The Grapevine

Concussion Recovery Takes Time; Student Athletes Might Want To Postpone Going Back To School After TBI

Concussion Guidelines
Students should wait to go back to school after a concussion. REUTERS/Brendan McDermid

Since parents are not equipped to identify symptoms of a concussion, experts say the time is now to create a concise set of guidelines governing concussion recovery. Evidence continues to show that rest is essential for the brain to repair itself after a hit to the head, but parents currently have no resources to tell them how much downtime their child will need and how they should handle the injury moving forward.

Researchers from the University of Rochester Medical Center have finished a study that compared recovery standards among student athletes who sustained a concussion and those who injured an extremity. Their results highlight the need for ready-to-learn guidelines that make it clear how long students should spend away from the classroom following a traumatic brain injury.

"Most students who play sports are not going to become professional athletes but they will need to continue with school and prepare for a career," said Dr. Erin Wasserman, currently a postdoctoral research trainee at the Matthew Gfeller Sport-Related Traumatic Brain Injury Center at the University of North Carolina Chapel Hill, in a statement. "So, just as they need guidance for when they can play again, they need guidance and protection for when it's appropriate to return to class and what to expect."

Wasserman and her colleagues compared academic problems among 70 high school athletes who sustained a concussion to 108 athletes who suffered a sports-related injury to their arms or legs. All of the students visited emergency departments in the Rochester area within 24 hours of being injured. The research team conducted telephone surveys one week and one month after the injury that assessed each student’s schoolwork, including their ability to concentrate and their performance on tests and quizzes.

Their findings showed that only 24 percent of students who were diagnosed with a concussion did not return to school within a week. Academic problems among student athletes who sustained a concussion were 16 points higher on the 174-point scale used by the research team compared to those who suffered an injury to their arms or legs. Although these disparities went away after one month for most athletes, they did not for those with a history of two or more concussions and for women, whose menstrual cycles can impact recovery.

The amount of time we spend resting both our bodies and our minds after a concussion is critical to the recovery process. Researchers from Georgetown University Medical Center recently conducted a similar study that compared the brains of mice who sustained a single concussion each day for 30 days and those who sustained one a week for 30 weeks.

Mice who sustained a single concussion each week suffered temporary loss of 10 to 15 percent of neuronal connections in their brains. However, there was no noticeable inflammation or cell death among these mice. Mice that sustained daily concussions, on the other hand, did experience inflammation and damage to the brain’s white matter that got progressively worse for two months and was still there after a year.

The American Academy of Pediatrics released a clinical report in October 2013 that found children recovering from head trauma may have trouble understanding and retaining new information. The lead researcher, Dr. Mark Halstead, called sending students back to school after the standard recovery time of around two to four weeks detrimental to both their academics and overall health. He recommends every parent adopt a personalized and gradual reintroduction to school based on the severity of the concussion, and his team published a useful symptom checklist for head trauma.

Source: American Journal of Public Health . 2016.

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