Updated Approach to Concussion Guidelines
The American Academy of Pediatrics have revised their guidelines for treating sport-related concussion, now encouraging light exercise, an earlier return to school, and use of electronic devices.
The American Academy of Pediatrics (AAP) has made some significant updates to its guidelines on the care of sport-related concussions. The clinical report, Sport-Related Concussion in Children and Adolescents, revises the 2010 guidance and will be published in the December issue of Pediatrics.
According to Mark E. Halstead, MD, FAAP, lead author of the report and a member of the AAP’s Council on Sports Medicine and Fitness, a significant change is that the AAP now encourages light exercise earlier in concussion recovery. This is because research has demonstrated that light exercise can be safe and may help hasten recovery from a concussion. However, this doesn’t mean that student-athletes should return to full sports practices or games before they are completely symptom free. Returning to full activity is a multi-step process, and light exercise has shown to be a safe preliminary step.
“A good rule of thumb for patients is starting with 20-30 minutes a day of light aerobic exercise such as brisk walking or light exertion on an exercise bike,” wrote Dr. Halstead in an editorial describing the new guidance. “If symptoms worsen while exercising, the athlete should stop and try again the next day. This often is referred to as sub-symptom threshold training.”
The report also addresses return-to-learn protocols. Instead of keeping students out of school for extended periods of time following a concussion, it recommends that they be allowed to return to school with symptoms after only a few days, typically missing no more than one to two days. Students will likely require adjustments to their workload, curriculum, and learning environment in order to minimize symptoms, but the report says keeping them out of the classroom for longer periods of time has shown to cause more harm than good.
“When athletes are kept out longer, anxiety and stress may increase from not being around friends, missing assignments and having concerns about their grades,” wrote Dr. Halstead. “Adding stress or anxiety to a student recovering from a concussion also has the potential to magnify symptoms, making it more challenging for the provider to determine if symptoms remain from the concussion or from stress/anxiety, thus prolonging recovery.”
Another update concerns the use of electronics. In the past, it was often suggested that student-athletes who suffer a concussion abstain from the use of electronics until all their symptoms subsided. But so far, Dr. Halstead says there is no conclusive evidence proving that using electronics can be a detriment to recovery. He suggests if a student is experiencing symptoms of light sensitivity when using a device, then they should reduce their use. Otherwise, it may actually be detrimental to deprive students of their electronic devices.
“Electronic devices can be helpful for students who struggle to read smaller print, as icon and font size can be increased easily on electronic devices,” wrote Dr. Halstead. “Access to audio versions of school materials that are readily available on electronic devices may help minimize symptoms provoked by reading.
“Pediatricians need to be cognizant that children are connected socially through their electronics, and taking these devices away can add stress or lead to feelings of being punished for their injury,” he continued.
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