Physician recommended school accommodations and student outcomes following a mild traumatic brain injury among youth with persistent post-concussive symptoms

Abstract

BACKGROUND: Post-concussion return-to-learn (RTL) guidelines include implementation of school accommodations. Yet, little is known about physician recommendations for school accommodations and their impact, particularly among youth experiencing persistent post-concussive symptoms (PPCS). OBJECTIVE: We examined the association between physician recommended school accommodations and student outcomes among youth experiencing PPCS. METHODS: Data from a randomized comparative effectiveness trial was used. Physician recommended school accommodations (≤90 days post-injury) were collected via chart abstraction. Grade point average was extracted from school records. Reports of problems at school, concussion symptoms, health-related quality of life (HRQOL), anxiety symptoms, and depressive symptoms were collected by survey (at baseline, three months, and 12 months post study entry). RESULTS: Of 200 participants (Mage = 14.7, 62% female), 86% were recommended school accommodations. Number of recommended school accommodations was positively associated with number of school problems at three months (aRR 1.18, 95% CI:1.12–1.24) and 12 months (aRR 1.11, 95% CI:1.05–1.18). No significant associations were found between recommended school accommodations and GPA, HRQOL, anxiety symptoms, or depressive symptoms. CONCLUSIONS: Physicians recommend more school accommodations for students experiencing more school problems post-concussion. Appropriate implementation of RTL recommendations made by physicians by fostering partnerships among physicians, students, and schools may be needed to achieve student-centered RTL.

How to identify and manage sports related concussions in primary care

“…Return to school/work —A randomised comparative effectiveness trial of 200 high school students suggests that school or college level patients should return to academic studies as soon as symptoms resolve and in line with returning to physical exercise 24. Based on expert opinion and narrative literature reviews, accommodations should be made on an individual level to rehabilitate patients in the classroom or workplace,2225 such as a reduced length of working day,26 with most people able to get back to full school or work activities by day 10 post concussion 27. A “return to learn” protocol has been described in the recent UK Concussion Guidelines for Non-Elite (Grassroots) Sport 5…”

“…Refer to a concussion expert, usually a consultant in sports and exercise medicine and their multidisciplinary team, if symptoms persist beyond 28 days 5. This occurs in roughly one fifth of cases and is commonly known as “post-concussion syndrome.”2528 Initial concussion management should be started by the GP.…”

Returning to school following concussion

“…Accommodations must focus on supporting participation without exacerbating symptoms (rather than avoidance until the child or adolescent is symptom-free) and consider pre-existing or current educational circumstances. 17,18 Adjust accommodations as needed to match abilities and challenges. Examples of accommodations include the following: • Allow for gradual exposure to various activities within the classroom and school setting, including screen time; complete avoidance of screen use, lights, smart boards, assemblies, music, and safe physical activity is not recommended in the long-term.…”

Retour à l’école après une commotion cérébrale

“…On devrait conseiller au patient ou à ses parents de communiquer tout de suite avec l'école pour identifier une personne-ressource qui sera responsable de soutenir l'étudiant après une commotion cérébrale. Les accommodements doivent viser à soutenir la participation sans exacerber les symptômes (plutôt que l'éviter jusqu'à ce que l'enfant ou l'adolescent n'ait plus de symptômes) et tenir compte des circonstances antérieures ou actuelles sur le plan scolaire 17,18…”