When a student steps into the school health office with a dazed look and a headache after a fall during recess, it's not just a moment of care—it's the beginning of an acute awareness and critical response strategy that could potentially impact the rest of that student's academic year, and even beyond. Recent studies indicate that approximately 1.1 to 1.9 million sports and recreation-related concussions occur annually among children aged 18 and younger in the United States, and about 10-30% of those affected develop Post-Concussion (or Post-Concussive) Syndrome (PCS), experiencing symptoms that can last for months or even years after the initial injury. Due to the wide variability of physical, cognitive, emotional, and sleep symptoms, the management of students with PCS presents unique challenges, particularly within a school setting.
The Definition
In 90% of concussions, symptoms are transient, and with appropriate rest and treatment, it usually takes around two to six weeks for full recovery and healing. Post-concussion syndrome is the persistence of common concussion symptoms such as memory and concentration problems, mood swings, personality changes, headache, fatigue, dizziness, and sleep disturbances past this expected recovery time frame. Evidence is limited on what exactly causes PCS. Still, several risk factors, including the severity of the initial injury, multiple hits to the head, prior history of concussion, mood disorders, migraines, or learning disabilities, have been identified.
The Impact
In the same way concussion symptoms can pose significant challenges for students in the classroom, affect their learning experience, and cause emotional distress, so too can PCS, albeit the effects are prolonged and, therefore, potentially more damaging. According to a study published in Pediatrics in 2015, student-athletes who experience persistent concussion symptoms and their parents tend to express more concern about the detrimental impact of concussion on their academic performance and learning abilities. The study also indicated a direct correlation between the severity of post-concussion symptoms and the level of school-related issues faced by students, regardless of their academic grade. These findings underscore the importance of cultivating a supportive school environment for students with PCS.
The Support
When the brain doesn't receive the rest it needs to heal from the trauma of a concussion, the risk of developing PCS significantly increases. Symptoms can become prolonged and more severe, complicating a student's return to school and activities. Implementing a tailored 'return to learn' plan (provided by a licensed HCP) when a student suffers a concussion is essential, and communication with teachers and parents/guardians is critical to ensuring a cohesive approach to the student's recovery. In the event a student is diagnosed with PCS, the individualized health plan should be revised and frequently updated with ongoing collaboration with families and healthcare providers. Regular communication can ensure timely adjustments to the student's learning environment and academic expectations.
Educating staff, students, and parents about concussions and PCS is fundamental. Awareness can foster a supportive community, encouraging affected students to vocalize their needs and challenges. Armed with knowledge, understanding, and a comprehensive approach to care, schools can be indispensable allies in the journey back to wellness and academic success for students navigating the complexities of PCS.
For more information on Concussion Management in the school setting, watch our video, A School Nurse Guide to Concussions!
