The Learning Effects of a Concussion in Children

In the past, the focus of pediatric studies and research of concussions has been primarily centered on diagnosis, education regarding the problem, and the timing of safe return to sports. Little attention has been given to academics and learning and how a concussion may affect the young student learner. However, the American Academy of Pediatrics (AAP) recently published a clinical report titled “Returning to Learning Following a Concussion”. This report attempts to provide a better understanding of factors that may contribute to difficulties at school after a concussion and serves as a framework for the medical home, the educational home, and the family home to guide the student to a successful and safe return to learning.

The report introduces the topic by explaining that concussions in students, especially student athletes, have received much attention. This report attempts to develop appropriate guidance and evidence-based recommendations for a “return to learn” (RTL).  Because of limited research in this area, the guidance provided in the report is based primarily on “expert opinion” and adapted from a program developed in Colorado to address this issue of RTL.

There are many published statements that discuss the importance of cognitive rest following a concussion. Cognitive rest refers to avoiding potential cognitive stresses, such as testing, video games, TV exposure, school work, etc. There is a need to return the student to complete school activities safely without unnecessary delay. This calls for an individualized approach for the student with a concussion, regarding cognitive rest and the student’s RTL in the school setting. Cognitive difficulties following a concussion have long been recognized and can clearly affect a student’s learning capabilities. There is also increasing evidence that using a concussed brain to learn may worsen concussion symptoms and perhaps prolong recovery time. Therefore, a goal during concussion recovery is to avoid overexerting the brain to the level of worsening or reproducing symptoms.

Research has demonstrated that recovery for the school-aged student with a concussion is usually within three weeks from the injury, but school adjustments during the recovery period may be necessary. Allowing adequate cognitive rest may help minimize a worsening of symptoms and potentially facilitate a quicker recovery without significant disruption of the student’s life. Because the diagnosis of concussion is largely symptom driven, use of symptom checklists may be helpful not only in evaluating what symptoms the student may be experiencing but also in rating the symptoms severity.

The report recommends a multidisciplinary team approach to maximize a student’s recovery from a concussion. The multidisciplinary team includes a “family team”, a “medical team” and possibly two “school teams”. The responsibility of the family team is to enforce rest and to reduce stimulation to the student during recovery while at home. The responsibility of the medical team is to evaluate the concussion, assess for a more severe neurological injury, and prescribe physical and cognitive rest until the symptoms improve. The school teams include one to supervise physical activity of the student at school and the other to supervise academic activity at school. Specifically, the school academic team must coordinate the return of the student to cognitive exertion and help to facilitate the appropriate level of academic adjustments necessary to reduce or eliminate symptoms.

As previously mentioned, returning a student to the classroom while symptomatic from a concussion requires an individualized approach. Usually, the student can return to school when he or she can tolerate cognitive activity for at least 30-45 minutes. The student may then benefit from 30 minutes of instruction and a 15 minute rest period before returning to class. Most students can resume normal academic activities within three weeks. A small percentage of students may require academic accommodations for longer term needs beyond three weeks. Academic modifications may be required for more prolonged and more permanent changes to an educational plan, necessitating special education with needs specified in an IEP (individual education plan).

The report also stresses that education regarding concussion is essential for the teams of individuals helping a student with a concussion during assessment, management and recovery. A comprehensive team approach, with educated partners, may help reduce mistakes in management, which could potentially result in reinjury during the healing phase, lengthen recovery, or result in untoward long-term outcomes.

Lastly, the report admits that there have been too few studies conducted thus far regarding the effects and role of cognitive rest after concussions and that further research is needed to clarify best practices for RTL. For more information, visit http://www.aap.org or http://www.essehealth.com.In the past, the focus of pediatric studies and research of concussions has been primarily centered on diagnosis, education regarding the problem, and the timing of safe return to sports. Little attention has been given to academics and learning and how a concussion may affect the young student learner. However, the American Academy of Pediatrics (AAP) recently published a clinical report titled “Returning to Learning Following a Concussion”. This report attempts to provide a better understanding of factors that may contribute to difficulties at school after a concussion and serves as a framework for the medical home, the educational home, and the family home to guide the student to a successful and safe return to learning.

The report introduces the topic by explaining that concussions in students, especially student athletes, have received much attention. This report attempts to develop appropriate guidance and evidence-based recommendations for a “return to learn” (RTL).  Because of limited research in this area, the guidance provided in the report is based primarily on “expert opinion” and adapted from a program developed in Colorado to address this issue of RTL.

There are many published statements that discuss the importance of cognitive rest following a concussion. Cognitive rest refers to avoiding potential cognitive stresses, such as testing, video games, TV exposure, school work, etc. There is a need to return the student to complete school activities safely without unnecessary delay. This calls for an individualized approach for the student with a concussion, regarding cognitive rest and the student’s RTL in the school setting. Cognitive difficulties following a concussion have long been recognized and can clearly affect a student’s learning capabilities. There is also increasing evidence that using a concussed brain to learn may worsen concussion symptoms and perhaps prolong recovery time. Therefore, a goal during concussion recovery is to avoid overexerting the brain to the level of worsening or reproducing symptoms.

Research has demonstrated that recovery for the school-aged student with a concussion is usually within three weeks from the injury, but school adjustments during the recovery period may be necessary. Allowing adequate cognitive rest may help minimize a worsening of symptoms and potentially facilitate a quicker recovery without significant disruption of the student’s life. Because the diagnosis of concussion is largely symptom driven, use of symptom checklists may be helpful not only in evaluating what symptoms the student may be experiencing but also in rating the symptoms severity.

The report recommends a multidisciplinary team approach to maximize a student’s recovery from a concussion. The multidisciplinary team includes a “family team”, a “medical team” and possibly two “school teams”. The responsibility of the family team is to enforce rest and to reduce stimulation to the student during recovery while at home. The responsibility of the medical team is to evaluate the concussion, assess for a more severe neurological injury, and prescribe physical and cognitive rest until the symptoms improve. The school teams include one to supervise physical activity of the student at school and the other to supervise academic activity at school. Specifically, the school academic team must coordinate the return of the student to cognitive exertion and help to facilitate the appropriate level of academic adjustments necessary to reduce or eliminate symptoms.

As previously mentioned, returning a student to the classroom while symptomatic from a concussion requires an individualized approach. Usually, the student can return to school when he or she can tolerate cognitive activity for at least 30-45 minutes. The student may then benefit from 30 minutes of instruction and a 15 minute rest period before returning to class. Most students can resume normal academic activities within three weeks. A small percentage of students may require academic accommodations for longer term needs beyond three weeks. Academic modifications may be required for more prolonged and more permanent changes to an educational plan, necessitating special education with needs specified in an IEP (individual education plan).

The report also stresses that education regarding concussion is essential for the teams of individuals helping a student with a concussion during assessment, management and recovery. A comprehensive team approach, with educated partners, may help reduce mistakes in management, which could potentially result in reinjury during the healing phase, lengthen recovery, or result in untoward long-term outcomes.

Lastly, the report admits that there have been too few studies conducted thus far regarding the effects and role of cognitive rest after concussions and that further research is needed to clarify best practices for RTL. For more information, visit http://www.aap.org or http://www.essehealth.com.

By Dr. Joseph Schacter, Esse Health Pediatrician                                                      Esse Health Tesson Ferry Pediatrics

13303 Tesson Ferry Rd., Suite 150

St. Louis, MO 63128

Phone: 314-842-5239