Aurora, state experts look at how best to help children recover from a concussion

CENTURY YEARS | During cheerleading practice in April, Jana Duey’s sixth-grade daughter, Karter, suffered a concussion when she fell several feet headfirst onto a gym floor mat. Days later, Karter still had headaches, dizziness and sensitivity to light and sound.

Karter rested at home in Centennial for a week and a half and then returned to school when her concussion symptoms were tolerable — initially only for half a day and with modifications that allowed her to do her schoolwork on paper instead of on a screen and take extra time to get to and from classes. Karter went to the nurse’s office when she had a headache, Duey said. She began physical therapy to rehabilitate her neck and regain her balance after the accident left her unsteady on her feet.

After children suffer a concussion, one of the biggest concerns for them and their parents or guardians is when they can return to sports. Julie WilsonKarter’s physician and co-director of the concussion program at Children’s Hospital Colorado in Aurora. Returning to school as soon as possible, with the right support, and doing gentle exercises that do not pose a risk of head injury are important first steps in concussion recovery, and in line with the latest research.

“It is very important to get children and teens back to their usual daily activities as soon as possible and as soon as they can tolerate them,” says Wilson.

In August, the Colorado Department of Education updated guidelines dispelling common myths about concussions, such as the fact that loss of consciousness is necessary for the diagnosis of a concussion. The revised guidelines reflect evidence-based best practices on how return to school and physical activity can improve recovery. Informing families and schools about the new guidelines is crucial, according to medical experts, especially during the fall when concussions from sports like football are increasing.

More than 2 million children According to the 2022 National Health Interview Survey, people across the country had ever been diagnosed with a concussion or brain injury. A flood of research in the past decade have shown that adolescents recover more quickly from a concussion and reduce the risk of long-term symptoms by exercising lightly, for example on an exercise bike or brisk walk, two days after a concussion. That time frame could also be the sweet spot go back to the classroomas long as the children can tolerate any remaining concussion symptoms.

“Even though the brain is not a muscle, it still acts like a muscle and has a ‘use-it-or-lose-it’ phenomenon,” says Christina Mastera pediatrician and sports medicine and brain injury specialist at Children’s Hospital of Philadelphia.

Rather than waiting at home until they fully recover, Master says students should return to school with extra support from teachers and breaks in their schedule to alleviate symptoms such as headaches or fatigue, with the goal of gradually doing more.

Every state has return-to-play laws for student-athletes, including policies such as removal from the sport, medical clearance to return and concussion education. While some states, such as Virginia and Illinois, have return-to-learn policies, Colorado is not one of them. To be named 15 other states have community-based concussion management protocols.

That’s what Colorado updated this summer. REAP — which stands for Remove/Reduce; Training; Adjust/Accommodate; and Pace – is a protocol for families, healthcare providers and schools to help students recover during the first four weeks after a concussion. For example, school staff can use an email-based system to alert teachers that a student has suffered a concussion, then send weekly updates with details on how to deal with symptoms, such as difficulty concentrating.

“We have new protocols to support these children,” said Toni Grishman, senior brain injury consultant with the Colorado Department of Education. “They may still have symptoms of concussion, but we can support them.”

The symptoms of a concussion disappear in most patients within the first month. However, patients with persistent symptoms, called persistent post-concussion symptoms, can benefit from a multidisciplinary care team that can include physicians, physical therapists, psychologists and additional school support, Wilson said.

David Howeldirector of the Colorado Concussion Research Laboratory at the University of Colorado Anschutz Medical Campus in Aurora, investigates how children and their families cope with the physical, cognitive, social and emotional consequences of concussions. In some studies, adolescents wear sensors to measure exercise intensity and volume, as well as common symptoms of concussion, such as sleep and balance problems. In other cases, children and their parents answer questions about their perceptions and expectations of the recovery process.

“What leads you to an injury is often made worse by the injury,” Howell said, citing anxiety, depression or simply going through a difficult time socially. Recovery can be influenced by relationships with peers and family.

Duey said the hardest part of Karter’s recovery was not being able to compete in cheer for nine weeks, including her team’s final game in Florida. Karter, now 12, watched practice and supported her teammates in the spring, but missing it tore her up inside, Duey said.

“There were a lot of tears,” Duey said.

While recognizing a concussion and acting quickly can help everyone, in reality, more than half of Colorado students may be slipping through the cracks with undiagnosed concussions, according to Grishman’s estimates.

The reasons for missed diagnoses are numerous, Grishman said, including lack of education, barriers to medical care, parents’ reluctance to inform schools about a concussion for fear their child will be excluded from activities, or failure to take symptoms seriously in a student with a previous history. of behavioral problems.

Getting schools to follow concussion guidelines is generally a challenge, Grishman said, adding that some districts still don’t. She said it was difficult to keep track of how many schools followed Colorado Education Department guidelines last year, but hopes improved data collection this year will provide more details. This past school year, Grishman and her colleagues trained 280 school staff in concussion management across 50 school districts in Colorado.

Whenever possible, athletic trainers should be on the sidelines to support student-athletes, Master said, and athletes should be aware of concussion symptoms in themselves and their teammates and seek immediate help.

But concussions aren’t limited to the school athletic field or sports like football or soccer. Adventure sports such as parkour, slacklining, motocross, rodeo, skiing and snowboarding also carry concussion risks, Wilson and Grishman said. “Cheerleading is actually one that has a lot of concussions associated with it,” Howell added.

Duey said Karter has occasional headaches, but her balance returned with the help of physical therapy and she no longer has symptoms from her concussion. She is back flying with her cheerleaders and preparing for competition.

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