“I don’t remember my daughter playing soccer, playing youth soccer, one summer,” Favre told WSPZ. “I don’t remember that. I got a pretty good memory, and I have a tendency like we all do to say, ‘Where are my glasses?’ and they’re on your head. This was pretty shocking to me that I couldn’t remember my daughter playing youth soccer, just one summer, I think. I remember her playing basketball, I remember her playing volleyball, so I kind of think maybe she only played a game or two. I think she played eight. So that’s a little bit scary to me. For the first time in 44 years, that put a little fear in me. …
“I think after 20 years, God only knows the toll.”
— Former NFL quarterback Brett Favre, telling Washington sports radio station WSPZ AM that he fears he has been affected by concussions. (TwinCities.com)
Most student-athletes want nothing more than to return to their sport after suffering an injury. Some injuries allow kids to return to school while recouperating. That’s not true of concussions. The point we hammer home to concussed athletes is they can’t return to the field or the court until they return to school, where they can learn efficiently again, without the return of concussion symptoms. Getting them to the point of being able to tolerate a full day of school can be a challenge to pediatricians, injured children, and their parents. When we prescribe to “shut down” a concussed child, we really mean shutting them down completely: No physical activity, no school work, no reading, no games, no TV or video games or computers or texting. They need brain rest, and that means doing nothing. Most kids can do nothing pretty good for 15 minutes. What’s hard for them are the other 1,425 minutes of the day.
Last week, the AAP issued new guidelines geared for use by doctors, parents, school administrators, and teachers to help children who suffer concussions recover as quickly as possible, so they can “return to learn.” Based on guidelines created by the Rocky Mountain Youth Sports Medicine Institute, the “REAP” program emphasizes four steps to get students back into school:
R – Reduce physical and cognitive, or mental demands
E – Educate the student athlete, families, educators, coaches and medical professionals on all of the potential symptoms
A – Accommodate for the student athlete academically
P – Pace the student athlete back to activity, play, and learning
Our first priority as pediatricians is to help your concussed child or teen feel better. Follow-up appointments in our office include a survey of residual symptoms, a neurologic exam, and neurocognitive ImPACT testing. As scores return to baseline and symptoms diminish, returning to school can be considered. Written instructions regarding duration of the school day (usually starting with half days), homework and testing accommodations, and prescribed rest periods (if needed) are given to parents to share with the school. Only when kids are back in school for full days, tolerating the noise and busyness of the school environment, getting their school work, homework and missed work completed efficiently , without their symptoms returning, can we begin the gradual “back to play” protocol.