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Concussion in Children and Adolescents: Application of Return to Learning Policies, Best Practices, and Special Education Law

  • Brain Injury Medicine and Rehabilitation (A Wagner, Section Editor)
  • Published:
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Abstract

Purpose of Review

The goal of this review article is to examine policies for return to learning (RTL), and how RTL intersects with best practices and special education laws and regulations.

Recent Findings

Concussion is a well-documented public health concern. Much research has been dedicated to return to play. However, recent focus has been geared towards RTL, as some evidence suggests that cognitive difficulties may linger somewhat longer than physical symptoms. While most concussions resolve quickly, some children are at higher risk for persistent symptoms (usually those with some additional concern such as depression or anxiety). The intersection of concussion and special education law is discussed.

Summary

Many children and adolescents who suffer from a concussion will have a relatively quick recovery, though there are educational needs even in the first week. Having an RTL plan, and understanding the legal rights of a child, is key to a successful reintegration back into school and cognitive demands.

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References

  1. Bryan MA, Rowhani-Rahbar A, Comstack RD, Rivara F. Sports- and recreation-related concussions in US youth. Pediatr. 2016;138:1–8. https://doi.org/10.1542/peds.2015-4635.

    Article  Google Scholar 

  2. CDC. Nonfatal traumatic brain injuries related to sports and recreation activities among persons aged </=19 years—United States, 2001-2009. MMWR Morb Mortal Wkly Rep. 2011;60:1337–42. https://doi.org/10.1542/peds.2007-0767.

    Google Scholar 

  3. Noble JM, Hesdorffer DC. Sport-related concussions: a review of epidemiology, challenges in diagnosis, and potential risk factors. Neuropsychol Rev. 2013;23:273–84. https://doi.org/10.1007/s11065-013-9239-0.

    Article  PubMed  Google Scholar 

  4. Hall RCW, Hall RCW, Chapman MJ. Definition, diagnosis, and forensic implications of postconcussional syndrome. Psychosom. 2005;46:195–202. https://doi.org/10.1176/appi.psy.46.3.195.

    Article  Google Scholar 

  5. Thompson LL, Lyons VH, McCart M, Herring SA, Rivara FP, Vavilala MS. Variations in state laws governing school reintegration following concussion. Pediatr. 2016;138:1–7. https://doi.org/10.1542/peds.2016-2151.

    Article  Google Scholar 

  6. Dreer LE, Crowley MT, Cash A, O’Neill JA, Cox MK. Examination of teacher knowledge, dissemination preferences, and classroom management of student concussions: implications for return-to-learn protocols. Health Promot Prac. 2017;18:428–36. https://doi.org/10.1177/1524839916650865.

    Article  Google Scholar 

  7. Lyons VH, Moore M, Guiney R, Ayyagari RC, Thompson L, Rivara FP, et al. Strategies to address unmet needs and facilitate return to learn guideline adoption following concussion. J Sch Health. 2017;87:416–26. https://doi.org/10.1111/josh.12510.

    Article  PubMed  Google Scholar 

  8. Individuals with Disabilities Education Act, 20 U.S.C § 1400. 2004.

  9. Individuals with Disabilities Education Act (IDEA). In: http://www.apa.org. http://www.apa.org/about/gr/issues/disability/idea.aspx. Accessed 10 Oct 2017.

  10. Lipkin PH, Okamoto J. The individuals with Disabilities Education Act for children with special educational needs. Pediatr. 2015;136:e1650–62. https://doi.org/10.1542/peds.2015-3409.

    Article  Google Scholar 

  11. Section 504 of the Rehabilitation Act of 1973, 34 C.F.R. Part 104.

  12. Americans with Disabilities Act legislation, 42 U.S.C.A. § § 12102 et seq. 2012.

  13. Zemek RL, Farion KJ, Sampson M. Prognosticators of persistent symptoms following pediatric concussion: a systematic review. J Amer Med Assoc Pediatr. 2013;167:259–65. https://doi.org/10.1001/2013.jamapediatrics.216.

    Google Scholar 

  14. Carney N, Ghajar J, Jagoda A, et al. Concussion guidelines step 1: systematic review of prevalent indicators. Neurosurgery. 2014;75:S3–15. https://doi.org/10.1093/neurosurgery/75.suppl_1.S3.

    Article  PubMed  Google Scholar 

  15. McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvořák J, Echemendia RJ, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013;47:250–8. https://doi.org/10.1136/bjsports-2013-092313.

    Article  PubMed  Google Scholar 

  16. Anderson V, Moore C. Age at injury as a predictor of outcome following pediatric head injury: a longitudinal perspective. Child Neuropsych. 1995;1:187–202. https://doi.org/10.1080/09297049508400224.

    Article  Google Scholar 

  17. Williams RM, Puetz TW, Giza CC, Broglio SP. Concussion recovery time among high school and collegiate athletes: a systematic review and meta-analysis. Sports Med. 2015;45:893–903. https://doi.org/10.1007/s40279-015-0325-8.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Crowe L, Collie A, Hearps S, Dooley J, Clausen H, Maddocks D, et al. Cognitive and physical symptoms of concussive injury in children: a detailed longitudinal recovery study. Br J Sports Med. 2016;50:311–6. https://doi.org/10.1136/bjsports-2015-094663.

  19. Barlow K, Crawford S, Stevenson A, et al. Epidemiology of postconcussional syndrome in pediatric mild traumatic brain injury. Pediatr. 2010;126:e374–81. https://doi.org/10.1542/peds.2009-0925.

    Article  Google Scholar 

  20. Connery AK, Peterson RL, Baker DA, Randolph C, Kirkwood MW. The role of neuropsychological evaluation in the clinical management of concussion. Phys Med Rehabil Clin N Am. 2016;27:475–86. https://doi.org/10.1016/j.pmr.2015.12.001.

    Article  PubMed  Google Scholar 

  21. Ransom DM, Vaughan CG, Pratson L, Sady MD, McGill CA, Gioia GA. Academic effects of concussion in children and adolescents. Pediatr. 2015;135:1043–50. https://doi.org/10.1542/peds.2014-3434.

    Article  Google Scholar 

  22. Halstead ME, McAvoy K, Devore CD, Carl R, Lee M, Logan K. Returning to learning following a concussion. Pediatr. 2013;132:948–57. https://doi.org/10.1542/peds.2013-2867.

    Article  Google Scholar 

  23. Kasamatsu T, Cleary M, Bennett J, Howard K, McLeod TV. Examining academic support after concussion for the adolescent student-athlete: perspectives of the athletic trainer. J Athl Train. 2016;51:153–61. https://doi.org/10.4085/1062-6050-51.4.02.

    Article  PubMed Central  PubMed  Google Scholar 

  24. McCrea M, Guskiewicz K, Randolph C, Barr WB, Hammeke TA, Marshall SW, et al. Incidence, clinical course, and predictors of prolonged recovery time following sport-related concussion in high-school and college athletes. J Int Neuropsychol Soc. 2013;19:22–33. https://doi.org/10.1017/S1355617712000872.

    Article  PubMed  Google Scholar 

  25. Lishman WA. Physiogenesis and psychogenesis in the ‘postconcussional syndrome’. Br J Psychiatry. 1998;153:460–9. https://doi.org/10.1192/bjp.153.4.460.

    Article  Google Scholar 

  26. Babikian T, McArthur D, Asarnow RF. Predictors of 1-month and 1-year neurocognitive functioning from the UCLA longitudinal mild, uncomplicated pediatric traumatic brain injury study. J Int Neuropsychol Soc. 2013;19:145–54. https://doi.org/10.1017/S135561771200104X.

    Article  PubMed  Google Scholar 

  27. Bijur PE, Haslum M, Golding J. Cognitive outcomes of multiple mild head injuries in children. J Dev Behav Pediatr. 1996;17:143–8. https://doi.org/10.1097/00004703-199606000-00001.

    CAS  PubMed  Google Scholar 

  28. Taylor HG, Dietrich A, Nuss K, Wright M, Rusin J, Bangert B, et al. Post-concussive symptoms in children with mild traumatic brain injury. Neuropsychol. 2010;24:148–59. https://doi.org/10.1037/a0018112.

    Article  Google Scholar 

  29. Mittenberg W, DiGiulio DV, Perrin S, Bass AE. Symptoms following mild head injury: expectation as aetiology. J Neurol Neurosurg Psychiatry. 1992;55:200–4. https://doi.org/10.1136/jnnp.55.3.200.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Brooks BL, Kadoura B, Turley B, Crawford S, Mikrogianakis A, Barlow KM. Perception of recovery after pediatric mild traumatic brain injury is influenced by the “good old days” bias: tangible implications for clinical practice and outcomes research. Arch Clin Neuropsychol. 2014;29:186–93. https://doi.org/10.1093/arclin/act083.

    Article  PubMed  Google Scholar 

  31. Grubenhoff JA, Deakyn SJ, Brou L, et al. Acute concussion symptom severity and delayed symptom resolution. Pediatr. 2014;134:54–62. https://doi.org/10.1542/peds.2013-2988.

    Article  Google Scholar 

  32. Kirkwood MW, Peterson RL, Connery AK, Baker DA, Forster J. A pilot study investigating neuropsychological consultation as an intervention for persistent postconcussive symptoms in a pediatric sample. J Pediatr. 2016;169:244–9.e1. https://doi.org/10.1016/j.jpeds.2015.10.014.

    Article  PubMed  Google Scholar 

  33. Centers for Disease Control and Prevention. Implementing return to play: learning from the experiences of early implementers. 2017. Retrieved October. 31 Oct 2017.

  34. DeMatteo C, Stazyk K, Giglia L, Mahoney W, Singh SK, Hollenberg R, et al. A balanced protocol for return to school for children and youth following concussive injury. Clin Pediatr. 2015;54:783–92. https://doi.org/10.1177/0009922814567305.

    Article  Google Scholar 

  35. Meehan WP, Mannix R. Pediatric concussions in the United States emergency departments in the years 2002 to 2006. J Pediatr. 2010;157:889–93. https://doi.org/10.1016/j/jpeds.2010.06.040.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Blackwell LS, Robinson AF, Proctor MR, Taylor AM. Same care, different populations: return-to-learn practices following concussion in primary and secondary schools. J Child Neurol. 2017;32:327–33. https://doi.org/10.1177/0883073816681351.

    Article  PubMed  Google Scholar 

  37. Arbogast KB, McGinley AD, Master CL, et al. Cognitive rest and school-based recommendations following pediatric concussion: the need for primary care support tools. Clin Pediatr. 2013;52:397–402. https://doi.org/10.1177/0009922813478160.

    Article  Google Scholar 

  38. Zonfrillo MR, Master CL, Grady MF, Winston FK, Callahan JM, Arbogast KB. Pediatric providers’ self-reported knowledge, practices, and attitudes about concussion. Pediatr. 2012;130:1120–5. https://doi.org/10.1542/peds.2012-1431.

    Article  Google Scholar 

  39. Torsheim T, Eriksson L, Schnohr CE, et al. Screen-based activities and physical complaints among adolescents from the Nordic countries. BMC Public Health. 2010;10:1–8. https://doi.org/10.1186/1471-2458-10-324.

    Article  Google Scholar 

  40. DiFazio MP, Kirkwood MW. Rest or withdrawal after concussion: a cautionary note. Contemp Pediatr 2014:9–10. http://contemporarypediatrics.modernmedicine.com/contemporary-pediatrics/news/rest-or-withdrawal-after-concussion-cautionary-note. Accessed 17 Oct 2017.

  41. DiFazio M, Silverberg ND, Kirkwood MW, Bernier R, Iverson GL. Prolonged activity restriction after concussions: are we worsening outcomes? Clin Pediatr. 2016;55:443–51. https://doi.org/10.1177/0009922815589914.

    Article  Google Scholar 

  42. Gibson S, Nigrovic LE, O’Brien M, Meehan WP. The effect of recommending cognitive rest on recovery from sport-related concussion. Brain Inj. 2013;27:839–42. https://doi.org/10.3109/02699052.2013.775494.

    Article  PubMed  Google Scholar 

  43. Grool AM, Aglipay M, Momoli F, Meehan WP III, Freedman SB, Yeates KO, et al. Association between early participation in physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents. J Am Med Assoc. 2016;316:2504–14. https://doi.org/10.1001/jama.2016.17396.

    Article  Google Scholar 

  44. Thomas DG, Apps JN, Hoffmann RG, McCrea M, Hammeke T. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatr. 2014;135:1–11. https://doi.org/10.1542/peds.2014-0966.

    Google Scholar 

  45. Eastman A, Chang DG. Return to learn: a review of cognitive rest versus rehabilitation after sports concussion. Neurorehabilit. 2015;37:235–44. https://doi.org/10.3233/NRE-151256.

    Article  Google Scholar 

  46. Meehan WP, Bachur RG. The recommendation for rest following acute concussion. Pediatr. 2015;135:362–33. https://doi.org/10.1542/peds.2014-0966.

    Article  Google Scholar 

  47. Brown NJ, Mannix RC, O’Brien MJ, et al. Effect of cognitive activity level on duration post-concussion symptoms. Pediatr. 2014;133:1–6. https://doi.org/10.1542/peds.2013-2125.

    Article  Google Scholar 

  48. Majerske CW, Mihalik JP, Ren D, Collins MW, Reddy CC, Lovell MR, et al. Concussion in sports: Postconcussive activity levels, symptoms, and neurocognitive performance. J Athl Train. 2008;43:265–74. https://doi.org/10.4085/1062-6050-43.3.265.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Ellis MJ, Cordingley D, Vis S, Reimer K, Leiter J, Russell K. Vestibulo-ocular dysfunction in pediatric sports-related concussion. J Neurosurg Pediatric. 2015;16:248–55. https://doi.org/10.3171/2015.1.PEDS14524.

    Article  Google Scholar 

  50. Master CL, Scheiman M, Gallaway M, Goodman A, Robinson RL, Master SR, et al. Vision diagnoses are common after concussion in adolescents. Clin Pediatr. 2016;55:260–7. https://doi.org/10.1177/0009922815594367.

    Article  Google Scholar 

  51. Collins MW, Kontos AP, Reynolds E, Murawski CD, Fu FH. A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion. Knee Surg Sports Traumatol Arthrosc. 2014;22:235–46. https://doi.org/10.1007/s00167-013-2791-6.

    Article  PubMed  Google Scholar 

  52. Baker JG, Rieger BP, McAvoy K, Leddy JJ, Master CL, Lana SJ, et al. Principles for return to learn after concussion. Int J Clin Pract. 2014;68:1286–8. https://doi.org/10.1111/ijcp.12517.

    Article  CAS  PubMed  Google Scholar 

  53. Master CL, Gioia GA, Leddy JJ, Grady MF. Importance of ‘return to learn’ in pediatric and adolescent concussion. Pediatr Ann. 2012;41:1–6. https://doi.org/10.3928/00904481-20120827-09.

    Google Scholar 

  54. McGrath N. Supporting the student-athlete’s return to the classroom after a sport-related concussion. J Athl Train. 2010;45:492–8. https://doi.org/10.4085/1062-6050-45.5.492.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Sady MD, Vaughan CF, Gioia GA. School and the concussed youth—recommendations for concussion education and management. Phys Med Rehabil Clin N Am. 2011;22:701–19. https://doi.org/10.1016/j.pmr.2011.08.008.

    Article  PubMed Central  PubMed  Google Scholar 

  56. Ylvisaker M, Adelson PD, Braga LW, Burnett SM, Glang A, Feeney T, et al. Rehabilitation and ongoing support after pediatric TBI: twenty years of progress. J Head Trauma Rehabil. 2005;20:95–109. https://doi.org/10.1097/00001199-200501000-00009.

    Article  PubMed  Google Scholar 

  57. Zirkel PA, Brown BE. K-12 students with concussions: a legal perspective. J Sch Nurs. 2015;31:99–109. https://doi.org/10.1177/1059840514521465.

    Article  PubMed  Google Scholar 

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Correspondence to Melissa Sutcliffe.

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Sutcliffe, M. Concussion in Children and Adolescents: Application of Return to Learning Policies, Best Practices, and Special Education Law. Curr Phys Med Rehabil Rep 6, 74–80 (2018). https://doi.org/10.1007/s40141-018-0174-0

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