What About Return-to-Learn?

Two important groups released information about concussions and youth recently.  The Institute of Medicine recently released its Sports-Related Concussions in Youth: Improving the Science, Changing the Culture, addressing concussions for the youth (obviously by the title).  This was on the heels of the American Academy of Pediatrics release of their second report on concussions, addressing the return-to-learn aspect.  I offered some opinions on both of the reports via Twitter, but was really underwhelmed by the information in both documents.  It seems to me that even though the car is pointed in the right direction the gas pedal is being confused with the brake pedal.  At best I feel the community is driving though the rear-view mirror.

A loyal follower and some time contributor, Dorothy Bedford, a self-described “parent activist in concussion education, awareness and advocacy, and newly retired school board member in Princeton NJ,” has penned the following post regarding return-to-learn and the AAP paper.  This is not your typical parent; “I come by the interest in return-to-learn honestly, both from my daughters’ concussion and from the point of view of a school board member – with the opportunity to help protect the brains of all students.”

With all of that said, below is her post.  Thank you, Dorothy.  As a reminder, the inbox is always open to contributors.

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The Pediatricians Weigh In on Returning-to-Learning – A Mixed Review

The American Academy of Pediatrics has released its second major clinical report on concussions. It’s a good first step which will help many pediatricians begin to address the second most important issue in concussion management (after “remove from play,” and before “return to play”).  On the other hand, ten pages limits the territory it can cover; there’s little new for the ATC who takes a broad view of concussion recovery; the report wildly underplays the complementary role of the neuropsych, and omits any discussion of some important symptoms. I think the most important contribution this report makes will be nudging school administrators to action, especially those who have been inattentive or resistant to dealing with concussions in the classroom and gradual return to learn. It’s hard to ignore the AAP.  I will confess, since its release my reaction has swung up and down with each re-reading. Five days later, I hope this will be a balanced review. I like to keep the conversation open.

“Returning to Learning Following a Concussion” was published on October 27 (full report here: http://pediatrics.aappublications.org/content/early/2013/10/23/peds.2013-2867.full.pdf+html)  complementing AAP’s 2010 clinical report on “Sport-Related Concussions in Children and Adolescents”. The lead author on both reports is Dr. Mark Halstead, a specialist in non-operative sports medicine at Washington University in St. Louis. Neuropsychologist Dr. Gerald Gioia of National Children’s Medical Center was a consultant. Dr Gioia is a co-author of the CDC’s Physician’s ACE Return to School form, which should be in the hands of every student athlete and their parents for any concussion-related visit to a doctor (http://www.cdc.gov/concussion/headsup/pdf/ACE_care_plan_school_version_a.pdf ). Six other professional societies have endorsed this report.

The Good:

For pediatricians in areas with thin or no sports medicine/neuropsych coverage, this report is going to be very important,  Continue reading

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AAP Confirms What We Have Been Saying For Some Time

This past Monday, the American Academy of Pediatrics released their findings of a research project on helmets and mouth guards in high school aged football players, the lead was this;

High-tech helmets and custom mouth guards do not reduce concussion risk for high school football players any more effectively than low-cost helmets or off-the-shelf mouth guards, a new study says.

This is a point we have been trying to hammer home since the inception of the blog; simply Physics does not allow for current technology to reduce or attenuate the true forces that cause concussion in the vast majority of the cases.  Those would be: acceleration, deceleration, rotation and angular vectors that cause the brain to shift inside the skull.

The most important thing about a helmet is that it’s well-maintained (regularly reconditioned) and has a proper fit.  Certainly there is some merit to the newer helmets padding designs for helping with the true linear forces reaching the skull; however helmets are doing what they’re designed for – preventing skull fractures and facial injuries.

It is unlikely that a helmet – as we currently know it – will abate those pesky forces attributed to concussion.  In reality if that is where the fix needs to come from then we will most likely be looking at some sort of apparatus that is attached to the shoulders that basically harnesses the head down.  The issue there, of course, is the range of motion to allow a player to see and move in a safe way.  Regardless this information presented by the AAP is nothing new but wonderful because it comes from a group that has “clout”.

What is more interesting to me – and a bit of an endorsement of our words – is that simple Continue reading