a student and a pe teacher walk into your office……

A Student and a PE teacher walk into your

office……

Why is this important to you?

No one worried in the good old days about non-athletes

Child abuse

Domestic violence

“Extreme sports”

Time course of recovery

Collins, et al. Neurosurgery 58:275-286, 2006

May not be the athlete- could have happened outside of school, in gym class, slip and fall, etc

Symptoms may be delayed or not manifest until brain is cognitively stressed

Student complains of symptoms

How can I tell if a student is hurt?

Consistent message to the Student (and parents)

The injury is real

◦ Waiting for a full recovery is critical.

◦ Prolonged recovery or even catastrophic injury by returning to activity too soon

◦ Academic accommodations can be provided during recovery

COGNITIVE• Fogginess• Concentration• Memory deficits• Cognitive fatigue

MOOD DISRUPTIONIrritabilitySadnessAnxiety

SLEEP DYSREGULATIONFalling asleepFragmented sleepToo much/too little sleep

SOMATICHeadachesDizzinessLight/noise sensitivityTinnitus

Adapted from Camiolo Reddy, Collins & Gioia, 2008

◦Wake up fatigued◦Develop headaches sitting in class◦Can’t fully grasp class material◦Feel worse as the day wears on◦Bothered by light/sound at school◦Feel more exhausted after school◦More symptomatic trying to do homework

◦Upset and worried they are falling behind◦Go to bed feeling worse

◦Improve with rest… Physical/sports exertion Mental exertion Sustained attention in class and during school day

Reading Homework Tests/quizzes/standardized testing Computer vs iPad use

Post-injury Symptoms

Higher number of concussions/mTBI mTBIs occurring too close in time

◦ Re-injury prior to full recovery Pre-existing learning disability or migraine

issues

Physical exertion OR cognitive stress can cause symptom flare-ups & prolong recovery.

Risk factors for prolonged recovery

◦Temporary?

◦ Can be a PERMANENT problem

◦ Improves more quickly with proper management

◦ Complete recovery typically expected

Learning and attention disability

Individualization

Innovation

Integration/Team work◦ RN – ATC◦ Guidance – Teachers◦ Psychologists – Social Workers◦ Parents

Fluid situation that will change over time

Implementing an Accommodation Plan

Excused absence from classes Time out of school/complete rest to

start? Partial attendance as able

Morning fatigue/poor sleep > arrive late

Afternoon fatigue in school > leave early

Selective attendance? Core classes vs. electives? Avoid classes that are too challenging?

Rest periods during the school day o School nurse’s office o Rest before symptoms become too

intenseo Take Tylenol/Advil, etc. as

recommended by doctoro Return to classes if feeling bettero Early dismissal if rest does not help sx

Extension of assignment deadlines!

◦ Homework, papers, projects◦ According to student’s capacity◦ Removes major source of pressure◦ Allows student to prioritize sleep & rest!

Excuse from some assignments ?

◦ More common in lower grades◦ Less catch-up to do during/after recovery◦ Consolidate work into more manageable

units◦ Allow independent work with alternative

ways to submit

Postpone exams

◦Until student is able to prepare and symptoms are under better control

◦Avoid high stakes testing (e.g. AP exams, SAT) while symptomatic

◦Extended time (x1.5 or x2) until recovered◦Spring injuries - wait until summer to

complete course work and exams?◦Evaluate true necessity of exam/quiz for

student assessment- ? Alternative format

Light/noise sensitivity

◦Excuse from assemblies◦Able to eat lunch away from cafeteria◦Cap and/or sunglasses for light sensitivity◦Avoid fluorescent lights, windows◦Limit iPod, TV, computer exposure based on

symptoms◦Limit texting◦Adapt music to what is comfortable

NO sports, gym, music/theater/dance

◦Use time for rest & homework◦Short practice visits to stay connected to team◦DO NOT ride bus to away games with team◦DO NOT sit on bench during games In stands with family if symptoms allow

◦Prom

Limit other forms of physical exertion

Heavy backpacks Climbing stairs Walking home from school/bus stop Caring for large animals, or walking the dog Operating heavy equipment DRIVING

◦Be aware of impaired judgement/ability to react to dangerous situations

Athletic Trainer Monitoring of symptoms Periodic neurocognitive testing

School Nurse Daily clinical evaluations Rest & recovery area Medication

Guidance counselor Coordinates academic accommodations

Academic Care Team

Teachers Adjust work according to changing status Reassurance Be careful of pressure

Psychologists Specific input for LD-ADHD students

Social Workers Adjustment support - especially in longer

recoveries

Need clear team leader through whom all information flows

Hold the medical team to a standard of communication◦ Forms to complete/care plan to communicate◦ Feedback to medical re. symptoms, performance

Have clear policies in place to deal with parents who do shop around, “I’ll sign and take responsibility”

Policies in place for 504 Plan for mTBI◦ Academics must have priority

Pressure from coaches (any kind)◦ “be there to support the team” “faking it”

Family◦ “when I played football” “we have a lot invested”◦ “just trying to get out of…” “my uncle is an EMT…”

?Friends and/or teammates◦ “faking it” “we lost because you were out”◦ Cyber bullying◦ Loss of social life if witheld from group activity

Beware of and protect from

www.cdc.gov/concussion

www.impacttest.com

www.sportsconcussion.net

www.sportslegacy.org

Resources for education

Questions?