Put the “Student” First in Student-Athlete Concussion Care

 As published in PsychologyToday.com, April 14, 2016

ReturntolearnHowever noble athletic pursuits provide, student-athletes are students first. Therefore, the concussion management process must honor this perspective and give student-athletes a fighting chance in the classroom or field of play.

Unfortunately in most cases, after a concussion injury the main question everyone asks is, “when can they return to play?” not “when can they return-to-learn?” The answer to either of these questions are key to the individual’s future success. But the Return-to-Learn decision is ultimately a higher priority. Concussions may be able to end a playing career, but we can’t let them prevent a future of prosperity.

Despite the glaring importance, most concussion protocols fail to include an adequate return-to-learn element, as written in the blog “3 Ways Most Concussions Protocols Fail.”

Student activities can be rigorous exercise for the brain. After a concussion, that’s the last thing you want to do. Recovering from a concussion requires “relative rest,” minimizing mental and physical stimulation until the student-athlete is symptom free. Relative rest refers to the avoidance of any mental or physical activity that provokes the athlete’s concussion-related symptoms. Resting the brain includes taking a break from typical academic activities. Healing from a concussion can be delayed if the athlete’s brain is forced to memorize, focus, make decisions, endure test-taking stress as well as other anxieties.

This return-to-learn recovery discussion is a bit of a gray area for most people, even medical professionals. So, I’ve integrated an automatic “academic care” plan along with every concussed injury reported using XLNTbrain. Using the student-athlete’s previous scores from the testing, the tool automatically creates a personalized plan for return-to-learn activities, as well as to obtain state-law required medical clearance for returning to play.

The recovery process should have parallel paths, one of school and one for sports. Rushing the student-athlete back to the to the field or classroom can exacerbate the problems and delay the recovery timeframe.

So, in an attempt to re-orient our thinking, I’ve assembled the following.

“Return-To-Learn” Concussion Protocol Guidelines

  • The recovery protocol actually begins prior to the season with a concussion baseline test, including cognitive, emotional and balance measurements. Look for the most advanced, because you don’t want to use outdated tools.
  • When a concussion is suspected, begin gathering data and follow the best practices below while administering any related first-aid.
    • If unconscious, do the ABCs, check airway, breathing and cardiovascular pulse before deciding to if/when/how to move the concussed individual.
    • Should the player stay unconscious for more than 30 seconds, call 9-1-1 immediately.
    • When the player becomes conscious, and spinal cord injury is ruled out, carefully assist the athlete to their feet, and ask them to walk off the field of play. Observe and assist as necessary.
  • Use a post-injury test using a mobile smartphone like the Sideline Assessment Tool and Balance Test from XLNTbrain Mobile. If that’s not available, use a clinical-caliber tool. The results of these scores will help understand the level of injury risk.
  • When in doubt, sit them out.
  • The results from the sideline testing should be sent to each of the responsible individuals, influencing the return-to-learn decision. This may include a doctor, coach, athletic trainer, parent or school administrators. With XLNTbrain, an email is sent automatically with the incidence report.
  • Assuming a concussion occurred, during the first 24 hours, the protocol calls for rest, which I refer to as “relative rest.” In others words, don’t do anything that may provoke the concussion symptoms like headaches, nausea, sleeplessness, for example.
  • Re-take the pre-season baseline concussion test, and compare results with pre-injury performance.
  • The course of recovery may include the need for an academic care plan with school accommodations that are customized to each individual injured athlete. This allows the student to return to the academic environment while minimizing provocation of symptoms. Inspired by the most recent American Academy of Pediatrics guideline recommendations, XLNTbrain automatically maps a concussed athlete’s symptoms to the appropriate academic accommodations for the return-to-learn protocol.
  • Once the injured student-athlete is free of symptoms at rest, begin a 5-Step progressive exertion recovery plan that tracks symptoms closely, with daily reports available for everyone involved. If all goes well, within seven days, the student-athlete should be returning to full academic and athletic activities.

Although not required for return-to-learn, obtaining medical clearance for returning to athletics at full speed is required by state law. To receive this clearance, it’s best to have all the data from steps 1 – 9.  Armed with this data, a medical professional can review the progress, daily symptoms, scoring on all the tests, and make an informed decision.

The goal is to return the athlete back to action safely. The gradual progression of mental and physical activity, while monitoring cognitive performance and daily symptom checklists help the student-athletes, school administrators, parents, coaches, and medical professionals avoid the dangers associated with concussions and returning too early.

School Administration Share Responsibility

A final disclosure — Academic performance can be an indicator of how well a concussed student-athlete is recovering. Teachers, counselors, and other academic administrators need to know the signs and symptoms, and understand the concussion may be impairing the student. Some accommodations may have to be taken, within reason, to help the student-athlete keep putting the “student” first, in student-athlete.

If you would like a demonstration of the XLNTbrain Sport concussion protocol, please register here.


About the Author


Neurologist Harry Kerasidis, M.D is the founder and medical director for the sports concussion management platform XLNTbrain, LLC, based in Maryland. He is also the founder of Chesapeake Neurology Associates in Prince Frederick, Maryland and serves as the Medical Director for the Center for Neuroscience, Sleep Disorders Center and Stroke Center at Calvert Memorial Hospital. Dr. Kerasidis authored Concussion-ology: Redefining Sports Concussion Management for All Levels, published in December.

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