Initial Rest

• 24 – 48 hours of relative cognitive rest:
• Sample activities permitted if tolerated by student:
• Short board/card games
• Short phone calls
• Photography (with camera)
• Crafts
• Activities that are not permitted at this stage:
• TV
• Technology use (for example, computer, laptop, tablet, iPad)/cell phone (for example, texting/games/photography)
• Video games
• Reading
• Attendance at school or school-type work
• The student moves to Stage 1 when:
• Symptoms start to improve or after resting 2 days maximum (whichever occurs first).

Stage 1

• Light cognitive (thinking/memory/ knowledge) activities
• Gradually increase cognitive activity up to 30 minutes. Take frequent breaks.
• Activities permitted if tolerated by student:
• Activities from previous stage
• Easy reading (for example, books, magazines, newspaper)
• Limited TV
• Limited cellphone conversations
• Drawing/building blocks/puzzles
• Some contact with friends
• Activities that are not permitted at this stage:
• Technology use (for example, computer, laptop, tablet, cell phone (for example, texting/games/photography))
• Attendance at school or school-type work
• The student moves to Stage 2 when:
• the student tolerates 30 minutes of light cognitive activity (for example a student should be able to complete 3-4 of the permitted activities listed above) and has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms.
• The student has completed a minimum of 24 hours at Stage 1.
• However:
• The student must return to the previous stage for a minimum of 24 hours when they have exhibited or reported a return of symptoms, or new symptoms.
• The student must return to a medical doctor or nurse practitioner when they have exhibited or reported a worsening of symptoms.

Stage 2

• Gradually add cognitive activity (as per activities permitted). When light cognitive activity is tolerated, introduce school work (at home and facilitated by the school).
• Activities permitted if tolerated by student:
• Activities from previous stage
• School-type work in 30-minute increments
• Crosswords, word puzzles, Sudoku, word search
• Limited technology use (for example, computer, laptop, tablet, cell phone (for example, texting/games/photography)) starting with shorter periods and building up as tolerated.
• Activities that are not permitted at this stage:
• School attendance
• The student moves to Stage 3a when:
• The student tolerates the additional cognitive activity (for example a student should be able to complete 3-4 of the activities permitted) and has not exhibited or reported a return of symptoms, new symptoms or worsening symptoms.
• The student has completed a minimum of 24 hours at Stage 2.
• However:
• The student must return to the previous stage for a minimum of 24 hours when they have exhibited or reported a return of symptoms, or new symptoms.
• The student must return to a medical doctor or nurse practitioner when they have exhibited or reported a worsening of symptoms.

Initial Rest

• 24 – 48 hours of relative physical rest
• Sample activities permitted if tolerated by student:
• Limited movement that does not increase heart rate or break a sweat
• Moving to various locations in the home
• Daily hygiene activities
• Activities that are not permitted at this stage:
• Physical exertion (increases breathing and heart rate and sweating)
• Stair climbing other than to move locations throughout the home
• Sports/sporting activity
• The student moves to Stage 1 when:
• Symptoms start to improve or after resting 2 days maximum (whichever occurs first).

Stage 1

• Light physical activities (as per activities permitted) that do not provoke symptoms.
• Movements that can be done with little effort (do not increase breathing and/or heart rate or break a sweat).
• Activities permitted if tolerated by student:
• Daily household tasks (for example, bed-making, dishes, feeding pets, meal preparation)
• Slow walking for short time
• Activities that are not permitted at this stage:
• Physical exertion (increases breathing and heart rate and sweating)
• Sports/sporting activity
• Stair climbing, other than to move locations throughout the home
• The student moves to Stage 2a when:
• The student tolerates light physical activities (completes both activities permitted from Stage 1) and has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms.
• The student has completed a minimum of 24 hours at Stage 1.
• However:
• • The student must return to the previous stage for a minimum of 24 hours when they have exhibited or reported a return of symptoms, or new symptoms.
  • The student must return to a medical doctor or nurse practitioner when they have exhibited or reported a worsening of symptoms.

Stage 2a

• Daily activities that do not provoke symptoms.
• Add additional movements that do not increase breathing and/or heart rate or break a sweat.
• Activities permitted if tolerated by student:
• Activities from previous stage
• Light physical activity (for example, use of stairs)
• 10-15 minutes slow walking 1-2x per day inside and outside (weather permitting)
• Activities that are not permitted at this stage:
• Physical exertion (increases breathing and/or heart rate and sweating)
• Sports
• Sporting activities
• The student moves to Stage 2b when:
• The student tolerates daily physical activities (completes activities permitted in Stage 2a) and has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms.
• The student has completed a minimum of 24 hours at Stage 2a
• However:
• The student must return to the previous stage for a minimum of 24 hours when they have exhibited or reported a return of symptoms, or new symptoms.
• The student must return to a medical doctor or nurse practitioner when they have exhibited or reported a worsening of symptoms.

Stage 2b

• Light aerobic activity
• Activities permitted if tolerated by student:
• Activities from previous stage
• 20-30 minutes walking/stationary cycling/recreational (that is, at a pace that causes some increase in breathing/heart rate but not enough to prevent a student from carrying on a conversation comfortably)
• Activities that are not permitted at this stage:
• Resistance or weight training
• Physical activities with others
• Physical activities using equipment
• The student moves to Stage 3 when:
• The student tolerates light aerobic activities (completes activities permitted in Stage 2b) and has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms
• The student has completed a minimum of 24 hours at Stage 2b.
• However:
• The student must return to the previous stage for a minimum of 24 hours when they have exhibited or reported a return of symptoms, or new symptoms.
• The student must return to a medical doctor or nurse practitioner when they have exhibited or reported a worsening of symptoms.