The Concussion Blog

From the Globe and Mail (Canada), St. Micheal’s College School has developed a return to school program from concussions.  As we know return to the classroom and the school environment can be just as harmful as rushing back to sports.

“There’s a lot of focus on the return to play but not on the return to the classroom, where the kids can have a number of difficulties due to their brain injury,” said Corinne Kagan, a program director at the Ontario Neurotrauma Foundation.

The classroom demands that students listen, learn and think, all of which involve brainwork. Some of the symptoms of a concussion, such as headaches, dizziness and trouble concentrating, can make this even more difficult.

What St. Michael’s has developed, Ms. Kagan said, is “a very good thing.”

I have been promoting this from the beginning here on the blog.  In fact the school I work with adopted a policy that deals with this exact thing.  I believe it to be the first of its kind in Illinois.  Simply we educate the athlete and parents about the injury and proper management; with that the school is suggesting and allowing students to be excused for up to three days before seeing a doctor.  Upon return the student will work with the guidance counselor, teachers and myself for a simple graded return to classroom activity.  Since each person is different in recovery there is nothing set in stone for academics.  We do have an understanding that if the student misses quizzes/tests they will not make up more than one a day until full recovery.  Homework is often allowed to be turned in on a “graded return”, and classroom performance is monitored by the teacher.

This is not required of the student or parents, rather a recommendation and not every kid that gets a concussion follows our guidelines.  However my limited sample size shows some serious results (based on concussions from January 2010 to present):

• 24 concussions (grades 7-12)
• Students that followed recommendations – 11
• Average days with symptoms (n=24) – 13.1
• Average days with symptoms following recommendations (n=11) – 6.8
• Average days with symptoms not following recommendations (n=12) – 19.2
• Average days return to sport following recommendations (n=11) – 13.5
• Average days return to sport not following recommendations (n=12) – 32.8 (the outliers in this data set are 10 and 13 days return to sport)
• The one data point not used in the not following the recommendations is a student that is on their 14th month out.

This in no way is scientific in structure, but it is observational.  Some obvious limitations are the treating physicians and their different approaches; however of the 24 concussions 22 were seen by one of 2 local physicians for clearance.

Every school should take the time to put in a simple educational process for the teacher first, then start the graded return to classroom before thinking about activity.  I simply took the Zurich recommendations and added a step.  After step 1 (rest) and before step 2 (light aerobic activity) I inserted our new step 2 – return to classroom/school.  And before moving to the next step the student-athlete must get through it without symptoms.  The vast majority of the concussed student-athletes get stalled at this step, and for the longest time.

It is very simple…  If you would like some consultation on this feel free to contact me or my employer (if you know it).