HACKENSACK, N.J. – A concussion shouldn’t just keep children and teenagers out of sports while they recover – it may also require a break from the classroom, according to a new report by the American Academy of Pediatrics.
The report, released Oct. 27, stressed the importance of avoiding intellectual stimulation while concussion symptoms are at their worst. The report noted that there is increasing evidence that using a concussed brain to learn “may worsen concussion symptoms and perhaps even prolong recovery.”
Doctors, researchers and educators have long noticed that students with concussions can find it challenging to learn, read or remember previously learned material. But the report went further, stating: “The school environment may also increase symptoms with exposure to bright lights and screens or noisy cafeterias and hallways.”
Dr. Howard Mazin, a pediatrician at Englewood Hospital and Medical Center in New Jersey, said he agreed with the report’s recommendations. “Everyone needs to understand that the student should not only avoid the activity that caused the concussion but all activities that utilize the brain need to be reintroduced slowly,” he said.
The academy offered a sample policy describing the accommodations that students with concussions might need, which include rest breaks, reduced school hours, homework help and more time for tests and assignments. Reading, writing and computer time might need to be limited, the policy suggested, and early dismissal may help injured students avoid crowded hallways. The report recommended that classroom time be reintroduced in small increments, such as 30-minute sessions.
The average recovery time for a school-age student is three weeks from injury.
“What we’ve seen over the last several years is borne out in this study – intellectual rest is just as important as physical rest,” said Dr. Stephen Thompson, chief of pediatric neurology at Hackensack University Medical Center.
Even seemingly benign activities such as watching a television sitcom require the brain to work, according to Thompson. “Passive forms of entertainment still engage the brain – processing the storyline, listening, the brain is still working,” he said.
Convincing parents, educators and even the injured child that full participation in school should not resume quickly sometimes proves difficult because the child often appears healthy, doctors said. But physicians now know that even when the child seems to be symptom-free, the brain is still healing.
“They appear physically well so they think they’re better,” Thompson said. “But when the brain is injured, it doesn’t process things as quickly and they struggle to do their classwork and assignments.”
High schools and youth sports teams have been under pressure in recent years to sideline athletes with concussions until they are healed.
Recent research into concussions among children, whether they occur on the ball field or the playground or because of an accident, has focused on the significant danger of reinjuring the brain before a concussion has fully healed. Called “second impact syndrome,” it can cause permanent damage to a growing brain.
But this is the first report on the dangers of classroom and other intellectual activities to a concussed brain. The academy noted that there is relatively little research into the issue and called for further study to improve the understanding of the best ways to help students recovering from a concussion.
Those who deal with injured children said they have been practicing the recommendations but the report makes it easier to educate others.
According the New Jersey School Boards Association, school districts statewide have policies that note the cognitive effects of head injuries and stress that accommodations may be needed so injured students get mental as well as physical rest.
Marcine Cirigliano, a nurse at Schuyler-Colfax Middle School in Wayne, N.J., said the school generally works with students, parents and doctors to tailor accommodations. “It’s on a case-by-case basis,” she said, noting that a girl who was healing from a head injury recently needed to rest in a dark spot in the nurse’s office during the day.
“The teachers can modify the work so they’re not overloaded,” Cirigliano said.
Nearly 500,000 emergency room visits nationwide each year are due to brain injuries in children age 14 and younger. Immediate symptoms of a concussion include headache, nausea, lightheadedness and numbness or tingling in the extremities. But symptoms that linger or show up days later may be more difficult to explain, especially for young children, experts say.
“They may feel drowsy, have sleep disturbances and just say they don’t feel right,” said Dr. Jeffrey Bienstock, director of pediatrics at The Valley Hospital in Ridgewood, N.J. “Then when they try to engage in intellectual activities they might become more irritable, and have difficulty thinking clearly. Some become embarrassed and angry.”
Physicians, educators, and parents need to remember that each child’s concussion is different and there isn’t a “cookie-cutter” approach for treatment, the academy’s report said.
“Every concussion is unique and will vary from student to student,” said Dr. Mark Halstead, lead author of the report.