The aim of this work is to study the nature and extent of the adverse academic effects faced by students recovering from concussion.METHOD: A sample of 349 students ages 5 to 18 who sustained a concussion and their parents reported academic concerns and problems (eg, symptoms interfering, diminished academic skills) on a structured school questionnaire within 4 weeks of injury. Postconcussion symptoms were measured as a marker of injury severity. Results were examined based on recovery status (recovered or actively symptomatic) and level of schooling (elementary, middle, and high school). RESULTS:Actively symptomatic students and their parents reported higher levels of concern for the impact of concussion on school performance (P , .05) and more school-related problems (P , .001) than recovered peers and their parents. High school students who had not yet recovered reported significantly more adverse academic effects than their younger counterparts (P , .05). Greater severity of postconcussion symptoms was associated with more school-related problems and worse academic effects, regardless of time since injury (P , .001).CONCLUSIONS: This study provides initial evidence for a concussion's impact on academic learning and performance, with more adverse effects reported by students who had not yet recovered from the injury. School-based management with targeted recommendations informed by postinjury symptoms may mitigate adverse academic effects, reduce parent and student concerns for the impact of the injury on learning and scholastic performance, and lower the risk of prolonged recovery for students with active postconcussion symptoms. WHAT'S KNOWN ON THIS SUBJECT:Concussion produces a range of symptoms that may impede academic functioning. The need for empirical validation exists, despite growing consensus on the importance of a guided return-to-school process for students recovering from concussion. WHAT THIS STUDY ADDS:This study provides initial evidence of a concussion' s adverse effects on academic learning and performance across all grades, including heightened levels of schoolrelated concern and amplified postinjury academic difficulties experienced by symptomatic students relative to their recovered peers.
Repeat concussion has been associated with risk for prolonged and pronounced clinical recovery in athletes. In this study of adolescent athletes, we examined whether an additional head impact within 24 h of a sports-related concussion (SRC) is associated with higher symptom burden and prolonged clinical recovery compared with a single-injury group. Forty-two student-athletes (52% male, mean age = 14.9 years) diagnosed with an SRC in a concussion clinic were selected for this study: (1) 21 athletes who sustained an additional significant head impact within 24 h of the initial injury (additionalimpact group); (2) 21 single-injury athletes, age and gender matched, who sustained only one discrete concussive blow to the head (single-injury group). Groups did not differ on initial injury characteristics or pre-injury risk factors. The effect of injury status (single-vs. additional-impact) was examined on athlete-and parent-reported symptom burden (at first clinic visit) and length of recovery (LOR). Higher symptom burden was reported by the athletes and parents in the additionalimpact group at the time of first visit. The additional-impact group also had a significantly longer LOR compared with the single-injury group. These findings provide preliminary, hypothesis-generating evidence for the importance of immediate removal from play following an SRC to protect athletes from re-injury, which may worsen symptoms and prolong recovery. The retrospective study design from a specialized clinical sample points to the need for future prospective studies of the relationship between single-and additional-impact injuries on symptom burden and LOR.
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