SLPOtherNeuroRehabilitation2022

Physician recommended school accommodations and student outcomes following a mild traumatic brain injury among youth with persistent post-concussive symptoms.

Julian Takagi-Stewart, Ashleigh M Johnson, Mallory B Smith and 6 others

PMID 35180137

WHAT IT FOUND

Physicians recommended more school accommodations for adolescents who reported more ongoing school problems.

However, these recommendations were not associated with better grades, fewer symptoms, or improved quality of life at 12 months, suggesting a gap between what doctors prescribe and what schools implement.

Key findings

01Adolescents who received four or more categories of school accommodations reported more problems at school at three and 12 months compared to those receiving fewer.

02Physician recommendations for accommodations were not significantly associated with student GPA, concussion symptoms, depression, anxiety, or health-related quality of life at either time point.

03Most adolescents (70%) received recommendations across four or more categories of accommodations, with non-specific advice being the most common.

STILL TO COME

How it was doneWhat they foundWhat it means for SLPs

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What it does not show

The sample was predominantly White and high-income, limiting generalizability to diverse populations. The study only captured physician recommendations, ignoring those from athletic trainers or school nurses, which are common in return-to-learn protocols. It is an observational analysis of a trial cohort, so it cannot determine if the accommodations caused the outcomes or if sicker students simply received more recommendations. The timing of clinic visits and follow-up surveys did not always align, making it difficult to interpret the sequence of events.

Declared interests

The authors declared no conflicts of interest.

The easy way to misread this

Do not interpret the finding that students with more accommodations reported more school problems as evidence that accommodations worsen outcomes. The data suggests that physicians recommended more accommodations to students who were already experiencing more difficulties, reflecting a matching of support to need rather than a negative effect of the support itself.

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