3 Keys to Know How and When to "Return-To-Learn" After Concussion Injury
Youth sports participants are "Students First" and need guidance in returning to class safely after a concussion injury
By Harry Kerasidis, MD
Once free of symptoms, the concussed student-athlete begins a progressive-exertion recovery protocol to complete prior to seeking clearance from a medical professional to return to athletic activities, or return-to-play. However, too often a “return-to-learn” protocol is overlooked, which could complicate healing, and have other negative affects.
Student-athletes are “students” first, and a premature return to the classroom may provoke the concussion symptoms, delay healing and even lead to other mild traumatic brain injury symptoms.
Here are three keys to consider when helping the individual return-to-learn safely.
1. Recovery Timelines Vary — Physical recovery may occur faster than full cognitive healing. Individual brain health also varies, based on history of prior injuries and other lifestyle factors. It is important to take into account the athlete's cognitive and emotional wellbeing before considering the return to physical exertion.
2. Monitor Symptoms — It is imperative that the athlete's symptoms are closely monitored during this phase of recovery, and avoid provoking symptoms of the concussion. The best way to do this is to use an internet-based concussion symptom checklist. Should headaches, sleep disturbances, or other complaints return, then the Plan should be revised so that the symptoms are no longer present. The immediacy of Internet communications allows the healthcare provider a nearly real-time tracking of the athlete's response to the return-to-learn process. Be patient, and communicate with school officials, recommending certain “adjustments” to the academic load during recovery.
3. Follow an Academic Care Plan — In my protocol, a carefully-constructed Academic Care Plan is established and customized to the needs of the student by mapping the symptoms the athlete is experiencing to the adjustments in the academic setting. In the absence of a tailored Academic Care Plan, it is advisable to follow the American Academy of Pediatrics guidelines, and consider making certain adjustments to avoid provoking concussion related symptoms. Adjustments should be specifically tied to the symptoms, ex. Allow late starts, and afternoon naps, if the individual is experiencing sleep disturbances. Adjustments may include:
- Late school starts, early dismissals
- Allow to dim lights, wear earplugs, sunglasses, and visits to nurse
- Look for emotional stress and mood problems. Refer to the school psychologist should they become apparent.
An argument could be made the return-to-learn decision is more important than return-to-play, considering the consequences. An athlete MUST NOT return to practice or gameplay if he or she cannot participate in a normal academic schedule without provoking symptoms.
Furthermore, should the student-athlete return to full academic activity after a concussion injury prematurely, the healing process may be delayed or halted, which can lead to prolonged Post-Concussion Syndrome, among other problems. At the same time, there is mounting evidence that keeping the student out of school and at complete rest is detrimental. There are emotional disturbances that emerge as the student is cut off from his or her peer group support system. This is often compounded by the stress of falling behind in their school work. Often the athlete kept home will begin to assume a "sick role" in the family dynamics.
From the study Abstract “Returning to learning following a concussion,” published in Pediatrics, the official journal of the American Academy of Pediatrics:
“Following a concussion, it is common for children and adolescents to experience difficulties in the school setting. Cognitive difficulties, such as learning new tasks or remembering previously learned material, may pose challenges in the classroom. The school environment may also increase symptoms with exposure to bright lights and screens or noisy cafeterias and hallways. Unfortunately, because most children and adolescents look physically normal after a concussion, school officials often fail to recognize the need for academic or environmental adjustments. Appropriate guidance and recommendations from the pediatrician may ease the transition back to the school environment and facilitate the recovery of the child or adolescent. This report serves to provide a better understanding of possible factors that may contribute to difficulties in a school environment 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.”
With the sports concussion protocol used in my neurology clinic, XLNTbrain Sport™ includes a fully customizable Academic Care Plan for concussed student athletes. This incorporates an option for an automated "pre-fill" algorithm to assist the healthcare provider in crafting an appropriate Care Plan. The software considers the most recent symptom checklist, completed by the individual online or through the XLNTbrain-mobile app and maps out related school adjustments and timeframe. Academic adjustments are made that are relevant to the student's symptoms allowing those that are needed and excluding those that don't apply.
Parents appreciate the Academic Care Plan because it facilitates the coordination between the healthcare provider and the school staff, while closely monitoring their child’s symptoms. Among all the features embedded in XLNTbrain Sport™, surprisingly this single attribute has received the most passionate positive response.
Harry Kerasidis, M.D. is the founder and medical director for the sports concussion management platform XLNTbrain, LLC, based in Maryland. He is also the founder of Chesapeake Neurology Associates in Prince Frederick, Maryland and serves as the Medical Director for the Center for Neuroscience, Sleep Disorders Center and Stroke Center at Calvert Memorial Hospital. His new book, “Concussionology: Redefining Sports Concussion Management” comes out next month.
XLNTbrain LLC helps prevent and detect concussions and guide a safe return to normal activity and gameplay. XLNTbrain is a proud sponsor of MomsTEAM Institute and SmartTeams™. Schedule a demonstration or obtain more information by calling (703) 675-1857, or emailing email@example.com.
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