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Students returning to sport after an ABI fact sheet

Students returning to sport after an acquired brain injury

Sports and physical education are important in the lives of Australian children. There are many benefits associated with a successful return to sports and leisure activities including improved self-confidence through socialisation and teamwork with other children as well as the improved fitness and physical skills. If children enjoy physical activity, they are more likely to be active as adults and so will enjoy long term health and lifestyle benefits.

When can a student safely return to sports following brain injury?

There is limited evidence in the medical literature to answer this question. The following are general recommendations based on the information available. The students return to sport should always be discussed with their medical team. When a student is safe to return to sport depends on many factors including:

  • age and previous medical history or learning difficulties
  • type and severity of injury
  • problems or impairments from the injury such as,
    • muscle weakness or tightness
    • co-ordination and balance
    • vision and visual perception
    • judgement and impulsiveness
    • fatigue (physical and mental)
    • reduced fitness due to hospitalisation and decreased activity following illness or injury
  • the nature of the sport and risk for further brain injury (team sports tend to become more competitive with age and may pose a greater risk of injury).

Things to consider when a student returns to sport

Physical, mental and emotional changes may make returning to activity more difficult for some students. They may:

  • be physically less able to participate
  • be fearful of further injury (which can be from both the student and care givers)
  • have decreased self-confidence and changed body image
  • suffer from significant fatigue or decreased endurance/fitness
  • have difficulty accessing appropriate sporting facilities or coaching
  • require modifications to activities to allow the student to access and participate in the activities with their peers.

Sports and risk of further injury

Some sports place students at greater risk of further injury. It is often recommended that students start with the low risk sports and progress to other sports under advice from the physiotherapist or doctor.

Low risk sports Moderate risk sports High risk sports
  • Walking
  • Running
  • Swimming (supervised)
  • Tennis
  • Dancing
  • Yoga / Tai Chi
  • Bowling
  • Rowing
  • Non-contact Martial Arts
  • Cricket
  • Golf
  • Cycling (supervised with helmet)
  • Volleyball
  • Softball
  • Gymnastics
  • Soccer
  • Netball / Basketball
  • Rugby / AFL
  • Contact Martial Arts
  • Wrestling & Boxing
  • Skating / skateboarding
  • Cycling on road
  • Surfing
  • Skiing / snowboarding
  • Horse Riding
  • Motorcycling
What you might see What this could mean Strategies
Student does not want participate in sport Reduced confidence
  • Encourage achievable tasks to increase confidence and participation.
  • Breakdown task and practice parts separately.
Student has difficulty completing tasks set for them in PE Reduced co-ordination
  • Reduce complexity of task.
Muscle weakness, spasticity or fatigue
  • Regular rest breaks.
  • Modify equipment eg. Lighter/bigger balls.
Difficulty following instructions
  • Simple 1-2 step instructions.
Student is falling or losing balance during sport Decreased balance
  • Closer supervision for tasks requiring higher level balance activities such as single leg activities or reduced base of support (eg. Balance beam).
Student is having trouble throwing, catching and kicking balls. Reduced coordination and/or motor planning
  • Reduce distractions
  • Use static rather than dynamic postures for ball handling eg. Stand and kick rather than run and kick.

Other considerations


Reintroduction to swimming also needs to be carefully monitored. Often students, who could swim prior to their accident or illness, may be slow and need specialised training to regain this ability. Things to consider include:

  • wether the student been cleared for return to swimming by their medical team
  • assess the student for water safety
  • monitor fatigue levels carefully
  • all staff involved to be aware of medical conditions such as seizures
  • students should always be supervised when in/near bodies of water because it is a medium that can be potentially high risk.

Warm-up and Cool Down

Everyone should warm up before sports and cool down following sports to decrease the risk of muscle injury. Having the time and right environment to do this is even more important following a brain injury especially if the student has coordination difficulties or muscle imbalance (tightness/weakness). Recommendations may include 5-10 mins of gentle activity and stretches. Specific stretches may need to be included for some students however you will be guided by the student’s therapist regarding these.

If you have any concerns, please contact the student’s parents and/or refer to the child’s therapists for further assessment and individualised strategies.

Contact us

Queensland Paediatric Rehabilitation Service
Queensland Children’s Hospital
Level 6, 501 Stanley Street, South Brisbane 4101
t: 07 3068 2950
t: 07 3068 1111 (general enquiries)
f: 07 3068 3909

In an emergency, always call 000.

If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.

Developed by the Queensland Paediatric Rehabilitation Service, Children’s Health Queensland. Updated: October 2017. All information contained in this sheet has been supplied by qualified professionals as a guideline for care only. Seek medical advice, as appropriate, for concerns regarding your child’s health.