Returning to the Classroom
Concussion injuries can directly impact a student's learning ability. Conversely, the cognitive learning process can adversely affect a student's recovery from a concussion. Therefore, concussed students may need varying levels of instructional modifications and academic accommodations during their symptom recovery, particularly early on in the acute stage, but can extend several weeks or months.
Current concussion management guidelines recommend concussed students remain at rest, both physically and cognitively to facilitate their recovery from symptoms. Cognitive rest refers to the reduction in mentally taxing activities, i.e. analytical problem solving, mathematical equation work, focused or prolonged reading, computer use, as well as activities involving saccadic eye movements such as using eyes to track objects, read, and smart-board work. Playing video games, texting, watching TV, and listening to music with earphones may also be discouraged during the symptomatic phase.
Just as concussed athletes follow a stepwise progression for "Return To Play," a progression back to the learning environment is equally important. A "Return To Learn" process emphasizes a collaborative team approach between school administration, school nurses, counselors, teachers, parents, and athletic staff (including a school's athletic training staff when student-athletes are involved). Because concussions occurring in athletics are less prevalent than those occurring on playgrounds, during recreational activities such as biking or skateboarding, accidents at home, falls, and motor vehicle accidents, a Concussion Management Team can be beneficial for recovery and returning all concussed students, athletic and non-athletic, to the classroom.
School staff should be familiar with the signs and symptoms of concussions. Additionally, school staff should know how to monitor students knowingly having a concussion, as well as recognize those possibly having a concussion unknowingly. There is greater concern for how long symptoms last, more so than which ones or how many might exist, but all three elements are important to the proper management of the concussed student.
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Signs To Look For After A Concussion
When students return to school after a concussion, school staff should watch for:
Source: CDC Heads Up to Schools. "Returning to School After a Concussion: A Fact Sheet for School Professionals."
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Symptoms of a Concussion Indicated by the Student
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General Considerations for "Return to Learn" Progression
In most cases, a concussion will not significantly limit a student's participation in school and usually involve temporary, informal instructional modifications and academic accommodations. The "Return to Learn" process encompasses Step 1 of the "Return to Play" progression during the entire time one remains symptomatic. Completion of the "Return to Learn" process precedes the start of "Step 2 - Return to Play" progression. In approximately 75 percent of cases, recovery from symptoms occurs within seven days, while roughly 90 percent recover from symptoms within 10 days. But nearly 5-10 percent percent of cases may take several weeks or months to recover from symptoms that experience Post-Concussion Syndrome, a chronic condition where symptoms persist long-term. The school's athletic trainer or other licensed healthcare provider will help guide decisions for the Concussion Management Team about a student's need for and level of modifications and accommodations, or adjustments, and their readiness to resume various school activities. Symptoms are monitored at regular intervals using a Graded Symptom Scale. Symptom scale scores can remain elevated or increased by exceeding levels of physical and cognitive activity where school activity should then be reduced when symptoms increase as a result. Members of the Concussion Management Team are to help identify triggers that cause symptoms to worsen, and modify school activity accordingly. Thereafter, school activities can be gradually increased as symptoms subside or decrease. If recovery becomes more prolonged (more than three to four weeks), there should be greater concern for a student feeling isolated or depressed and experiencing anxiety from not attending school, falling behind, and missing out on playing sports and other extracurricular activities. Additionally, a 504 Plan or an IEP may need to be considered for those having prolonged recovery extending beyond several months. |
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School Accommodation Options Based on Symptom Type
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| Headaches |
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| Sensitivity to Noise (phonophobia) |
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| Sensitivity to Light (photophobia) |
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Other visual problems
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| Concentration or Memory (Cognitive) Problem |
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| Sleep Difficulties |
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Levels of Instructional Modifications and Academic Accommodations
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| *Graded Symptom Scale Score ranges shown are a general guide and are not intended as objective criteria for dilineating stages of recovery or indication for specific instructional modifications or academic accommodations. Graded Symptom Scale Score ranges are extremely subjective and vary dramatically by individual, and also dependent on the selected Grading Symptom Scale used to derive a symptom score. |
| REFERENCES: Oregon Concussion Awareness and Management Program, Max’s Law: Concussion Management Implementation Guide for School Administrators. Center on Brain Injury Research & Training, Western Oregon University. http://www.ode.state.or.us/teachlearn/subjects/pe/ocampguide.pdf Halstead ME, McAvoy K, Devore CD, Carl R, Lee M, Logan K, Council on Sports Medicine and Fitness, and Council on School Health. Returning to Learning Following Concussion. Am Acad Pediatrics, 132 (5) 948–957, Nov 2013. http://pediatrics.aappublications.org/content/132/5/948.full.pdf+html. ImPACT Applications, Inc., September 2013. [Webinar] Almquist J, Connecting the Dots Between Clinical Assessment and Academic Accommodations. Center for Disease Control, US Dept. of Health and Human Services, 2013. Heads Up to Schools: Know Your Concussion ABC’s. Returning to School After a Concussion: A Fact Sheet for School Professionals. http://www.cdc.gov/concussion/pdf/TBI_Returning_to_School-a.pdf. The REAP Project. McAvoy K. REAP The Benefit of Good Concussion Management. Rocky Mountain Hospital for Children, Center for Concussion. http://issuu.com/healthone/docs/reap_oct21/1?e=1811185/5400960. |
