[westerner]

Sorry in advance for venting as I know some folks have it worse. But I want to share my story about my 13 year old daughter "M" as I am broken hearted to see her suffer and I would like to get input on return-to-school approaches.

In September, M got hit in the head with a basketball in gym class. The ball was stuck in the ceiling and then came loose and hit her in the forehead from a great height. I took her to the emergency room, they did a scan which came back OK, she appeared to have no obvious neurological issues. Emergency room doctor as well as her regular doctor said "OK to return to school with cognitive breaks". Since then, M has headaches that never go away. Headaches vary from 1) "I can ignore it" to 2) "Hurts" to 3) "Really Hurts" depending on how much sustained schoolwork/classroom activity she does. When her headache is at level 1 or 2 you would almost not know she has a concussion, she functions well and is her bright and expressive self. But at 3 she has difficulty concentrating and needs to lie down and I cry about the pieces of her life that are passing her by.

In September and early October she was trying to do a full day in school with rest in the nurse's office as needed, but her headaches were at level 3 most days. It was difficult to get through all her homework and she was acting a bit scattered. She took two weeks off in October and towards the end her headaches were almost 0. After the two weeks, she went back to trying a full day with ad hoc breaks, and within a few days her headaches were right back up to 3. Her regular doctor put her on a half day starting beginning of November. The school put together a schedule of 4 out of 9 periods which focused on core subjects and alternated classroom time with rest periods in the nurse's office. On this schedule M did better. Her headaches were at 1 most of the time with occasional 2's. She could get through her homework fine but still acted scattered sometimes.

M saw Neurologist 1 in mid-Nov. Neuro1 said to aim for partial activity; no activity is not good, and too much activity is not good. He put all the burden on the school to figure out how to help my daughter through this.

In early December the school nurse and I compared notes on my M's headaches and she seemed to be doing relatively OK, so we increased her schedule to 5.5 periods out of 9.

M saw Neuro1 again in mid December but I was really put off by him. He rambled, asked M bizarre questions and was highly critical of the school without providing much in the way of specific instructions. I decided to seek another neuro.

I took M to see Neuro2 a week later. Neuro2 is part of the NYU-Langone concussion program in NYC. I liked Neuro2. She listened attentively, took detailed notes, and gave M a thorough neurological exam that tested her memory and thinking skills which came back good. Neuro2 OK'd the 5.5/9 schedule and refered my daughter to Neuropsychology. I told Neuro2 that I was looking for guidance on how adjust my M's schedule over time, but Neuro2 said that Neuropsych are the ones who coordinate with the school. Does that sound right to you?

Since the 5.5/9 schedule M's headaches are at 2 most of the time with some 1's and 3's. She acts less scattered and I've helped her be more disciplined about her homework. Throughout, M is in good spirits and doesn't complain and is her usual sunny self for the most part.

I see two possible approaches:
1) Give M partial school activity to the level she can handle.
2) Reduce school activity to 0 until symptoms go to 0, then increase very slowly, stopping if symptoms go above 0.

So far we are following #1. That was what Neuro1 recommended, and Neuro2 endorsed it. The partial schedule gives M a good chance of passing the school year.

But I wonder about #2. After reading other stories here, I feel she was truly blessed to have been able to bring her symptoms to 0 with two weeks off in October. Maybe we should be aiming to keep her symptoms at 0 and increase very slowly, backing off if her symptoms go above 0, for however long it takes. But that may cause her to repeat the year, Heaven forbid. That would be a big emotional blow to her.

Please let me know what you think.