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Get kids back to school sooner after concussion for a better recovery, new study says


A new Canadian study says that kids who have suffered a concussion should get back to school sooner to give them a better recovery.

The study, published in the JAMA Network Open on Friday, found that kids between eight and 18 who returned to school in fewer than three days after injury showed more improvement in symptoms 14 days later than kids who stayed home from school longer.

Concussion symptoms can include physical pain, dizziness, sensitivity to light or sound and balance problems; cognitive challenges such as difficulty concentrating or remembering things; sleep disruption and mental health problems such as depression or anxiety, said Dr. Roger Zemek, senior author of the study and a concussion expert at the CHEO Research Institute in Ottawa.

It’s OK for kids to still have some symptoms when they go back to class, as long as they can tolerate them, he said.

An early return to school allows kids to see their friends, avoid the stress of missing too many classes, keep a normal sleeping schedule and do light to moderate activity, which has previously been shown to be beneficial for blood flow and brain healing, he said.

Zemek said he hopes this study will help combat mixed messages and outdated thinking about how to help kids recover from concussions.

“People think ‘well if some rest is good, lots of rest is better’ and they take that delayed or cautious approach, either because [of] what was in the old guidelines or doing what they think is best,” he said.

Going back to school helps with recovery

Guidelines for health-care providers have not always kept pace with changing evidence — and advice on when to return to school has not necessarily been clear, Zemek said.

“This study really is one of the first to show that it is not only important that kids do return to school, but returning early — even if they had a high symptom burden — helps them with the recovery.”

The research showed that kids who had the worst symptoms after their concussion actually benefited the most by returning to school earlier, Zemek said.

An empty classroom with green arrows on the floor.
A Grade 6 classroom is shown in Toronto on Sept. 14, 2020. Concussion-injured students can start their early return by going to school for one or two hours first, then progressing, says one of the study’s co-authors. (Nathan Denette/The Canadian Press)

The Canadian Paediatric Society recently updated its concussion position statement, a spokesperson said in an email on Friday.

“Two fairly new recommendations apply to return to school and learning. First, medical clearance by a physician is no longer required to return to school, and second, children and youth should be encouraged to return to school as soon as possible, provided significant individualized supports are in place,” the position statement said.

It’s important for schools to make accommodations for students with concussions, such as excusing them from any contact-based gym activities where they could hit their head again and allowing students experiencing cognitive symptoms to postpone tests until they have improved, Zemek said.

Concussion-injured students can start their early return by going to school for one or two hours first, then progressing to half days and then full days, based on what they can tolerate, he said.

The researchers examined data for 1,630 children aged five to 18 who had been to nine emergency departments across Canada between August 2013 and June 2015. Just over half of the kids had missed only one to two days of school, which was considered an early return.

They found that decreased symptoms after 14 days were associated with an early return to school among kids age eight to 18 — even when their initial symptoms had been more severe.

The researchers did not find the same association among the younger five- to seven-year-olds, but Zemek believes that’s because the youngest children recover better than their older counterparts regardless of when they go back to school.

Dr. Mark Halstead, a pediatric sports medicine physician at St. Louis Children’s Hospital who was not involved in the study, says the research findings “mirror what we see in clinic.”

“The nice thing [about] this study, which was well done and I feel the methodology was sound, is that it offers additional support that we don’t need to be isolating and shutting kids down completely from things to get them well, and in fact that may prolong recovery,” Halstead said in an email to The Canadian Press.

“We shouldn’t be afraid that making the brain work and doing some work in school  — with proper breaks and adjustments to workload throughout the school day — will actually worsen the brain injury. It may worsen symptoms, but won’t injure the brain further,” he said.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.


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