Back to school after an acquired brain injury

The following information is designed to help you understand the difficulties which may arise following an acquired brain injury (ABI) in children.

It will be useful to share this with the teachers and other school staff who will be supporting a child or young person on their return to school after an acquired brain injury.

An acquired brain injury may affect children in different ways, but there are common symptoms. Minor adjustments may be needed in supporting a child or young person successfully back into school.

Effects of an acquired brain injury

Effects of an acquired brain injury may include physical difficulties, cognitive difficulties and emotional or behavioural changes.

Physical difficulties

Examples of physical difficulties include:

• poor balance or coordination
• headaches
• dizziness
• fatigue
• sensitivity to light or noise

Cognitive difficulties

Examples of cognitive difficulties include:

• poor concentration
• poor memory
• brain fog
• fatigue
• difficulty with new learning

Emotional or behavioural changes

Example of emotional or behavioural changes include:

• irritability
• frustration
• impulsiveness
• anxiety
• heightened emotions such as angry or sad
• altered sleep

Fatigue

Fatigue is a common issue following a brain injury and can be long-lasting. It is an overwhelming feeling of tiredness and lack of energy, and can affect physical, cognitive and emotional functioning. Common signs of a child struggling with fatigue include:

• being less coordinated, or having slurred speech
• reduced concentration or ability to process information. This may be more noticeable at the end of the day or towards the end of the school week
• brain fog, such as being confused or unable to maintain focus
• emotionally labile, such as immature or dysregulated behaviours

Some children are unable to recognise their fatigue. Having regular rest breaks in the timetable will help to reduce these symptoms.

Returning to school

Most children will be able to return to school after a short period of rest. This is usually around 1 to 2 weeks, although this may be longer with more serious injuries.

This will be when they no longer have any significant headaches, when they are feeling well enough, and when the team around them feel it is appropriate.

A phased return is often recommended to manage fatigue and reintegration into a learning and social environment. Any phased return should be tailored to the individual child. For example, just 1 or 2 lessons, or alternate days.

They will need to be closely monitored to gradually increase time. If there is an increase in any of the physical, cognitive or emotional symptoms described above, it may be appropriate to reduce time again.

Other forms of support include:

• reducing class-time
• avoiding crowded or noisy environments
• chunking work and allowing more time for completion
• providing rest breaks
• emotional support

PE and sports

Children and young people need to avoid physical activity where there is risk of re-injury for a period of 6 months. This will mean some PE activities such as contact sports or trampolining will be unsuitable.

However, light, non-contact exercise is beneficial, and children should be encouraged to participate in gentle activity.

Return to sport will always be on the guidance of the hospital consultant.

When should we seek help?