The Facts About Coming Back from a Concussion

A concussion is a type of mild traumatic brain injury, or TBI, caused by a forceful jolt or blow to the head that temporarily disrupts how the brain works. Usually, the signs and symptoms are immediate. Here’s what you need to know:

• A person does not need to be knocked out or lose consciousness to have a concussion.
• At least 80% to 90% of traumatic brain injuries are concussions.
• Most children and teens recover completely from a concussion within days or weeks.
• The signs and symptoms of a concussion are immediate and often appear in the first few hours after injury but will gradually improve.

In the information that follows, we answer several of the most popular questions about recovering from a concussion, including what to do after a concussion, how to facilitate returning to school and how to develop a concussion recovery plan. Teachers, coaches and parents can use this information to help kids and teens succeed in school after a concussion.

What is a traumatic brain injury?

A TBI occurs when an external force causes injury to the brain. There are two types of traumatic brain injuries: mild and moderate to severe.

• Mild TBIs are not associated with brain damage, and problems are generally temporary.
• Moderate to severe TBIs often require extended hospitalization and frequently result in damage to the brain, which leads to lasting cognitive, academic and psychological problems.

Severity of a brain injury

The majority of traumatic brain injuries are mild, such as concussions, and generally result in temporary problems. Moderate to severe brain injuries often require extended hospitalization.

Symptoms of a concussion

Concussion symptoms can vary from kid to kid. For most, these symptoms will be temporary. There are three categories of symptoms: physical, cognitive and behavioral.

Physical concussion symptoms

• Headaches
• Blurred vision
• Sensitivity to noise or light
• Nausea
• Dizziness
• Balance difficulties
• Changes in sleep patterns
• Tiredness

Cognitive concussion symptoms

• Difficulty paying attention
• Concentration problems
• Lack of follow-through on tasks
• Trouble following directions
• Mental "fog"
• Slowed thinking
• Confusion
• Forgetfulness

Behavioral and emotional concussion symptoms

• Irritability
• Frustration
• Moodiness
• Sadness or anxiety

If a child has a moderate to severe brain injury, they may exhibit more serious symptoms. This means they need immediate medical attention, and you should call 911 or go to the nearest emergency room. The following symptoms could indicate a child has suffered a more severe brain injury:

• Significant drowsiness or inability to wake up
• A headache that is especially severe or gets worse
• Weakness, numbness or tingling in the arms or legs
• Repeated vomiting
• Slurred speech
• Convulsions or seizures
• Increasing confusion, restlessness or agitation
• Unusual behavior

The truth about concussions

Problems caused by concussions don’t last long.

Most young people recover completely from a concussion, and it can take anywhere from a couple of days to several weeks. Problems can last longer, but this is rare. Persistent problems can be related to the severity of the injury and to non-injury factors, such as increased stress levels.

Students can go back to school, even with symptoms.

With the involvement of a healthcare provider and appropriate monitoring at school, a student who has experienced a concussion can return to school, even if they are still exhibiting symptoms. Severe symptoms will require additional medical evaluation and follow-up but keeping a child out of school for an extended period of time often causes unintended academic, social and emotional problems.

Complete rest isn’t necessary.

In the first few days of concussion recovery, reducing stimulation can help manage symptoms. However, texting or watching television will not affect recovery. In fact, too much rest often does more harm than good.

Temporary adjustments are usually adequate.

In most cases, students do not need special education services after a concussion. Short-term, informal adjustments for academic support is standard. A Concussion Comeback Plan is a great way to make those adjustments while also allowing a child to resume normal activities.

The Concussion Comeback Plan

A Concussion Comeback Plan can help a student successfully transition back to school. Every student is different, so these steps should serve as general guidelines. Each student will need a concussion recovery plan tailored to their specific needs and circumstances.

Step 1: Understand concussions.

Know the basics:

• Symptoms from a concussion are most noticeable in the first few hours and days following the injury. These symptoms should gradually improve.
• Right after a concussion, a student should increase their rest and decrease their activity.
• After a few days, the student can gradually return to daily routines. This includes going to school, although a slight schedule adjustment may be necessary. It is fine to read, write and complete schoolwork.
• After a concussion, an athlete should only return to play under the approval and supervision of a qualified healthcare provider.

Fact: After the first few days, it’s important to resume normal activities. If a student is well enough to participate in leisure activities and socialize, they should be well enough to attend school.

Step 2: Assign a comeback coordinator.

A student's comeback coordinator could be a school nurse, counselor, psychologist, special educator or classroom teacher. It should be someone at school who takes the lead in communicating and partnering with the student, family, school staff, athletic personnel and healthcare providers. The comeback coordinator will:

• Help gather information: They understand and can discuss the nature of the injury, current status and expected recovery course with the student, the student's caregivers and their healthcare team.
• Provide documentation: They keep a record of progress in the student's school file and athletic file for reference.
• Communicate with school personnel: They convey information verbally and in writing to all relevant school staff, including teachers, administrators and athletic personnel.
• Communicate outside of the school: They inform caregivers and healthcare personnel of symptoms. They also report on the student's management of school demands so that involved personnel can support as needed.

Step 3: Support the student.

The educational team helps provide a “soft landing” for a student when they return to school after a concussion. Some students may require a more gradual transition, returning to school for only an hour or two a day at first. The student can work toward half days, and then, when ready, resume full days. The educational team should remain flexible with the student’s schedule and workload expectations throughout recovery.

The student may also require a variety of accommodations at school. These adjustments are typically temporary and informal.

Know how to help a student who has had a concussion.

General

• Excuse the student from classes or activities that require strenuous or risky physical activity, such as physical education and recess, until cleared by medical personnel.
• Have a comeback coordinator meet with the student regularly to monitor progress, assist with communication inside and outside school, coordinate and monitor accommodations, and ensure the student’s workload remains manageable.
• Provide rest time or breaks during the day. For example, allow the student to visit the healthcare office when they are experiencing headaches and return to class when they are feeling better.

Classroom

• Allow preferential seating to allow for close monitoring and focused attention.
• Give notes that summarize the material covered in class to the student.
• Provide more opportunity for individualized follow-up after class or at the end of the school day to ensure successful learning.

Schoolwork

• Design a reasonable plan of assistance to support completion of missed assignments.
• Excuse missed, non-essential assignments or exams.
• Reduce or modify classroom and homework assignments.
• Grant additional time for homework, exams and assignments.
• Negotiate timing of large assignments and exams so that due dates do not fall at the same time.

Testing

• Carefully consider whether any upcoming standardized tests, such as state testing and college entrance exams, should be rescheduled.
• Reschedule exams if the student is highly symptomatic or coordinate exams to avoid multiple tests in one day.
• Allow the student to take tests in a distraction-free environment.

Step 4: Monitor the student.

School staff who are aware of the student’s injury should carefully monitor the student for several weeks after a concussion. The comeback coordinator should take responsibility for regularly checking in with classroom teachers and other relevant staff until symptoms subside. If problems develop, the comeback coordinator should notify the parents and healthcare team.

In general, school staff should look for the following:

• Any change in the student’s ability to function in the school environment
• A drop in academic performance or grades
• Social or emotional changes
• Unexpected or prolonged absence from school

Step 5: Know when to consult a healthcare provider.

It’s rare to see serious complications after a concussion. If they do occur, they’re generally apparent within the first few hours or days after the initial injury. It can be a good idea to stay in close contact with outside healthcare professionals or brain injury specialists when:

• Significant problems after concussion last more than two or three weeks.
• There is uncertainty about which physical or athletic activities are medically safe.
• The student’s cognitive or academic problems appear especially severe.
• A student has sustained multiple concussions.
• A student has sustained a brain injury that involved an abnormal CT or MRI scan.
• A student has sustained a moderate or severe TBI.

The specialist you should consult depends on the nature of the complications and the services that specialist can provide. Ongoing physical problems like headaches or dizziness may require help from a qualified concussion expert. Lasting or severe cognitive or emotional problems may require help from a neuropsychologist.

504 Plan

A small percentage of students may display persistent problems after a concussion that could interfere with school performance. A concussion specialist who studies cognition and behavior, such as a neuropsychologist, should evaluate these students to better understand why they are not recovering as expected. Often, complicating factors such as underlying emotional, social, learning or attention challenges play a role. These students may require formal accommodations at school, such as those implemented through a 504 Plan.

What is the 504 Plan?

The 504 Plan is part of the civil rights law that prohibits discrimination against individuals with disabilities. It formalizes accommodations and modifications to ensure students with disabilities have equal access to a free and appropriate education. The 504 Plan is different than the Individualized Education Program, or IEP, which is a more extensive special education program. The 504 Plan and IEP are not usually necessary for children recovering from a concussion, but they may be helpful in rare cases when a student is experiencing prolonged concussion symptoms.

Contact our concussion experts

To schedule an appointment with the Concussion Program at Children's Hospital Colorado, call 720-777-2806.