Home » academic accommodations » Ensure Successful Return To Classroom After Concussion, Says Pediatrics Group

From the American Academy of Pediatrics

Ensure Successful Return To Classroom After Concussion, Says Pediatrics Group

AAP recommends team approach involving family, medical and school personnel to get concussed students back on track in school

Longer period of rest needed?

Moser also questioned the authors' of the AAP clinical report's admittedly arbitrary recommendation that parent consider returning a concussed child back to learning when they are able to "tolerate symptoms comfortably for up to 30 to 45 minutes," as she was unsure what the phrase  'tolerate comfortably' meant.

"If a student, during the first week or more [after concussion], has headaches after being on a computer or reading for 30-40 minutes, then I am not sure how they can sustain a day of school, even with rest breaks between classes. I recommend that parents and students work with a concussion specialist who can tailor a plan for them and decide if the student really completed a long enough comprehensive rest period." 

In the same vein, Moser questioned the AAP report's repeated assertion, based on research published in 2006,[6] that almost all pediatric athletes recover from concussion within three weeks, when more recent research using advanced neuroimaging and neuroradiologic techniques, as well as other research, has furnished "increasing evidence to suggest that the youth brain takes much longer to return to normal, likely months."

"Although the authors stress that each concussion is unique and there is no 'cookie-cutter' approach in management," Moser said she was "concerned that parents and health care providers will hinge their expectations [about recovery] on this 'three weeks' idea."  

1. Halstead ME, et al. Council on Sports Medicine and Fitness; Council on School Health: Returning to learning following a concussion. Pediatrics 2013;132(5):949-957

2. Halstead, ME, Walter, K. "Clinical Report - Sport-Related Concussion in Children and Adolescents"  Pediatrics. 2010;126(3):597-615 (http://aappolicy.aappublications.org/cgi/content/full/pediatrics;126/3/5...).

3. Rocky Mountain Youth Sports Medicine Institute, Center for Concussion. REAP Guidelines. Available at: http://www.rockymountainhospitalforchildren.com/sports-medicine/concussi.... (accessed June 18, 2013)

4. Zonfrillo MR, Master CL, Grady MF, Winston FK, Callahan JM, Arbogast KB. Pediatric providers' self-reported knowledge, practices, and attitudes about concussion. Pediatrics. 2012;130(6):1120-1125.

5. McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.  Br J Sports Med 2013;47:250-258.

6. SCAT3. Br J Sports Med 2013;47:259  

7. Child SCAT3. Br J Sports Med 2013;47:263.

8. Moser RS, Glatts C, Schatz P.  Efficacy of Immediate and Delayed Cognitive and Physical Rest for Treatment of Sport-Related Concussion. J Pediatrics 2012;161(5):922-926 (after one week of strict cognitive and physical rest, concussed high school athletes scored significantly better on neurocognitive tests and reported statistically significant decreases in the number and severity of post-concussion symptoms

9. Collins M, Lovell MR, Iverson GL, Ide T, Maroon J. Examining concussion rates and return to play in high school football players wearing newer helmet technology: a three-year prospective cohort study. Neurosurgery. 2006;58(2):275-286, discussion 275-286

10. Brown NJ, Mannix RC, O'Brien MJ, Gostine D, Collins MW, Meehan WP. Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms. Pediatrics 2014;133(2):1-6.

11. Majerske CW, Mihalik JP, Ren D, et al. Concussion in sport: postconcussive activity levels, symptoms, and neurcognitive performance. J Athl Tr. 2008;43(3):265-274.

12. Giza C, Kutcher J, Ashwal S, et. al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013;80(24):2250-2257 DOI:10.1212/WNL.ob013e31828d57dd.

13. Herring SA, Cantu RC, Guskiewicz KM, et al. American College of Sports Medicine Concussion (mild traumatic brain injury) and the team physician: a consensus statement-2011 update. Med Sci Sports Exerc. 2011;43(12):2412-2422.

14.Harmon KG, Drezner J, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. 2013;47:15-26.