Heightened concern about youth concussions spurred legislation in Minnesota and national guidelines governing when injured athletes can safely return to sports, but many parents and educators remain confused about when students' brains have healed enough that they can safely return to class.
The American Academy of Pediatrics weighed in on Sunday, with new guidance called "Returning to Learning," in an effort to keep concussed kids from being rushed back to class in ways that could prolong their brain injuries and cause their grades to plummet.
But the nation's foremost pediatrics organization also acknowledged that there is no one way to recover from a concussion, and urged parents, doctors and educators to work together in easing students back to school.
"One concussion may not act the same as the other one," said Dr. Mark Halstead, a St. Louis pediatrician who cowrote the guidelines. "Some students might have trouble with noises or bright lights at lunch. Others might have trouble in their math classes but be fine in all of the other ones."
For Hannah Sipe, a junior at Big Lake High School, it was a little of everything — the lights, the noise, the crowded hallways, and the taxing work of applying a healing brain to deep thought.
Back in the fall of 2011, Hannah tried to return to class after suffering four concussions in soccer and basketball the prior school year. Her parents figured the honors student could resume a full class load. She was outwardly healthy, so school officials didn't see the need to provide additional support. A doctor even suggested that lingering symptoms at that point might just be psychological.
But two weeks into her freshman year, Hannah's headaches and exhaustion grew so severe that she was hospitalized for four days.
"I don't know if I passed out or something that made them take me to the hospital, or if it was just pain," said Hannah, who is now 16.
Even if the nation's pediatricians can't provide a how-to manual, they are raising attention that should compel schools to support concussed students earlier and offer flexibility in their coursework, said Hannah's mother, Susan Sipe.
"We've been crying for this for years," she said. "Nobody quite knew what to do with us."
Now in her junior year, Hannah gets several accommodations at school. Focusing on the dial of a combination lock makes her dizzy, so she carries all her things in a backpack. So does looking up and down from the board to her notebook, so her teachers give her study notes.
The pediatrics guidance emphasizes accommodations in the first three weeks following a concussion, when many students will recover if their brains receive sufficient rest.
Simply yanking these kids from school until they are healthy isn't always the best solution, the document says. While sometimes necessary, it can cause stress and other problems for students who would function just fine with modest support.
"There's no research to suggest we're going to speed up that person's recovery," Halstead said. "We just don't want to hinder it."
The Academy of Pediatrics issued "return to play" guidance in 2010, and recommended that athletes receive written medical clearance before resuming sports. With 1,000 children suffering sports-related concussions in the state each year, the 2011 Minnesota Legislature adopted similar rules and required concussion training for coaches.
Cooperation among adults is critical because the students are often skeptical — especially high-performing students who try to ignore their symptoms and hurry back to their usual schedules, Halstead said.
"It's just as hard as getting [injured] athletes to come off the field," Halstead said. "They just keep pushing themselves because that's all they know."
Hannah made steady progress her sophomore year, when her high school designated her as disabled and created an Individual Education Plan that allowed her to complete coursework at home.
So far this year, she has succeeded in two classes at school, while taking the rest at home, and reconnected with old teammates by managing the varsity soccer team.
She no longer plays the French horn or participates in sports. Hannah said it was hard to see another girl wear No. 8, her jersey number since she was little. An active church youth group and a support group for teens with long-term concussion symptoms have helped her cope with the loss of sports and the struggles with schoolwork.
The Sipes are left wondering, "What if?"
What if Hannah had spoken up about her injuries and removed herself from games right away? What if they hadn't put her back in sports, even when doctors cleared her, or tried to put her back in school without help?
They'll never know, but Hannah hopes others will learn from her experience, take concussions seriously, and ask for help from their schools.
"The what ifs," Hannah said, "will kill you."
Jeremy Olson • 612-673-7744
