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  • November 20, 2014

When in Doubt, Sit It Out - Ladue News: Health-wellness

When in Doubt, Sit It Out

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Posted: Thursday, March 27, 2014 12:00 pm

Parents on the sidelines cringe whenever a young athlete takes a blow to the head. Most schools are proactive in informing parents and athletes of the potential dangers associated with concussions, a common type of traumatic brain injury in which symptoms, including dizziness, confusion and memory loss, may not be apparent for days—or even weeks—after the initial injury.

Cautious physicians and school officials advocate immediate suspension of athletic activity for a set time to allow for recovery. However, a researcher at Washington University School of Medicine suggests that students may benefit from time off from classes, as well.

Dr. Mark Halstead, a pediatric sports medicine specialist with Washington University Physicians, is lead author of ‘Returning to Learning Following a Concussion,’ published in the November 2013 edition of the journal Pediatrics. “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,” he said in a news release about the study. “In addition to physical rest, children recovering from a concussion also need cognitive rest. They can struggle in school and often have difficulty focusing and concentrating for several days or weeks.”

Halstead’s view is supported by other experts, including Dr. Raman Malhotra, director of the Concussion Clinic at SSM Cardinal Glennon Children’s Medical Center and director of the sports neurology and concussion program at Saint Louis University School of Medicine. “Cognitive recovery is one of the cornerstones of immediate management of concussions,” he says. “Once a concussion is diagnosed, we prescribe both physical and mental ‘rest’ for the healing brain.”

This ‘rest’ means no physical activity, classwork or homework, and minimal media and ‘screen time,’ Malhotra adds. “Once the athlete starts to feel better, they can slowly reintroduce both physical and mental activity. In some cases, students may feel fine going back to school in the next day or two. Other times, recovery can be more prolonged. It is not uncommon for us to recommend that the student gradually ‘return to learn.’ This may mean initially going back to school for only one or two classes before eventually returning full-time.”

The variability of recovery means that treatment plans must be individualized, adds Dr. Sarah Alander, a specialist in pediatric emergency medicine with Mercy Clinic Children’s Post-Concussion Service. “In the hours to days after injury, most kids feel pretty bad, and are not going to function very well in school. It makes sense to stay home when they are very symptomatic,” she says. “However, blanket ‘remove from school for X amount of time’ doesn’t make much sense, and in fact can cause anxiety for the child if he or she is falling behind in school work because they are required to stay home when they feel well enough to participate.”

Like Malhotra, Alender recommends that children return to school when able, with individually tailored accommodations regarding length of school day, work load, visual and auditory stimulation, and length of time given for assignments, among other things. Most children recover fully within a few weeks, she adds.

“The best protection for a young athlete from concussion is education,” Malhotra says. “If an athlete recognizes that they may have suffered a concussion, the most important thing to do is take themselves out of the game and notify a coach, parent or trainer. This typically leads to a quick and complete recovery.” Remember, when in doubt, sit it out.

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