By Erika B Persson MD, FRCPC, Dip Sport Med, Pediatric Sport Medicine Physician, Glen Sather Sports Medicine Clinic
Concussion is a very common problem among athletes participating in contact or collision sports. The media and popular press have increased awareness of this injury by increased reporting in both print and television. High profile professional athletes such as Sydney Crosby being afflicted with chronic and prolonged concussion symptoms have also made concussion a hot sport medicine topic.
A concussion occurs when the head sustains either a direct or indirect force, which is then transmitted to the brain. A concussion causes changes to the brain function, not structure, thus findings are not visible on imaging studies such as MRI or CT scans. There are many symptoms of concussion including headache, balance problems, mood and emotional issues, sleep disruption, difficulty concentrating and irritability. Symptoms of concussion can vary from person to person, and with each successive concussion.
Treatment for sport-related concussion involves an individual approach to each athlete and their symptoms. Mental and physical rest is the cornerstone of treatment and should be in place until symptoms fully resolve. After this period of rest and symptom recovery, a graduated “return-to-learn,” followed by” return-to-play” is recommended. Most athletes that sustain a concussion have short-lived symptoms (2-10 days) that spontaneously resolve without any lasting effect; however, there is a small minority that will have a complicated and prolonged recovery.
Many physicians and other healthcare providers are able to recognize and diagnose a concussion. The popular press has reinforced the need for physical rest, but new evidence has identified the importance of mental rest in the recovery from concussion. It is equally, if not more, important to rest the developing brain from mental stimuli such as academics, TV watching, text messaging and video games after a concussion is sustained to allow the brain to “reset and heal.”
Many patients that have ongoing, prolonged or worsening symptoms after concussion have missed the mental-rest component of their treatment plan. These student athletes try to struggle through classes and have to face many difficult things at school such as academic stresses, including concentrating on new concepts and testing. Aspects of the school environment and technology such as smart boards, bright fluorescent lights and loud hallways can aggravate and prolong concussion symptoms. Concussed athletes may be seen as “faking their illness” as there are no visual indications to the concussion injury. By making the brain function, instead of resting during recovery from concussion, symptoms are prolonged. It is important that a student returns-to-learn before returns-to-play.
Accommodations for the classroom and school environment are essential when returning a concussed student back to learning after their injury. Students should not be returned to the learning environment until they have had resolution of concussion symptoms. Upon returning to learn, the first stages should involve less intense cognitive activity, such as reading, at home first to ensure no recurrence or increase of concussive symptoms. As the athlete increasingly tolerates the cognitive load, gradual reintroduction into the classroom for a few classes each day is possible, with the student monitoring symptoms to ensure the added mental stress does not cause recurrence of the concussive symptoms.
The number of days for a student athlete to get back to full academics and the accommodations that are required to accomplish the return-to-learn process varies from student to student. Depending on symptoms, some students may need to reduce visual stimuli by wearing sunglasses in the classroom or having pre-printed notes rather than using the smart board. Others may need to be excused from classrooms a few minutes earlier to avoid the noisy hallways if loud noises are a problem.
When returning to the learning environment students should be permitted to go to a quiet room if their symptoms increase during class. However, if the symptoms do not abate within a short time (20-30 minutes), the student should be sent home for more mental rest.
Concentration is often difficult during the recovery from concussion and students may need altered seating in the classroom or extra time for assignments. In the extreme setting or prolonged school absence, an individualized program plan may be required for the student to remain in the school setting. Teachers and school administrators need to work with a concussed student and their family to gradually catch up on their missed work and delay any testing until the student is caught up.
Schools are beginning to recognize concussion and its impact on learning. However, many schools have not had enough education on the ways a student suffering from concussion requires modification to the learning environment. It is promising that many school boards are in the process of formalizing concussion protocols. As well, a number of governmental agencies are putting into place “concussion safety laws” for student athletes. With more awareness of the appropriate assessment and treatment of concussion, and the graduated return-to-learn before return-to-sport, the risk of ongoing symptoms and chronic impairment of academic performance and learning will be significantly lower.
Any student athlete who is suspected to have sustained a concussion should be removed from physical activity immediately and assessed by a healthcare provider who can help them make a safe return to both the classroom as well as to the field of play.
This information is provided for your knowledge only and does not replace the medical advice of your personal physician. Talk to your doctor for more specific medical advice tailored for your health needs.