Report calls for systematic testing after a concussion

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Most research on concussions suffered by adolescent athletes has focused on when it is safe for them to return to the sport. But there's another problem that requires more attention, according to a clinical report presented at the recent national conference of the American Academy of Pediatrics in Orlando.

"We focus so much on getting these kids back onto the field that we don't always think about the challenges associated with getting back into the classroom," said the lead author, Mark Halstead, an assistant professor of pediatrics and orthopedics at Washington University in St. Louis, and a sports medicine physician at St. Louis Children's Hospital.

Neurocognitive tests, such as those developed by UPMC Sports Medicine, "have not been applied systematically to determine when and how a student is ready to take on the typical cognitive demands in a school setting," the clinical report said.

"In addition to physical rest, children recovering from a concussion also need cognitive rest," Dr. Halstead said. "They can struggle in school and often have difficulty focusing and concentrating for several days or weeks."

Most adolescents recover from a concussion within three weeks, but some take much longer.

"Every concussion is unique and symptoms will vary from student to student, so managing a student's return to the classroom will require an individualized approach," Dr. Halstead said.

"Students appear physically normal after a concussion, so it may be difficult for teachers and administrators to understand the extent of the child's injuries and recognize the potential need for academic adjustments," he said.

Parents, doctors, and school teachers, administrators and coaches should work together to develop a treatment program that fits the particular needs of the student, the report said.

The goal "is to avoid overexerting the brain to the level of worsening or reproducing symptoms," the report said.

Experts in Pittsburgh recommend the same thing for their patients.

"It's a good idea to set up a management strategy for each concussion, focused on the student's symptoms, because not everyone's symptoms will present the same way," said Jon French, a clinical instructor in neuropsychology at the University of Pittsburgh.

When a child is first diagnosed with a concussion, he or she needs a period of cognitive rest, which may mean no texting, video games, computer use, reading or television. The student should return to school when he or she "can tolerate cognitive activity or stimulation for approximately 30 to 45 minutes," the report said.

When the student returns to school, careful attention should be paid to determine which classes, if any, exacerbate symptoms, such as headaches, dizziness and sensitivity to light.

Pediatricians should learn educational terminology "to assist them in being precise in what they are requesting of schools," the report said.

Schools should establish a "point person" for the pediatrician to contact, and the pediatrician's office should identify a "point person" for the school to contact to facilitate exchange of information.

An additional benefit for doctors of this approach is that it "also can reduce the likelihood of a pediatrician's office from receiving frequent phone calls from many individuals about the same situation," the report said.

The clinical report, published Oct. 27 in the journal Pediatrics, is adapted from a concussion management program developed at the Rocky Mountain Hospital for Children in Denver. It contains checklists developed there for evaluating the severity of post-concussion symptoms.

Another list offers simple means of ameliorating the more common symptoms. For instance, frequent breaks can alleviate headaches. A student with sensitivity to light should be permitted to wear sunglasses in class.


Jack Kelly: or 412-263-1476.

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