STEVE INSKEEP, HOST:
Years ago, high school sports teams did not consider concussions a big deal.
JANIE HEARD: We used to just - if a kid got knocked out on the football field, we put smelling salts under their nose, and we sent them back out.
INSKEEP: That's Janie Heard of Trinity Christian Academy in Dallas. NPR's Michel Martin has been talking with young people there. And elsewhere in today's program, we hear a mother and son talking through football injuries. Right now, we hear of a more modern approach to treating concussions in school. Here is Lauren Silverman from our member station KERA in Dallas.
LAUREN SILVERMAN, BYLINE: Trinity is one of thousands of high schools in the U.S. trying to bring kids back from concussions in a more balanced way. And senior Graham Hill has recovered so well under its academic rehab program that...
(SOUNDBITE OF FOOTBALL PRACTICE)
SILVERMAN: ...He's returned to football practice. Still it took a long time for this defensive end to suit back up after his concussion. For months, he felt sick. His stomach hurt, he was exhausted and there was a pressure in his skull like a balloon was being inflated in his head.
GRAHAM HILL: It's kind of hard to describe. It's like a migraine on steroids.
SILVERMAN: The instructions from the doctor were simple - no football and, for a while, no school.
HILL: Immediately it was - do absolutely nothing, basically be brain dead. Just sit in a dark room, no electronics, no reading, no loud noises and just focus on getting your mind better.
SILVERMAN: So as long as he had symptoms, Graham didn't hang out with friends, even text them. He missed two full weeks of class during his all-important junior year and then went back part-time.
HEARD: Our goal is to get them back to where they were academically before the brain injury. And it's different for every one of these kids.
SILVERMAN: Administrator Jamie Heard created the school rehab program at Trinity after she had a serious concussion years ago. In the past four years, she's helped 128 students throughout the school with a gradual return to class after a brain injury.
For Graham, that took months. For some, it's quicker. The newest thinking is to create a unique game plan for each kid using their symptoms as a guide. And it's a big change from the so-called cocoon therapy - the idea that more rest must be better.
DANNY THOMAS: Most people would assume is that when you are resting, you're having less stimulation on your brain and then, therefore, you would have lower symptoms because you're not challenging yourself.
SILVERMAN: Danny Thomas is a pediatric emergency medicine doctor at Children's Hospital of Wisconsin. He led a randomized trial to test the idea of strict rest for young patients with concussions.
THOMAS: What we found was that patients who were randomized to the strict rest group took longer to recover and had more symptoms during that recovery period.
SILVERMAN: That's right, headaches and nausea were worse for the kids resting more for five days instead of two. And they complained of emotional symptoms like irritability and sadness.
THOMAS: The pendulum had swung too far towards rest. And hopefully, this study has moved that pendulum back to the middle.
SILVERMAN: Even before Thomas' study was published, Janie Heard of Trinity had adopted the custom approach. She coordinates with doctors, students, parents and teachers to make sure a student is doing as much work as possible without aggravating symptoms. Sometimes that means avoiding technology.
HEARD: In our schools, we use screens all the time now. We have overheads, Smartboards. So our kids know they have to put their heads down in class if a screen is being used when they are recovering from a concussion.
SILVERMAN: For a student taking six classes and applying for scholarships, trying to give the brain the appropriate amount of rest can be a challenge, but it's crucial. Dr. Gerry Gioia of Children's National Medical Center in Washington, D.C., says the brain's electrical transmissions, which govern the whole body, can be affected by a concussion.
GERRY GIOIA: I often say the software system of the brain now is impaired, and all of the functions that that software runs - like your thinking and your behavior, your emotion, your sleep - can potentially be impaired as well.
SILVERMAN: The evidence shows getting all that back online takes some flexibility and a lot of patience. For NPR News, I'm Lauren Silverman in Dallas.