School and the Concussed Youth: Recommendations for Concussion Education and Management

Abstract

Synopsis School learning and performance is arguably the critical centerpiece of child and adolescent development, and there can be significant temporary upset in cognitive processing after a mild traumatic brain injury, also called a concussion. This injury results in a cascade of neurochemical abnormalities, and in the wake of this dysfunction, both physical activity and cognitive activity become sources of additional neurometabolic demand on the brain and may cause symptoms to re-emerge or worsen. This paper provides a foundation for post-injury management of cognitive activity, particularly in the school setting, including design and implementation of school-wide concussion education and management programs. Definitions of cognitive over-exertion and cognitive rest are provided, with guidelines for managing cognitive load in individuals based on their symptom profile and neurocognitive performance. On a broader scale, guidance for the development of comprehensive concussion education and management programs in schools is provided. Proactive management could facilitate recovery by ensuring less cognitive exertion and stress during the recovery period.

Qualitative Examination of Adolescent Health-Related Quality of Life at 1 Year Postconcussion

“…The feelings of frustration noted in our study appeared to stem from varied sources, including the nature and longevity of the physical symptoms, interpersonal relationships, and time missed from school and sport. Although these observations validate previous research, 27 the causes of postconcussion emotional dysfunction remain unclear. Physiologic factors, stress and anxiety, not being understood by others, and psychological components may contribute alone or in combination to postconcussion emotional dysfunction.…”

Mind the gaps—advancing research into short-term and long-term neuropsychological outcomes of youth sports-related concussions

“…'Smart helmets' are being used in some speciality research centres to standardize the physical force and angular acceleration that accompanies head hits, and the utility of these helmets to measure and predict impacts that may result in concussion is currently under investigation. 36,37 Young people recovering from concussion can experience important challenges, including altered social and academic development, [38][39][40] lower scores on general intelligence tests, and decreased school performance (measured by grade-point average). 39 Lower levels of parental education and child academic achievement both correlate with poorer concussion recovery.…”

Mandated High School Concussion Education and Collegiate Athletes' Understanding of Concussion

“…Previous investigators 11,29,30 have found that training efficacy was influenced by training modalities and content. Furthermore, we examined the effect of legislation from only 2 states.…”

“…The results presented here suggest several ways in which the design and delivery of concussion education to student-athletes can be improved, building on recommendations from other investigators. 10,29,30 The first recommendation is for state and local officials and educators to work with high schools and their athletic departments to determine why athletes are not reporting receiving education and to work to ensure uniform, effective delivery of concussion education to their athletes, across sports and genders. Nearly 25% of athletes in this study who matriculated to college in the postlegislation era reported not having received concussion education.…”