps you stay calm under stress (A1.2).

Your turn

What is a concussion?

True or false: you must be knocked out to have a concussion.

What is the difference between a sign and a symptom?

Name three symptoms of a concussion.

Name two red flags that mean you should call 911.

Should someone with a suspected concussion return to the game if they feel better after 15 minutes?

What comes first: full-time school or full-contact sport?

More practice: warm-up

Can a concussion be seen on an X-ray?

Sign or symptom: a blank stare.

Sign or symptom: feeling sick to your stomach.

How long is the first step of relative rest?

What does "When in doubt, sit them out" mean?

More practice: on your own

Why should screens be limited in the first day or two after a concussion?

A friend hit her head yesterday and today feels foggy and can't focus in math. What should she do and why?

Why can a hit to the body cause a concussion?

Name two strategies, other than rest, that support recovery.

Why does Rowan's Law matter to young athletes in Ontario?

Challenge

Explain why a teen might hide concussion symptoms, and give two ways a team could make it easier to report them.

Marco is in step 3 of return-to-sport and his headache comes back during solo drills. What should happen next, and why?

A Grade 8 student is back at school but gets headaches in loud classes and can't keep up. Suggest three supports the school could offer during step 3 of return-to-school.

Check your understanding

Quiz

Which statement about concussions is true?

Which is a red flag that means calling 911?

A player shows signs of a concussion but says they feel better after 10 minutes. What should happen?

What is recommended in the first 24 to 48 hours?

Which comes before returning to full-contact practice?

Feeling "in a fog" after a hit is an example of...

For parents and teachers

Big idea: This lesson covers the Grade 8 expectation to describe the signs and symptoms of concussions, as well as strategies that support healthy recovery (D1.1). It builds coping skills (A1.2) and perseverance during a slow recovery (A1.3).

Facts used: Return-to-School and Return-to-Sport steps follow Parachute Canada's 2024 strategies (at least 24 hours per return-to-sport step; full-time school and medical clearance before step 4 of return to sport). Rowan's Law details come from the Government of Ontario.

How to help at home:

Check that your child knows the red flags and that they should never return to play the same day after a suspected concussion.
If your child's team or club asks you to review concussion awareness resources each year, do it together.
If your child has a concussion, follow your health care provider's advice, tell the school, limit screens at first, keep regular sleep and meals, and be patient. Frustration and low mood are common during recovery.

Common difficulties: mixing up signs and symptoms; believing you have to be knocked out; thinking "I feel better" means "I'm healed". Talk through the Jordan and Aisha examples. This lesson is not medical advice: always follow the advice of your own doctor or nurse practitioner.