School performance in youth after a concussion

Abstract

ObjectiveThis study aimed to identify school problems and levels of cognitive activity in youths aged 5–18 years with a concussion during the recovery stages of return to school (RTS).Study DesignIn a prospective cohort, participants completed in-person assessments at three time points: First Visit Post-injury, Symptom Resolution Visit, and Follow-Up Visit. These time points varied based on the participants’ recovery progress. The post-concussion symptom scale (PCSS) and a cognitive activity scale were completed every 2 days until symptom resolution was achieved. Participants and their parents completed a school questionnaire detailing how their concussion had impacted their school learning/performance and their level of concern about their injury as well as the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT).ResultsSixty-three percent (N = 44/70) of participants returned to school by the First Visit Post-injury (average 7.7 days following injury), and of these, 50% (N = 22) were experiencing school problems. Sixty-five participants (out of 70) returned to school at the Follow-Up Visit, and of these, 18% reported school problems. There was a significant difference in the school problems reported by parents and youth. At the First Visit Post-injury, the youth reported more problems (p = 0.02), and the In-Person Symptom Resolution Visit with parents reported more problems (p = 0.01). The cognitive activity score increased, while the PCSS score decreased from RTS Stage 1 to Stage 5.ConclusionsThis study identified that 50% of youth experienced school problems at the First Visit Post-injury, whereas only 18% reported school problems at the Follow-Up Visit. There is a significant difference in the perception of school problems reported by youth and their parents at different stages of recovery. The amount and complexity of cognitive activity increased with decreasing symptoms and increasing RTS stage. Findings can guide youth with a concussion and their parents in supporting a cautious return to school with accommodations. Healthcare providers and researchers can use this knowledge to better support youth in their return to school and understand the importance of gathering information from youth and their parents to gain the best insight into recovery.

Dose-Response Effect of Mental Health Diagnoses on Concussion Recovery in Children and Adolescents

“…The median days from injury to return to symptom-limited exercise also varied by sociodemographic and clinical characteristics (Table 6). In our cohort, women (23.5, IQR [14,38] vs 20, IQR [12,28]; P < 0.01), older adolescents (22, IQR [13,33] vs 20, IQR (11,27] in 5-8 year olds; P < 0.05), and nonsport-related MOI (24, IQR [13,40] vs 21, IQR [13,28]; P < 0.01) returned to symptom-limited exercise later. In addition, patients with any previous mental health diagnosis also returned to exercise later (22 days, IQR [12,30]), with those with ≥3 pre-existing mental health diagnoses returning the latest (23 days, IQR [16,45]; P < 0.01).…”

“…17 Multiple domains may be affected after concussion, including cognitive, emotional, sleep, visual, and vestibular function. 3,[9][10][11]13,16,22,25 Pre-existing conditions involving these domains, including mental health disorders, may be exacerbated by concussion, 22 and interactions between domains of dysfunction may contribute to persisting symptoms, but the characteristics of these interactions are not well understood. The emotional domain may be particularly challenging to assess by clinicians and others working with children and adolescents with concussion, due to stigma attached to various mental health symptoms and diagnoses 28 ; thus, prompt recognition of mental health issues and understanding their interaction with other factors are important first steps toward developing targeted individualized approaches to treatment after concussion.…”

The Role of Level of Play in Concussions in High School Athletes

“…For example, one systematic review demonstrated evidence for increased vulnerability of persistent symptoms postconcussion among teenage athletes, particularly during high school 6. Thus, prevention of concussions in high school athletes is particularly important as this age group may be more susceptible to long-term impacts due to the vulnerability of the developing brain and the increased potential for neuropsychological impairment that can impact academic and social outcomes 2,7–10…”