During cheer practice in April, Karter, Jana Duey’s sixth-grade daughter, suffered a concussion when she fell several feet head-first onto a mat in the gym. Days later, the young woman still had a headache, dizziness, and sensitivity to light and noise.
Karter rested for a week and a half at his home in Centennial, Colorado, and then returned to school when his concussion symptoms were tolerable; At first, he only went half a day and with an adapted schedule that allowed him to do assignments on paper instead of on the computer, and take more time to go from one class to another.
According to Duey, Karter went to the infirmary when he had a headache. He also began physical therapy to rehabilitate his neck and regain his balance after the accident, as he felt unsteady when walking.
After children suffer concussions, one of the biggest concerns for them and their parents or caregivers is when they can return to sports, said Julie Wilson, Karter’s doctor and co-director of the Concussion Program at Children’s Hospital Colorado in Aurora. .
Returning to school as soon as possible, with the right support, and doing light exercise that doesn’t involve the risk of hitting your head are important steps in recovery after a concussion, according to the latest research.
“It is very important that children and adolescents return to their usual daily activities as soon as possible and as soon as they can tolerate them,” Wilson said.
In August, the Colorado Department of Education updated its guidelines to debunk common myths about concussions, such as the need for loss of consciousness to diagnose a concussion.
The new guidelines reflect evidence-based best practices on how returning to school and exercise can improve recovery. According to medical experts, educating families and schools about these new guidelines is essential, especially during the rise of concussions in the fall due to sports like football and soccer.
More than 2 million children nationwide have ever been diagnosed with a concussion or brain injury, according to the 2022 National Health Interview Survey.
Numerous studies over the past decade have shown that adolescents recover faster from concussions and decrease the risk of long-term symptoms by doing light exercise, such as on a stationary bike or brisk walking, two days after the concussion. That same period may also be the ideal time to return to the classroom, as long as children can tolerate the remaining symptoms of concussion.
“Even though the brain is not a muscle, it acts like one and has a use-it-or-lose-it phenomenon,” said Christina Master, a pediatrician and sports medicine and brain injury specialist at Children’s Hospital of Philadelphia.
Instead of waiting at home to fully recover, Master suggests students return to school with additional support from teachers and breaks to alleviate symptoms such as headaches or fatigue, and gradually increase activity.
All states have rules for injured student-athletes, including removal from sports, medical clearance to return, and concussion education. Although some, like Virginia and Illinois, have “return to learn” policies, Colorado is not among them. This and 15 other states have community-based concussion management protocols.
That’s what Colorado updated this summer. REAP —which means Remove/Reduce; educate; Adjust/Accommodate; and Progresar—is a protocol for families, health care providers, and schools to help students recover during the first four weeks after a concussion.
The school can send a message to alert teachers that a student has suffered a concussion, and then send weekly updates with details on how to manage symptoms, such as difficulty concentrating.
“We have new protocols to support these children,” said Toni Grishman, senior brain injury consultant for the Colorado Department of Education. “They may still have symptoms of shock, but we can support them.”
Shock symptoms resolve in most patients during the first few months. However, those with persistent symptoms, called persistent post-concussive symptoms, may benefit from a multidisciplinary care team: doctors, physical therapists, psychologists and additional support at school, Wilson said.
David Howell, director of the Colorado Concussion Research Laboratory at the University of Colorado Anschutz Medical Center, is studying how children and their families cope with the physical, cognitive, social and emotional impacts of concussions.
In some studies, teens wear sensors to measure the intensity and volume of exercise, as well as common concussion symptoms, such as sleep and balance problems. In others, children and their parents answer questions about their perceptions and expectations about the recovery process.
“What you bring to an injury is often exacerbated by the injury,” Howell said, mentioning anxiety, depression or simply going through a difficult social time. Recovery can be influenced by relationships with friends and family.
Duey said the hardest part of Karter’s recovery was that he wasn’t able to be with the cheerleaders for nine weeks, including his team’s final competition in Florida. Karter, now 12, watched practice and supported her teammates in the spring, but missing the competition hurt her deeply, Duey said.
“There were a lot of tears,” Duey said.
While recognizing a concussion and acting quickly can help anyone, in practice, more than half of student cases in Colorado can go undetected with undiagnosed concussions, according to Grishman’s estimates.
The reasons for missed diagnoses are many, Grishman said, including lack of education, barriers to medical access, parents’ reluctance to inform schools about a concussion for fear that their child will be excluded from activities, or not taking symptoms seriously in a student with a history of behavioral problems.
Getting schools to follow concussion guidelines, in general, is a challenge, Grishman said, adding that some districts still don’t do so.
He said it’s difficult to track the number of schools that followed Colorado Department of Education guidelines last year, but he hopes improved data collection will provide more details this year. Over the past school year, Grishman and his colleagues trained 280 school staff members in concussion management across 50 Colorado school districts.
Whenever possible, coaches should be on the sidelines to support student-athletes, Master said, and athletes should be aware of concussion symptoms in themselves and their teammates and seek care immediately.
However, concussions are not limited to the school athletic field or sports such as football or soccer. Adventure sports such as parkour, slacklining, motocross, rodeo, skiing and snowboarding also pose concussion risks, Wilson and Grishman said. “Cheerleading, in fact, is one of the sports with a lot of concussions associated with it,” Howell added.
Duey said Karter occasionally has headaches, but he regained his balance with the help of physical therapy and no longer has symptoms of concussion. She’s back on the cheer team and getting ready to compete.
