During office visits Dr. Logan reviews the school day schedule with patients “and we try to target different areas where they can feel comfortable to rest. I’m asking their opinion on where the best spots in their day are to get some rest. Because if I just say, ‘you’re going to do this, this, and this, what’s their likelihood of following through with those instructions? It’s really low.”
She recommends limiting computer time, reading, math, and note-taking during recovery, as each task tends to cause symptoms to worsen. “Having either the teacher’s notes supplied to them or having another student take notes for them may allow them to tolerate more class time than they would if they were trying to take notes,” said Dr. Logan, who has also served on the National Collegiate Athletic Association Committee on Competitive Safeguards and Medical Aspects of Sports. “Listen to lectures only.” At home, they should perform only activities that don’t exacerbate symptoms. This means limiting instant messaging, texting, watching TV, and playing video games.
A subset of concussive patients will be overstimulated by light and sound, “so it’s important to ask about that and make adjustments in the school day,” she said. “This would involve reducing sound and light when you can, wearing sunglasses and earplugs. You might have to write a note for that. It would involve avoiding classes like band, choir, and shop class, and avoiding crowded hallways, cafeterias, maybe allow that student to leave early or arrive a few minutes late to get them out of that busy hallway and help them extend their school day.”
Dr. Logan recommends delaying tests that may fall in the time line of recovery, such as midterms, finals, or college-readiness tests such as the SAT. “A brain-injured person is not going to do well on any of these tests,” she said. “In notes to school personnel write ‘no testing for now,’ or ‘postpone testing.’ ”
She advises pediatricians to “proactively identify” the point person at school who keeps tabs on how your patient is doing. “It’s going to be different at every school,” she said. “At one school, it might be a nurse. At another, it might be a teacher or an assistant principal. You have to identify that person. If you’re sensing that there’s going to be a problem, or if the parent says ‘nobody’s listening to me,’ call that point person. It really pays to get on the phone and talk about this patient. That goes so far and can help decrease problems with the next concussion patient at that school. Make sure the school feels like they’re on a team with you, that it’s not a doctor telling the school what they have to do.”
Patients can gradually progress to a full school day “when symptoms go away,” Dr. Logan said. “I like them to be able to tolerate nearly a full school day before we start to give them homework, because I know that during the day they’re giving all they have in energy reserve. When they get home they need time for their brain to rest.”
Dr. Logan reported having no financial disclosures.
On Twitter @dougbrunk