It is estimated nearly 1.7 million people receive a brain injury each year. Approximately 75% of those injuries are concussion type brain injuries. And school aged children are particularly at risk for concussions. In 2009, 248,418 children age 19 and under were treated for concussions or traumatic brain injuries related to sport or recreation.
A lot of attention has been paid to getting kids back to play after a concussion. In fact a return-to-play protocol has been developed to allow the player to return to the sport in six systematic steps. But for students, getting back into the classroom is more important than getting back to sports.
Because the brain’s normal functioning is temporarily disrupted after a concussion or brain injury, kids need return-to-learn protocols to help manage school activities at a pace that is appropriate for their recovery.
Concussions are more than just a hit to the head
Depending on the force of the hit, a child will likely be dazed or may even lose consciousness. At the time of the injury, signs of a concussion and disrupted brain functions include a headache, dizziness, seeing stars, ringing in the ears, nausea, vomiting, slurred speech, delayed response to questions, fatigue, or a lack of memory surrounding the event.
When working properly, the brain’s cells use electrical charges to signal when to release neurochemicals, called neurotransmitters and hormones. These bind to other neurons, telling the next cell to fire and release its own neurochemicals. But concussions cause changes in these neurons and effects the release of these chemicals, which can affect brain function.
The prevailing theory is that when the head or body receives a significant impact, these neurochemicals leak or spill out of the cells. Therefore after a severe-enough hit, the chemicals in the brain may not work the way they are supposed to.
Recovery has to start with complete rest
During the phase immediately after the concussion brain cells need more oxygen and glucose, which is delivered to the brain via the blood circulatory system. Recovery starts with prescribed physical and mental rest to allow the body to deliver more of what the brain needs to stay healthy and recover. That’s why activities that will increase the heart rate – and divert oxygen and glucose from the recovering brain – such as running, walking long distances or lifting heavy objects, are discouraged.
In this phase of recovery proper amount of sleep is incredibly important and kids should stay away from caffeine that could prevent getting the full amount of sleep the brain needs.
As for mental rest – that means limiting or completely restricting reading, computer and cell phone use, socializing, playing musical instruments and playing loud music. Rest really means rest.
The road to recovery
Recovery from a concussion can last from days to months. The chemical balance critical to proper brain function needs to return to normal. Think about a broken arm or a sprained ankle. You wouldn’t second-guess it if someone had to take time off from normal physical activities to recover from this kind of obvious, external injury. The brain also needs time to recover before normal activity, such as studying, can resume.
There’s evidence that younger brains take longer to recover than more mature brains. And while recovering, a child may face a number of different symptoms.
Cognitive symptoms can include difficulties with attention and concentration, slowed thinking, forgetfulness, trouble making decisions and difficulty being organized. A child could also have physical symptoms such as headaches, sensitivity to light or noise, balance problems and trouble sleeping can also occur. And let’s not forget emotional health; feelings of depression and anxiety, irritability or a sense of being overwhelmed can also be features of post-concussion recovery.
Picture having those symptoms and trying to do schoolwork or stay focused in a noisy classroom.
Building a return-to-learn protocol
The severity of the injury and symptoms can vary from person to person and from age to age. The pace of recovery is hard to predict, which is why there isn’t a standard return-to-learn protocol for getting kids back to normal school work.
But there are some common features such as rest, attending school when symptoms allow (perhaps on a part-time basis), and allowing the student to gradually participate in more normal activities as symptoms permit.
The idea is to reintroduce activities progressively, so that the return to school can match the level of recovery. The severity of symptoms needs to be monitored to make sure they aren’t getting worse as more activities are introduced. Symptoms can ebb and flow; some days headaches can be very painful but sensitivity to noise is tolerated, whereas other days there may be no headaches but the student may tire easily. Over time, activities ramp up to pre-concussion levels. This way a child isn’t forced to take on work or obligations that they aren’t yet ready for.
Cognitive symptoms can make school work difficult at first
When the student does return to school they may have some difficulties with attention and concentration or slowed information processing or other cognitive, physical or emotional issues. Students may need accommodations, like delaying exams or help taking notes. They might also need to leave class early to avoid getting stuck in crowded hallways.
Over time, partial school days can become full school days as symptoms lessen and tolerance for the cognitive demands of school increases. Some accommodations such as recording lessons or modified workloads when students return to a full-day school schedule may still be needed. Homework assignments should gradually increase as the amount of the other accommodations decreases.
A federal 504 plan, which outlines accommodations to for children with disabilities, including learning and attention issues, might be needed. The plan helps provide a supportive environment for the student while they recover.
When symptoms are gone or minimal, full school days, normal workloads and physical activities can resume. If symptoms worsen, it’s time to dial back activities again. When the student can manage a normal workload, without exacerbating post-concussion symptoms, then they should be cleared to engage in all school activities.