Daily activities mainly refer to the necessary activities that people perform every day to meet their daily needs, including basic daily living and functional daily living. In basic daily life, sleep problems were often mentioned, with adolescents with mTBI frequently describing themselves as tired, insomniac, or hypersomniac (“I feel sluggish and want to sleep” (16)). In functional daily life, the decline in memory and reading ability is most prominent (“There is a gap between reading it and my brain understanding it”) (16), which can lead to difficulties in daily organization, storage, and finding items.

Some adolescents noted that similar locations to injury-related scenarios caused them distress and avoidance, making daily commuting challenging, Additionally, other family members needed to take care of them, leading to increased household financial costs, like transportation expenses, medical bills, and reduced family productivity (“Because my parents have their own business, you know, going to the clinic is a whole day’s torture”) (14). The impact of daily life is a test for adolescents themselves, as well as for other family members. It is essential for the community in which the family lives to provide medical services and assistance.

Adolescents have a wide range of interests and hobbies, which are not only for leisure and entertainment but also a means of self-expression and self-actualization. They are also an important way to enhance a sense of belonging and identity within a group. After mTBI, adolescents reduced their activities in hobbies due to physical symptoms such as headaches, dizziness, and sensitivity to sound and light. They were often advised to stop or decrease the time they spend watching TV, playing video games, listening to music, and playing instruments. (“I started dancing at four years old, and I was the lead in the company’s dance performances, but now I cannot participate anymore”) (16). Additionally, adolescents had to change their sports habits. Fearing further injury, they gave up the sport they loved, which even affected their future career choices (“I have earned my black belt in martial arts—it is my peak, but I have to stop there. I love the sparring part but I really cannot do that anymore. I quit martial arts, and it changed my life”) (12). These hobbies are often discontinued based on the advice of healthcare professionals. However, there is no mention of when or how they should be resumed. This requires a multidisciplinary team of professionals, such as sports coaches, music teachers, and healthcare professionals, to develop a strategy together. However, such collaboration is clearly not common.

During adolescence, as academic workload and competitive pressure increase, academic performance gradually becomes a focal point of concern for individuals, families, schools, and society. Therefore, adolescents with mTBI often rush to return to school under academic pressure, but the results are often unsatisfactory. First, the school environment can exacerbate physical symptoms. (“The school lights are especially bright and are hurting my eyes. I have to go home an hour after arriving at school”) (12). Even when they persist in attending school, physical discomfort and lack of concentration also make classroom learning inefficient (“Taking notes, looking at the blackboard, shifting focus back and forth, is a bit difficult”) (11). When unable to persist in class, adolescents frequently visit the nurse’s office for breaks (“If I cannot focus, I just wander around for the entire class. Sometimes I go there just to get some medicine”) (14). Meanwhile, mTBI leads to a decline in learning abilities, including memory loss, slowed reactions, and reduced reading and thinking skills (“I cannot remember things, and my brain mixes up words”) (11), resulting in brain fog when handling school-related tasks. Furthermore, widespread digital learning tools worsen physical discomfort, further resulting in poor learning efficiency (“Looking at a smart tablet, or trying to read a sentence in a book or script, also makes my eyes very tired and worsens my headaches.” (15)). Finally, when faced with piled-up assignments and tasks, adolescents fell more pressure and are reluctant to rest (“Since it is the end of the school year, I do not have much time to catch up on about three weeks of missed work…; I have to finish everything before finals”) (13), which in turn worsens mTBI symptoms, creating a vicious cycle. Clearly, the school administration has not provided sufficient support for adolescents returning to campus and has failed to establish a unified and feasible policy.

Negative emotions are emotions with negative valence, mainly including anxiety, fear, and anger. Compared with their physical development, adolescents’ psychological development is relatively slow, which means that they are still in a semi-mature state. When encountering changes and failures, they are more likely to feel frustrated and experience negative emotions. Although some believe that they are not affected by mTBI (“I just put one more thing to my experience lists, but I do not suppose it changes who I am”) (12), most adolescents are caught up in negative emotions, such as anxiety, fear, sorrow, and self-doubt. The pressure of failing to complete one’s academic work is the primary source of anxiety and fear (“I’m falling behind, I have to retake exams, so I have so much to do, and it is very overwhelming for me”) (15). At the same time, to obtain more information or convenience, adolescents need to communicate with schools, medical institutions, and other organizations during their recovery period, but the process is often fraught with obstacles, which further exacerbate their psychological burden (“If I cannot get an exemption from school in time, I’m worried I’ll have to write it, and I will not do well”) (11). Moreover, concerns about future life and the fear of reinjury often trouble adolescents (“‘My goodness, will I get another concussion?’ It makes me very worried about hitting my head again and how it might affect my memory and concentration”) (12). These unresolved pressures trap adolescents in various negative emotions, leaving them feeling overwhelmed. (“I’ll become very, very sad for no reason”) (16). Emotional issues are common, and internalizing them can easily lead to mental health problems. However, professional psychological assessments and guidance are rarely mentioned, and when faced with negative emotions, adolescents often find themselves “fighting alone.”

Social withdrawal refers to passive, evasive, and isolated behaviors in social situations. After mTBI, adolescents began to actively or passively reduce or even avoid social activities due to physical and psychological changes (“I want to stay away from everyone, without worrying about anything or anyone”) (16). Some adolescents describe feelings of exhaustion when participating in social interactions (“Talking to people makes me so tired that my entire social life is ruined. I just cannot talk to anyone”) (13). They are misunderstood but unable to defend themselves (“Oh, you are just doing this to avoid school…” It is too difficult… So I have not said much yet”) (13). Many adolescents feel awkward and embarrassed about bothering others (“It is like a compulsion; they do not fully understand the situation… It is more like they are robots. It is like they read online ‘This is what I should do,’ and then they do it”) (9). Socializing is an essential part of life. Can we provide a social platform where adolescents with mTBI feel comfortable? For example, they can participate in screen-based recreational social activities via their mobile phones to avoid the awkwardness of face-to-face communication. In addition, the platform can be used to connect with other young people who have had similar experiences. A peer who has suffered a concussion and subsequently recovered will be a valuable resource. However, it is extremely important to maintain the security of the platform network and avoid interference from inappropriate information.

Academic accommodation refers to adolescents having more choices in their academic pursuits, such as fewer learning tasks, more rest time, or separate exam venues. However, such accommodations are often limited and difficult to obtain. Some teachers do not trust students’ self-reports (“I remember arguing with the school because they did not believe I had memory problems unless I could prove it on paper, like taking a memory test”) (15). Some teachers are also unable to provide long-term academic accommodations due to external pressures or their limitations (“I can sense their struggle—it is not that the teachers do not want to help, but they cannot… because we have to adhere to so many standardized rules”) (9). Some adolescents also fail to advocate for themselves, either because they were unaware of the process or distrusted their teachers (“My counselor is disorganized; even if I do not get support from other teachers, it is better than spending a month trying to find him”) (13). Healthcare professionals can provide medical assistance to help adolescents obtain academic accommodations, but implementation varied (“My English teacher failed me in the first semester—he did not believe I was hospitalized, even after the doctor had spoken to the school”) (18). The process of obtaining academic accommodations is fraught with uncertainty, communication between adolescents and teachers is not going smoothly, and there is no comprehensive policy in place to help them.

Following mTBI, some adolescents experience symptoms like amnesia, making them eager to understand what happened. (“You have no idea what happened, and it seems like no one can. I do not know if I was different when I arrived”) (18). The treatment process for mBTI is also unsatisfactory (“My parents were not sure what to do, neither did the doctors. I just went to school and had to rely on painkillers to cope with it”) (12). Adolescents reported that healthcare providers’ education on care and exercise recommendations were crucial, but sometimes the advice was ambiguous and hollow (“The doctor told me what I could not do, but did not tell me what I could do” (13)) (“The rehabilitation handbook lacks humanity. I would rather be treated as a person than a number” (12)). Some adolescents mentioned that because people around them knew little about mTBI, it was difficult for them to get timely and effective help (“When I got hit, I did not realize a concussion, so I proceeded with the game, which probably made things worse”) (12). They suggested that schools should use videos, presentations, and other forms of centralized education (e.g., “A video or cartoon… can show how someone with a concussion struggles in school and how friends or peers can help, or how to recognize if someone has a concussion”) (15). The characteristics of mTBI make the process of collecting medical history uncertain. In many cases, there is no opportunity to conduct a systematic medical assessment, and treatment lacks specificity. For adolescents, there is no established education system for such accidents, and self-rescue and rescue efforts after an accident cannot be carried out smoothly.

Family and friends are important sources of social support for adolescents with mTBI, including emotional support, instrumental support, and informational support. Adolescents mentioned that classmates and friends could understand their fatigue and stress help them complete teamwork (“I did less work than usual, and they helped me solve problems and correct my assignments”) (15), ensure they did not forget class materials, and secure their safety in school (“They watched out for me to see if I tripped or felt dizzy”) (11). They also joined teachers in discussing academic accommodations and helped adolescents secure their rights. When adolescents were misunderstood, they stood up for them, offering explanations and arguments. They considered the limitations of adolescents’ activities when making plans and provided ample emotional support (“I loved their surprise visits—I did not know they had come after playing basketball… I was so happy”) (15). While peer support is important, parental assistance is more practical, such as researching healthcare options and health resources, arranging medical appointments, and strategically communicating with school administrators to advocate for academic accommodations (“Parents can communicate with schools better than my friends. My friends are not my guardians and they do not have adult authority”) (13). In addition, parents prioritized their children’s health, allowing them to stay home and helping with homework (“My mom helped me a lot—since I struggled with screens, she emailed my teachers; I dictated, while she typed”) (11). Adolescents described that the sense of security provided by parents was irreplaceable (“I was terrified and in so much pain—I needed my mom by my side all week. She slept in the rocking chair next to me”) (18). Indeed, family and friends play a key role in the support system for adolescents. However, from another perspective, community and social network support are rarely mentioned by adolescents. This warrants careful consideration, exploration of the underlying reasons, and the implementation of appropriate measures.

The treatment options for mTBI are relatively limited, primarily consisting of symptomatic medications such as pain relievers and anti-vertigo drugs, with varying degrees of effectiveness depending on the individual. Many adolescents reported long waiting times in emergency rooms after injuries, and doctors provided overly generalized information and very limited treatment options (“I just wanted to cure my headache, but nothing they gave me worked. I stayed in the hospital for a few nights, yet there was still no relief”) (18). Rehabilitation strategies for mTBI mainly include cognitive and motor recovery training. This often requires multidisciplinary teamwork of neurologists, rehabilitation specialists, and psychologists, but this seems difficult to achieve. In the survey, adolescents did not establish long-term effective relationships with professionals (“After admission… I even did not know the doctor’s name—completely anonymous”) (18). They noted that physical and occupational therapies were often provided too late and lacked specificity, expressing a need for more detailed guidance (“I appreciated one nurse who gave practical advice, including concrete examples of optimal self-management within my capabilities”) (13). Adolescents preferred professionals who showed genuine interest in their needs rather than just focusing on the injury (“While conducting tests, she talked with me—unlike others who just did their job and left. We discussed a lot, and it was cool”) (18).

Adolescents indicated that their requirements on the environment rested with reducing noise and light (“I would go to a quiet, slightly dark place”) (16), far away from crying infants (“That lady kept coming back with puzzles and baby stuff…it got annoying over time”) (18). From a psychological perspective, adolescents’ sense of psychological security and self-efficacy is closely tied to the predictability and manageability of their surroundings. Unlike younger children, they did not desire constant attention; instead, they wanted to escape adult supervision and restrictions… A relatively independent space and sense of control were beneficial. They could decide how to spend their time and access age-appropriate entertainment (“I enjoyed coffee and video games they bought, which helped pass the time”) (18). Although it is beneficial for adolescents to control their environment, this places higher demands on guardians. How to communicate effectively, avoid excessive interference, understand adolescent psychology, and respect their personalities and views. These issues require more theory and practice.

During mTBI recovery, the most common advice adolescents received was to take a complete break from physical and cognitive activities, followed by a gradual resumption of activities. However, since the advice given by doctors was not clear, each person’s rest and activity strategy differed. Some believed it was necessary (“I will not go back to school until I feel completely better”) (12), They argued that boredom might lead to engaging in activities detrimental to mTBI recovery (“Playing video games until I feel dizzy and then falling asleep”) (17). Adolescents believed they needed to engage in activities to help them manage their energy, like using schedules to plan daily tasks (“Listening to audiobooks and playing with pets”) (16). Moreover, they reintegrated meaningful physical activities into their lives, as exercise not only restored energy but also stabilized mood and improved sleep quality. Overall, relative rest can reduce overall brain metabolism and is more conducive to recovery than complete rest. The type and intensity of activities need to be further standardized. It is worth emphasizing that when adolescent athletes are forced to withdraw from sports due to rest regulations, they should maintain contact with their teammates and coaches. They need additional social support and intervention.

Self-healing involves observing the relationship between the mind and body. By accepting oneself, thinking positively, and regulating emotions, one can restore mental and physical health. Adolescents with mTBI described that they relieved stress through physical relaxation (massage, acupuncture, bathing (16)). They also often engaged in self-counseling through reflection and positive psychological suggestions (“overcome it,” “endure the pain,” “calm yourself down,” “pray” (16)). Some viewed mTBI as a life medal (“They tend to think of me as a child who has had more concussions than most. Compared to other things I have done, this is what I am more known for”) (12), while others channeled anxiety into motivation, came out of from anxiety and depression after deep reflection, and achieved a change in mindset (“During the break, I truly reflected on who I am… It made me a better person, pulling me out of the darkness”) (12). Self-healing among adolescents largely involves sharing simple experiences that are easy to implement but highly random. However, providing professional psychological guidance tailored to the characteristics of adolescents, such as rational emotive therapy and relaxation therapy, can be more effective in helping them restore their physical and mental well-being. Compared to neurological symptoms, mental health has not received sufficient attention, professional psychological services are not widely available, and the mental health education system needs to be improved.