TOO MUCH, TOO SOON

Children and teens recovering from a concussion may experience difficulty with school work longer than anticipated, a new study suggests. "The most notable finding was the range and degree of problems and concerns that students with concussions and their parents reported with school," said study lead author Gerard Gioia, chief of neuropsychology at Children's National Medical Center in Rockville, Md. "The brain is one's organ of learning. When it is injured, it should not be surprising that learning will be affected."

Gioia and his colleagues surveyed 239 student-parent pairs plus another 110 parents about any concerns they had regarding school work after students experienced a concussion. The students, aged 5 to 18, were evaluated within a month of having had a concussion with several thinking, memory and concentration tests.  Students not experiencing any symptoms and performing well on the tests were classified as having recovered, while those still experiencing symptoms were considered not recovered.

Study participants who had not yet recovered reported experiencing various school-related difficulties.   

• For example, 88 percent of students in the unrecovered group said symptoms such as headaches, fatigue or trouble concentrating were interfering in at least one way at school, compared to 38 percent in the recovered group.  
• Similarly, more than three-quarters of those not yet recovered were having trouble with academic skills, such as needing more time for homework and having a hard time studying or taking notes, compared to 44 percent of those who had recovered, the findings showed.  
• High school students with ongoing post-concussive symptoms particularly expressed concern about their academic work.   
• About two-thirds of the unrecovered high school students said they felt moderately or very concerned about their school work, compared to 52 percent of middle school students and 38 percent of elementary students. 
• A large majority of students who had not yet recovered and their parents believed their grades in at least one school subject had been affected by their concussion. 
• Among those who had recovered from their concussions, fewer than half of the students or parents said they noticed any changes in their grades. 
• Math was the most troublesome subject, the students said, followed by reading and language arts, science and social studies, according to the study.
  

"It is important to note that as the stakes get higher, especially with grades and test scores in high school, so does the concern by patients regarding school performance," said Dr. Shayne Fehr, an assistant professor of orthopedics at the Medical College of Wisconsin in Milwaukee. "Concussion effects in the classroom can be 'invisible' to teachers. Communication about the plan and expectations for recovery are key."

Fehr suggested that parents and teachers follow the 2013 recommendations from the American Academy of Pediatrics regarding concussion recovery.   "I recommend that students get back to school gradually once symptoms are tolerable and they can focus for around 30 minutes,"  Fehr said. "Initially, I recommend adjustments such as increased time to complete homework, delaying deadlines for projects and pushing back testing until students are tolerating full days of school."

Ideally, Gioia said, a trained concussion management team -- including individuals such as a school nurse, guidance counselor, school psychologist and athletic trainer -- should be formed to work closely with a student's teachers to implement the appropriate accommodations for that student's specific symptoms.

SOURCES: Gerard A. Gioia, Ph.D., division chief and professor, pediatric neuropsychology, and director, Safe Concussion Outcome, Recovery & Education (SCORE) Program, Children's National Medical Center and George Washington University School of Medicine, Rockville, Md.; Shayne D. Fehr, M.D., assistant professor, orthopedics, Medical College of Wisconsin, Sports Medicine and Concussion Clinics, Children's Hospital of Wisconsin, Milwaukee; Robert Glatter, M.D., emergency physician, Lenox Hill Hospital, New York City; June 2015, Pediatric