Tuesday, November 12, 2013

Return to Learning Guidelines Following Concussion

At the end of October the American Academy of Pediatrics (AAP) published a series of guidelines to assist in returning young people to learning following a concussion.  I published a link to the full article on the A4IA Facebook Page shortly thereafter, but I wanted to take the time to introduce the statement to you today.  As we learn more and more about concussions, how to recognize them and how to manage them the idea of cognitive rest along with physical rest has become an increasingly popular concept. 

The concept was even discussed in the guidelines published following the 4th International Conference on Concussion in Sport held in Zurich last November.  The resulting consensus statement from this conference did not lead to specific guidelines on how to return to learning (RTL).  The AAP has since tackled that project and developed some key concepts that pediatricians, parents and school administrators, staff and teachers should be familiar with.  The intended audience is pediatricians, but I found these guidelines very helpful as an athletic trainer and believe parents and schools will think the same.

You can review the full statement, HERE.

Following my own review of the statement I have the following recommendations for parents who are dealing with a young child or adolescent who has suffered a concussion and returning to learning:
  • Remember, everyone’s recovery from a concussion is different.  The rate at which symptoms start to dissipate will vary from person to person and concussion to concussion.  Be flexible and adjust your child’s rest needs based on their symptoms and not “cookbook” recommendations.
  • Read the AAP’s entire statement on RTL and be sure your child’s pediatrician is familiar the statement and is willing to work with you and your child’s school to facilitate your child’s recovery and return to school.  Most students will recover within 1-3 weeks and help will only be needed for a short period of time.
  • Become familiar with education jargon relative to the various types of academic adjustments that are available so you can communicate clearly with your child’s pediatrician and school (the statement can help with this).
  • Become familiar with the resources available at your child’s school from both a health and academic perspective and communicate with appropriate parties as needed while your child is returning to school.  This should be a team effort.  For example, who is the school nurse, school psychologist, athletic trainer, special education contact?
  • If your child suffers prolonged post-concussion syndrome it is important to consider further follow up with a neuropsychologist (or other specialist) who is familiar with pediatric concussions.
  • Remember, students should be at their academic “baseline” BEFORE returning to sports.
  • The statement provides additional concussion resources at the conclusion of the statement and while they were likely intended for pediatricians I believe they may be useful in answering additional questions for parents and others.

Just as returning to sport too soon after a concussion can prolong symptom, it is believed that returning to school too soon can do the same.  It is important to know that research is still being done to continue to clarify RTL guidelines, but based on what we know it appears that the same graded return process that is used for physical exertion is also a useful process when considering cognitive exertion.  In the end, as I always seem to say, be prepared and have a plan.  It’s a team effort to return a child to school and sport following a concussion and the more you know, the more the team will know.

Submitted by Heather L. Clemons, MS, MBA, ATC

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