Return-to-Learn as Important as Return-to-Play after Concussion

May. 19, 2016

Student-athletes who get a concussion often return to school within a week but still have significant problems in the classroom and cannot perform at a normal academic level, according to a new study—suggesting the need for accommodations and return-to-learn guidelines following a concussion.

Published in the American Journal of Public Health, the research from the University of Rochester Medical Center is believed to be the first of its kind. Researchers compared academic problems among 70 students following a diagnosed concussion versus academic problems among 108 students who suffered other sports-related injuries to arms or legs, such as an ankle sprain. Most of the athletes were injured during a high school sport or a club or intramural sport at college.

All of them visited emergency departments (EDs) in the Rochester, N.Y., area for treatment within 24 hours of being injured (including the ED at UR Medicine’s Strong Memorial Hospital).  Investigators used telephone surveys to assess each patient’s schoolwork—the ability to concentrate and take tests or quizzes, for example—one week after injury and again one month after the injury occurred.

On a 174-point scale, academic problems among the concussed students were nearly 16 points higher at one week than the students who suffered other types of sports injuries. At one month post-injury, there were no differences except among athletes with a history of two or more prior concussions and females. (Earlier research by the University of Rochester showed that a woman’s menstrual cycle plays an important role in brain recovery and that females generally recover more slowly from brain injuries.)

There are no science-based protocols to guide school districts, colleges and concussed athletes about going back to class, said Erin Wasserman, Ph.D. She conducted the research as a doctoral candidate in epidemiology in the Department of Public Health Sciences at UR, from September 2013 through January 2015. Wasserman is now at the Matthew Gfeller Sport-Related Traumatic Brain Injury Center at the University of North Carolina-Chapel Hill, working as a postdoctoral research trainee.

“Most students who play sports are not going to become professional athletes but they will need to continue with school and prepare for a career,” Wasserman said. “So, just as they need guidance for when they can play again, they need guidance and protection for when it’s appropriate to return to class and what to expect.”

Accommodating students with a brain injury is no different from accommodating students with a broken leg, said URMC concussion expert Jeffrey Bazarian, M.D., M.P.H., professor of Emergency Medicine, Neurology, Neurosurgery, and Public Health Sciences and a co-author of the study.

"You wouldn't ask students to run a mile or do the 100-yard dash the day they get their cast off," Bazarian said. "Going to school is taxing on the brain and we have to show flexibility when it comes to our students."

He suggested that future guidelines would find a middle ground between staying home and going back to school initially for a full day. As symptoms such as headache, dizziness, blurry vision, and difficulties with concentration and memory disappear, students can gradually increase their school time, said Bazarian, who treats patients at UR Medicine's concussion clinic.


The study also noted that 24 percent of students who were diagnosed with a concussion did not return to school within one week. These athletes participated in the survey a month after their injury; having so many students unable to return to class quickly reinforces a need for return-to-learn guidelines and academic accommodations.

UR epidemiologist Edwin van Wijngaarden, Ph.D., associate professor of Public Health Sciences, who was Wasserman’s advisor, also co-authored the study.

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