Lately there has been a lot of attention in the media about the long term health effects of concussions in both adolescents and professional athletes. The attention is due to the growing amount of evidence that concussions can have a long term impact on the structure and subsequent function of the brain – affecting mood, memory, cognitive abilities, and motor function. Over the short term, concussions can cause several challenges that can persist for months, including headaches, difficulty concentrating, problems with short term memory, etc.
In practice I have seen several adolescents who have suffered from concussions due to their participation in different sports (e.g., football, rugby, hockey, water skiing, downhill skiing, cycling, speed skating). Each of these children had various symptoms following the concussion, influencing their ability to return to sport and more importantly, influencing their return to normal daily activities including schooling at a level pre-concussion. There are a lot of questions concerning how to know when children/adolescents is ready to return back to normal activity and what steps can be taken to facilitate one’s return. A recent journal article has been published exploring these questions.
In the journal Pediatrics published on Oct 27, 2013, a review titled “Returning to learning following a concussion” gives guidance on how to safely transition a child/adolescent back to school after suffering a concussion. This is important as not only can concussions affect one’s ability to learn, but taxing a concussed brain can worsen symptoms and slow recovery.
Before summarizing the review, it is important to be able to recognize if a person has suffered a concussion. The signs (something that can be seen by another individual) or symptoms (something that is felt by the affected individual) can vary, and may not even be present for a few days following the incident. These signs and symptoms include:
- Headaches
- Confusion or feeling as if in a fog
- Amnesia following event
- Seeing stars
- Temporary loss of consciousness
- Ringing in ears
- Nausea or vomiting
- Fatigue
- Speech difficulty
- Difficulty concentrating
- Irritability or other personality changes
- Sensitivity to light and noise
- Sensitivity to motion or difficulty with balance
- Sleep disturbances
In a learning environment, many of the above symptoms can both affect the ability to learn and can be triggered by a child’s surroundings following a concussion. For instance:
- Headaches can distract a student: Can be triggered by noise in classroom, by lighting, and the child focusing on tasks.
- Dizziness: Can be brought on by walking or standing.
- Light sensitivity, double vision or blurry vision: Can affect attention and can be brought on by using computers and/or a tablet, lighting, etc.
- Sleep disturbances: Excess fatigue can affect attention, memory, learning, and can affect recovery. Excessive sleeping while trying to recover can affect one’s sleep cycle, further impacting on sleep.
Reintroducing a child back to a learning environment first requires having the student detail what symptoms are present and their severity. If the child’s symptoms are sufficient enough to affect his/her ability to concentrate or tolerate stimulation (noise, lights, movement) for up to 30 minutes, then the child should remain at home. While at home, it is recommended that only light mental activities be done (light reading, interacting with family, limited television watching are allowed as long as symptoms are not triggered), and activities including video games, computer and tablet use, and texting should be kept to a minimum.
When the child/adolescent is able to manage 30 to 45 minutes of stimulation comfortably, then they are free to return to a modified learning environment (school or tutoring). Modifications include taking a 15 minute break for every 30 minutes of instruction time and a reduction in course work. It is important to continue to check in with the student to see if his or her symptoms are persisting or are made worse by studying. If the symptoms are not present, the workload can be gradually increased back to normal levels.
There are several strategies that can also be implemented to reduce signs/symptoms experienced following a concussion. For example, to reduce:
Headaches:
- Take frequent breaks
- Identify triggers for headaches (noise, light, etc) and reduce exposure
Dizziness
- Lie head down if symptoms present
- Avoid crowded areas in school (hallways)
Visual symptoms:
- Reduce brightness or exposure to computers, smart boards, videos
- Wear hat, visor or sunglasses if light sensitive
- Avoid fluorescent lighting
Noise sensitivity:
- Avoid noisy areas and take breaks in quiet areas
- Consider earplugs
- Avoid busy hallways at school
- Delay, reschedule or have extra time provided for major tests and assignments
Difficulty concentrating or with memory:
Fatigue
- Take rest breaks
- Shorten school and study time
There are many factors to consider in helping a child/adolescent to recover from a concussion. It is important for them to not only limit physical activity, but also mental activity as it can affect recovery time. By implementing the above, the majority of children/adolescents are back to their normal routine within 3 weeks of suffering from the concussion.
If your child has suffered from a head injury or concussion, please seek immediate medical care. In addition, consult with a health care provider about the child’s return to normal daily activities, including school and sport.
If you have any questions about concussions, returning to activities or sport following a concussion, or on naturopathic medicine, please contact Graham Beaton at 613-290-6115.
Graham Beaton is a naturopathic doctor practicing in the Centretown neighbourhood of downtown Ottawa.
