Overview

A concussion is a mild form of a traumatic head injury which impacts brain function, which is usually caused by an impact on the head or body.¹ Falls are the most common cause of head injuries, that is why children and athletes are more likely to be affected. During recovery, rest is recommended, this means that students who have suffered a concussion might experience trouble completing their schoolwork.  A full recovery is common if a rest period has been taken. 

Concussions temporarily results in the loss of normal brain function.² Short-term effects of concussion include having trouble concentrating, headaches, alternating moods, sleep disturbances, and issues with memory and balance.¹ Although it is common for some people to lose consciousness following a concussion, it is not a prerequisite for the diagnosis of the condition; so it is recommended that all head injuries, no matter the severity, are monitored carefully. 

Data suggests that concussions are very common in people below the age of 24 and those older than 75; however,children between the ages of 0-14 are the most common age group experiencing this condition.³ This is mostly because of the vigorous activity taking place when children play. Other  common causes of concussion include sports-related and cycling accidents.⁴

Students and concussions

Because children are one of the most likely sufferers from concussions, it is no surprise that their studies are in turn affected. Research has shown that children and young people require much longer healing periods than adults when recovering from a concussion.⁶ 24-48 hours of rest is the minimum rest time recommended, due to the impact of the concussion on the brain's ability to function normally. This often means a gradual return to school is necessary to ensure the child is not suffering from any post-concussion issues. 

The time away from school and longer rest periods required during the recovery process mean many students and parents feel anxiety surrounding the impact of a concussion on school performance. It is recommended to discuss this with your healthcare provider to determine if longer time off is required to ensure a full recovery. 

Understanding concussions

Causes of concussions

Concussions can be caused by impacts on the body or head, for example during an accident or when falling over. The impact causes a sudden disruption to the part of the brain which regulates awareness and consciousness.⁴ Although it is often assumed that the individual will lose consciousness, this is not always the case. 

After experiencing a concussion, careful monitoring of the patient is required, usually for 48 hours. Frequently, the vast majority of patients achieve full recovery after 7-14 days.⁵ During this time, it is recommended to not partake in physical activity (e.g., sports). 

Symptoms of concussions

The symptoms of concussions can range from mild to severe. Always contact a medical professional immediately after any head injury. The most common symptoms include:

• Headache 
• Dizziness 
• Nausea 
• Confusion - unaware of where they are, slow response to simple questions, or a blank expression
• Difficulties in balance
• Issues with vision - double vision, blurred vision, seeing spots or ‘starry’ vision 
• Memory difficulties 

Some less common symptoms can include:

• Sudden uncharacteristic changes in behaviour and emotions, like sudden tears,  laughter, or irritability
• Slurred speech 
• Loss of consciousness
• Issues with reading or writing 
• Weakness in arms or legs  
• Sudden deafness in one or both ears 

Certain factors can make an individual more vulnerable to the impacts of a head injury, so it is important to always contact a healthcare professional immediately. To relieve symptoms temporarily while waiting for health care advice, the following could be performed:

• Apply a cold compress to the injury to reduce any swelling 
• Take a mild painkiller (e.g., paracetamol).Remember to retain medication packaging and to inform healthcare providers of any medication that has been administered.
• Avoid drinking alcohol or taking any recreational drugs  

After a concussion 

The damage caused by concussions can vary depending on the severity of the injury. However, typically the extent of the damage is minimal, and does not cause any long-term problems or complications. 

However, a repetitive history of brain injuries can cause longer-term issues with mental abilities. This is typically more common in athletes who compete in sports like boxing.⁴ 

Post-concussion syndrome (PCS) is not widely understood. Because of this, doctors recommend monitoring patients, especially children, for a minimum of 48 hours. Keep an eye out for the following symptoms in the days or hours following the concussion:

• Amnesia 
• Persistent headaches
• Abnormal changes in behaviour 
• Prolonged vision problems
• Clear fluid leaking from nose or ears 
• Difficulties in speaking 
• Consistent vomiting 

If these symptoms persist, contact A&E immediately. 

Impact of concussions on academic performance 

Immediate impacts

A concussion impacts the brain's ability to operate normally, which can impact a range of activities, especially those which require prolonged attention or concentration. The child may suffer from feeling more tired than usual, difficulties concentrating, or feeling irritable, sad, or emotional.⁸

Following a consultation with a healthcare provider and depending on the severity of the concussion, differing advice may be given. Always listen to your healthcare provider first. 

All patients are recommended to rest for the first 24-48 hours following a concussion, to avoid making the symptoms worse. This means physically and mentally draining activities such as watching TV, playing video games, or looking at a phone screen should also be avoided. 

Managing schoolwork during recovery 

Following 24-48 hours of rest, a gradual and staggered return to regular activities is encouraged with careful monitoring. 

All school activities which could increase the risk of further injury should be avoided in all cases until clearance is obtained from a healthcare provider. In most cases, a note from a doctor or caregiver will be required to excuse the child. 

Teachers should be informed of the situation to keep an eye out for the child and to avoid setting excessive homework. In some cases, the teacher can work with the child to provide necessary alterations, for example:

• Choosing a new seat in the classroom, maybe closer to the teacher and the board. 
• Ask if the lesson can be recorded to allow the child to cover the material again following the lesson. 
• Ask the teacher if they can share the lesson material with the child either before or after the lesson. 

Impacts on schoolwork can cause anxiety in students, so it is important that the child understands the importance of rest. It is important the teacher is aware of the problem, so the child is not punished for an instance of late or missed homework, potentially increasing the child’s stress.

Role of parents and educators

Immediately following the concussion

The symptoms of a concussion, especially in children, can often be overlooked so it is up to the parent or teacher to watch for the symptoms and contact the relevant healthcare provider to seek assistance and prevent any further harm. 

If you believe the child has or could suffer from a concussion you can:

• Remove them from further harm if possible 
• Talk to them and determine how they feel. Asking simple questions such as their name or where they are can help determine this
• Get medical advice
• Encourage the child to rest. Both mental and physical rest is essential

Make sure to keep the child monitored at all times in the first 48 hours following a concussion. 

Ensure all teachers are aware of the situation so the child is not exposed to any unnecessary stressors for late or missed homework. 

Returning to school

Experts recommended a minimum rest period (including physical and mental rest) of 48 hours.⁶ Ensure all adults who will be around the child are aware of the situation and are on the lookout for any returning symptoms. 

A gradual return to mentally or physically strenuous activities is recommended to ensure the child is fully recovered. If any of the symptoms of the concussion return during or after the activity, it indicates the child is not ready and requires further rest.⁶

Sometimes starting with mild activities like a short walk can help gradually test the child and develop their confidence without over-exerting them. Sometimes a healthcare professional would recommend the following options:

• Returning to school part-time first 
• Returning to school full-time gradually taking part in more of their usual school activities 
• Full return to school and day-to-day activities

There should be a minimum of 24 hours between each of these steps.⁹

Summary

A concussion is a mild traumatic brain injury which results in an impacted brain function. Symptoms can include nausea, dizziness, confusion, loss of balance or irritability. Concussions are typically caused by a fall or accident, so they are most common in children and athletes. It is recommended that the individual has a minimum of 48 hours of physical and emotional rest following the injury so this can impact schoolwork. 

To ensure the child is fully healed, adults and teachers in contact with the child should be informed of the situation and steps taken to avoid unnecessary stress on the child. A gradual return to school and day-to-day activities is sometimes recommended, but activities in which the child can further injure themselves should be temporarily avoided.