Helping a student-athlete make a successful return to learning after a concussion is just as important as ensuring their safe return to sports, and requires a team approach involving parents, health care professionals, and schools, says the American Academy of Pediatrics. [1]
"Students appear physically normal after a concussion, so it may be difficult for teachers and administrators to understand the extent of the child's injuries and recognize the potential need for academic adjustments," said lead author, Mark Halstead, the author of the AAP's 2010 guidelines for pediatric concussions.[2]
"We know that children who've had a concussion may have trouble learning new material and remembering what they've learned, and returning to academics may worsen concussion symptoms," writes Halstead.
The report said it it was "unfortunate that [so] little attention has been given to academics and learning and how a concussion may affect the young student learner."
"Every concussion is unique and symptoms will vary from student to
student, so managing a student's return to the classroom will require an
individualized approach," said Halstead. "The goal is to minimize
disruptions to the student's life and return the student to school as
soon as possible, and as symptoms improve, to increase the student's
social, mental and physical activities."
Research, the report says, has shown that a school-aged student usually recovers from a concussion within three weeks. If symptoms are severe, some students may need to stay home from school after a concussion. If symptoms or mild or tolerable, the parent may consider returning him or her to school, perhaps with some adjustments, says the AAP.
Students with severe or prolonged symptoms lasting more than 3 weeks (the point at which some experts classify a concussed student as having post-concussion syndrome) may require more formalized academic accommodations, the group says.
Great first step
"Overall, the authors should be commended for providing this educational and informative piece discussing concussion and the effects on students," said sports concussion neuropsychologist Rosemarie Scolaro Moser, PhD, Director of the Sports Concussion Center of New Jersey and a MomsTEAM concussion expert. "Their assertions that concussion management is a team approach, that each concussion is unique, that students need academic accommodations are important public messages. It is a great first step in educating pediatricians about this growing public health concern and their roles in concussion team management," Moser said.
To that end, the AAP report, not surprisingly, contains a host of specific recommendations for pediatricians, including that they:
- Assess the concussed student for a more serious structural or neurologic injury;
- Know how the symptoms of concussion can affect the student in the school setting (see table below), as a thorough understanding of potential problems the student can encounter will help the pediatrician make appropriate recommendations to the school, the student, and student's family;
- Discuss with patients and parents other potential stressors which may affect symptom reporting, such as:
- family or relationship problems;
- pressures from coaches and teammates to return to sports; and/or
- restriction from participation in important upcoming life events.
- Employ age-apppropriate symptom checklists serially to follow a student through their recovery and identify areas that might require more targeted interventions.
- Because many of the symptoms reported after concussion may not be unique to concussion (for example, some students may have pre-existing depression, chronic daily or intermittent headaches, learning disabilities, or attention deficit/hyperactivity disorder), further inquiry as to the specific nature of the symptoms reported by the student or observed by the parent may be needed.
- Different symptoms checklists[5] are recommended for students in seventh grade and up (SCAT3) [6] and for kindergarten to sixth grade (Child-SCAT3);[7]
- Take a careful concussion history to account for any preinjury conditions, especially for those experiencing prolonged postconcussive symptoms, which should be managed concurrently;
- Prescribe adequate physical and cognitive rest, as appropriate, to help minimize a worsening of symptoms and potentially facilitate a quicker recovery without significant disruption to the student's life;
- Communicate with other members of the multidisciplinary team on an ongoing, as-needed basis to coordinate and facilitate a concussed student's return to learn (see next section);
- Counsel concussed athletes on the current recommended return to activity progressions, as outlined in the AAP's 2010 clinical report.[2]
Concussion symptoms: implications for learning
The report provides helpful information on the potential implications in school for a student experiencing particular concussion symptoms and the kind of adjustments that may be required as a result:
| Sign/Symptom | Potential Implications in School |
Potential Adjustments |
|
Headache |
|
|
|
Dizziness/lightheadness |
|
|
|
Visual symptoms: light sensitivity, double vision, blurry vision |
|
|
|
Noise sensitivity |
Troubles with various aspects of the school environment
|
|
|
Difficulty concentrating or remembering |
Challenges learning new tasks and comprehending new material:
|
|
|
Sleep disturbances |
|
|
