Monday, May 25, 2015

When should concussed athletes return... to the classroom?

When we discuss athletes who have been concussed, much of the discussion often concerns when they will return to play. However, when we discuss student athletes who have been concussed, parents often ask 'when can they return to school and academics?'

When should concussed athletes return… to the classroom?

When we discuss athletes who have been concussed, much of the discussion often concerns when they will return to play. However, when we discuss student athletes who have been concussed, parents often ask ‘when can they return to school and academics?’ 

There has been much published this season concerning NFL players in that the first step in treatment of any concussed athlete is complete mental and physical rest. For a student-athlete, that usually includes keeping them home from school initially when they are severely symptomatic and not allowing them to begin academics again until there is a decrease in symptoms and improvement in neurocognitive testing.

How to best return a student-athlete to school has been a work in progress with many theories being put forth but no consensus among physicians.  While this is not a complete list of recommendations, these are often the most common accommodations suggested. 

Classroom Conditions

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In general, athletes are sent back to school on a limited schedule—either sending them to school during subjects in which they have shown neurocognitive improvement or giving them an abbreviated schedule.  They are usually kept out of physical education classes and recess, and it is recommended that they eat lunch with a few friends outside of the noise and bright lights of the cafeteria. It is also often recommended if they remain somewhat dizzy that they are given copies of power point presentations or notes ahead of class so that they are not constantly looking up and down at a computer projection or blackboard.

Classroom work is reintroduced gradually. In fact, sometimes it is necessary to temporarily drop an athlete an academic level so that they can ease back into school if they continue to be challenged academically. The return can be overwhelming so help with organization of schedules and materials from a peer or teacher is often necessary. In addition, rest breaks may be necessary as the sudden return to school may be difficult after being at compete rest during the initial phase of treatment. 

The athlete is usually given extra time to complete written assignments and make up work that was missed. Homework is usually decreased and forgiven when it can be. Often, substitutions can be made from the written to the spoken word for those who are dizzy with continued reading (i.e. listening to an audio book of a reading assignment as opposed to reading it.) It may also be necessary to help with light and sound by allowing sunglasses to be worn in bright light or be seated closer to the teacher so the student can focus on what is said instead of classroom chatter behind them. Finally, computer classes are usually limited or held if the flickering light from a computer continues to make concussion symptoms worse.

Testing

As far as testing is concerned, timed testing is usually difficult as the athlete usually has a slowed reaction time. Thus, extra time is given once an athlete is cognitively ready to take an examination. Missed exams add up quickly, so forgiving of tests is optimal. It may also be optimal again to change from the written to the spoken word in order to test.  For example, the athlete may not be able to take a timed test on Great Expectations, but can orally tell you everything about the story.  Finally, incompletes should be given instead of failures and changed to a grade once the athlete makes up their assignments.

Student-athletes have the most success when there is a written program in place to address recovery and return from concussion at school. The coordinated efforts of the physician, guidance department, child study team, teachers, school nurse and certified athletic trainer working simultaneously in response to a written plan often leads to the greatest successful recovery for the concussed athlete.

-By Robert Franks, D.O.

About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

J. Ryan Bair, PT, DPT, SCS Founder and Owner of FLASH Sports Physical Therapy, Board Certified in Sports Physical Therapy
Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Ellen Casey, MD Physician with Drexel University Sports Medicine
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Justin D'Ancona Philly.com
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Brian Maher, BS, CSCS Owner, Philly Personal Training
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
Gavin McKay, NASM-CPT Founder/Franchisor, Unite Fitness
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
Kelly O'Shea Senior Producer, Philly.com
Tracey Romero Sports Medicine Editor, Philly.com
David Rubenstein, M.D. Sports Medicine Surgeon, Rothman Institute
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
Thomas Trojian MD, CAQSM, FACSM Associate Chief of the Division of Sports Medicine at Drexel University
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