Returning to School After a Concussion
Between 1.1 and 1.9 million young athletes are estimated to suffer sports-related concussions every year. Almost all recover without problems and quickly return to full participation in their schoolwork. But some face challenges. They tire quickly, have trouble focusing, complain of headaches or dizziness, sleep poorly and suffer mood swings. The few with lasting symptoms may be set back at school for a full year.
Despite guidelines designed to help children with concussions return to learning, many schools lack formal policies, and many parents and school professionals lack the knowledge, training and capacity to properly help.
“It would be nice to have a protocol for return to full classwork,” one teacher told a University of Washington research team studying the unmet needs of students after concussion. “I know in sports we have a gradual plan for returning kids to practice then competition, but there is no such plan for school.”
Communication often breaks down at multiple links—between parents and the school, between the child’s doctor and the school nurses, and among various school professionals from the attendance office to counselors to teachers and nurses. “Schools need a flow chart with a step-by-step guide,” one parent suggested.
Even if everyone followed guidelines and flow charts, however, there is no guarantee they’d succeed. None of the recommendations has been rigorously evaluated or tested.
What you need to know
In the absence of strong evidence, researchers, educators and others recommend these common-sense tips to help a child or adolescent return to learning following concussion.
Working with a doctor
- Students should have regular follow-up visits with a doctor to see if symptoms are improving or whether they will need help returning to school.
- If a student needs to make adjustments, or “accommodations,” to lessen school demands, the doctor should write a letter to the school explaining the student’s limitations and the doctor’s recommendations for returning to learn. The U.S. Centers for Disease Control and Prevention has created a template for a school letter that a doctor can complete.
- Students may return to school if bothered by symptoms, but returning too early can make symptoms worse.
- Students should return to school before fully returning to sports.
Making adjustments at school
- Parents should actively engage with teachers, counselors, school nurses and others if a child needs to make accommodations to return to school.
- Parents should find out who will act as a case manager to support their child at school and serve as a primary contact. This may be a school nurse, psychologist, counselor or teacher.
- Students may need to adjust their schoolwork and other demands to prevent symptoms from worsening.
- Adjustments may include reducing the number of hours spent in school; spending less time on schoolwork or computers; taking frequent breaks; allowing more time to take tests and complete assignments; helping students organize daily tasks and more. (For additional information, see the CDC’s fact sheet for school professionals.)
- Some students may require temporary absence from school while they recover.
- Although most students return to school within two to five days, a student who continues to struggle may benefit from a Section 504 Plan. Section 504 Plans are designed to provide supplemental services to students with temporary or permanent disabilities.
5 factors that influence return to school
Experts who gathered in Berlin in 2016 to review the research on sports concussions in children concluded that five factors influence how fast and successfully children return to learning following a concussion:
- Age: Adolescents tend to have more symptoms than younger children and symptoms that are more severe. They also tend to need more time to recover and to return to school and sports.
- Symptoms: Students who have more symptoms and symptoms that are more severe tend to take longer to return to school and sports, and benefit from more accommodations at school.
- School resources: Schools that create concussion policies and educate students and parents about concussion also tend to align their concussion management practices with best-practice guidelines, provide more accommodations to students with concussions, and take a more systematic team approach to helping students return to learning.
- Medical follow-up. Students seen for a concussion in a hospital emergency room are more likely to receive academic accommodations for their return to school if they follow-up with a doctor.
- Subject matter. Certain academic subjects pose greater difficulty than others for a student who has suffered a concussion. Math is the most challenging, followed by reading/language, arts, science and social studies.
Students who have persisting difficulty returning to school should seek care at a center that specializes in concussion or brain injury and offers care from a variety of health care professionals. Persisting symptoms may have a range of causes, and a team of healthcare providers and educators working together can put together a plan that’s right for each student.