During cheerleading practice in April, Jana Duey’s sixth-grader daughter, Karter, suffered a concussion when she fell several feet headfirst onto the gym mat. After several days, Karter still had headaches, dizziness, and sensitivity to light and noise.

Karter rested for a week and a half at home in Centennial, Colo., then returned to school when her concussion symptoms were tolerable — initially only for half days and with accommodations that allowed her to do homework on paper instead of a screen and take extra time. to get to and from classes. Karter went to the nurse’s office when he had a headache, Duey said. She began physical therapy to rehabilitate her neck and regain her balance after the accident left her unsteady on her feet.

After children suffer concussions, a primary concern for them and their parents or caregivers is when they can return to sports, said Julie Wilson, Karter’s physician and co-director of the Concussion Program at Children’s Hospital Colorado in Aurora. Returning to school as quickly as possible with appropriate support and performing light exercises that do not pose a risk of head injury are important first steps in concussion recovery and according to the latest research.

“It is very important that children and adolescents return to their normal daily activities as soon as possible and as soon as they can tolerate them,” Wilson said.

In August, the Colorado Department of Education updated guidelines that dispel common myths about concussions, such as a loss of consciousness being required for a concussion diagnosis. The revised guidelines reflect evidence-based best practices on how returning to school and exercise can improve recovery. Educating families and schools about the new guidelines is critical, according to medical experts, especially during the fall spike in concussions from sports like football and soccer.

More than 2 million children nationwide have been diagnosed with a concussion or brain injury at some point, according to the 2022 National Health Survey. A number of studies over the past decade have shown that teenagers recover faster from concussions and decrease the risk of prolonged symptoms by doing light exercise, such as on a stationary bike or brisk walking, two days after a concussion. That time frame can also be the ideal place for returning to the classroom, as long as children can tolerate any remaining concussion symptoms.

“Even though the brain is not a muscle, it acts like one and has a use-it-or-lose-it phenomenon,” said Christina Master, a pediatrician and sports medicine and brain injury specialist at the Children’s Hospital of Philadelphia.

Instead of waiting at home to fully recover, Master said, students should return to school with extra support from teachers and breaks in their schedule to relieve symptoms such as headaches or fatigue, with the goal of gradually more.

Each state has return-to-play laws for student athletes, which include policies such as removal from the sport, medical clearance to return and education about concussions. While some states, such as Virginia and Illinois, have return-to-learn policies, Colorado is not among them. It and 15 other states have community concussion management protocols.

That’s what Colorado updated this summer. REAP — which stands for Elimination/Reduction; Educate; Adjust/Accommodate; and Pace – is a protocol for families, health care providers and schools to help students recover during the first four weeks after a concussion. For example, school staff can use an email-based system to alert teachers that a student has suffered a concussion, then send weekly updates detailing how to manage symptoms such as difficulty concentrating.

“We have new protocols to support these kids,” said Toni Grishman, senior brain injury consultant with the Colorado Department of Education. “They may still have concussion symptoms, but we can support them.”

Concussion symptoms resolve in most patients within the first month. However, patients with persistent symptoms, called persistent post-concussive symptoms, may benefit from a multidisciplinary care team that may include physicians, physical therapists, psychologists and additional school support, Wilson said.

David Howell, director of the Colorado Concussion Research Laboratory at the University of Colorado Anschutz Medical Campus, studies how children and their families cope with the physical, cognitive, social and emotional impact of concussions. In some studies, teens wear sensors to measure exercise intensity and volume, as well as common symptoms of concussion, such as sleep and balance problems. In others, children and their parents answer questions about their perceptions and expectations of the recovery process.

“What you bring to an injury is often exacerbated by the injury,” Howell said, citing anxiety, depression or simply going through a difficult time socially. Recovery can be influenced by peer and family relationships.

Duey said the most difficult part of Karter’s recovery was not being able to cheer for nine weeks, including his team’s final competition in Florida. Karter, now 12, watched practices and supported her teammates in the spring, but the loss tore her up inside, Duey said.

“There were a lot of tears,” Duey said.

While recognizing a concussion and acting quickly can help anyone, in practice, more than half of Colorado students can slip through the cracks with undiagnosed concussions, Grishman estimates.

The reasons for missed diagnosis are many, Grishman said, including lack of education, barriers to medical care, parents’ reluctance to tell schools about a concussion for fear their child will be excluded from activities or not take symptoms seriously at a student with antecedents. of behavioral problems.

Getting schools to follow concussion guidelines in general is a challenge, Grishman said, adding that some districts still don’t. She said it was hard to track the number of schools that followed the Colorado Department of Education’s guidelines last year, but she hopes improved data collection will provide more detail this year. During the past school year, Grishman and her colleagues trained 280 school staff in concussion management in 50 Colorado school districts.

Whenever possible, athletic trainers should be on the sidelines to support student athletes, Master said, and athletes should be aware of concussion symptoms in themselves and their teammates and seek care immediately.

But concussions aren’t limited to the school athletic field or sports like soccer or football. Adventure sports such as parkour, slackline, motocross, rodeo, skiing and snowboarding also carry concussion risks, Wilson and Grishman said. “Cheerleading is actually one that has a lot of concussions associated with it,” Howell added.

Duey said Karter has occasional headaches, but has regained her balance with physical therapy and is free of her concussion symptoms. She’s back to flying with her cheerleading squad and getting ready to compete.