CONCUSSIONIs a mild Traumatic Brain Injury

Concussion: Definition – cdc.gov

• A concussion is a type of TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works

• Concussions can also occur from a blow to the body that causes the head to move rapidly back & forth

• ALL concussions are serious. ALL

Concussion = Latin Word “to shake violently”

Concussions in Pennsylvania

• Annually, approximately 22,000 children ages 0-21 years sustain concussions

Following a Concussion

• There are actual METABOLIC CHEMICAL CHANGES that take place in the brain.

Brain injury can occur even if there is NO loss of consciousness

• Initial CT/MRI scans are likely to be normal

“Concussion cannot be diagnosed by any one test.”

• Jeffrey Kutcher, MD• Chair, Sports Neurology Section, American

Academy of Neurology

More that 90% of concussions DO NOT involve loss of consciousness.

Memories of events BEFORE & AFTER the concussion are

MORE accurate assessments of SEVERITY than loss of

consciousness.

A child’s brain is not fully developed until the early to mid-20’s…

The majority of your students will recover within the first 3-4 weeks

• Until recovered, students should receive accommodations in all settings to promote cognitive & physical rest

For students who linger, striking a balance between the need for rest

& keeping up with academic content is the biggest struggle.

You will hear/see these terms:• Concussion• Mild traumatic brain

injury• Mild brain injury• Mild head injury• Minor head trauma• mTBI• ALL MEAN

CONCUSSION ONE “term” is not more severe in nature. ALL=Concussion

Types of concussed students you will see:

• Concussions occurring at school

• Concussions occurring over the weekends/breaks/summer

• Concussions occurring during school sports

• Concussion occurring during non-school sports

• MVA

Types of concussed students you will see:

• Student doesn’t miss any school• Student stays home for period

of time• Student returns to school,

symptoms flare, but they push through. This goes on for a few weeks, because student is waiting for dr. appointment

• Once he/she sees dr., dr. may place on homebound rest for period of time because at this point, symptoms are so severe

CONCUSSION• ALL CONCUSSIONS

ARE SERIOUS• 80% OF CONCUSSIONS

RESOLVE DURING THE FIRST 3 WEEKS

• IN SOME CASES SYMPTOMS PERSIST FOR MUCH LONGER, 5 – 10% LAST A LIFETIME

SIGNS & SYMPTOMS OF CONCUSSION

Thinking/Remembering

• Difficulty thinking clearly• Feeling slowed down• Difficulty concentrating• Difficulty remembering new

information

Physical

• Headache• Nausea & vomiting (early on)• Balance problems• Dizziness• Fuzzy or blurry vision• Feeling tired, having no energy• Sensitivity to noise or light

SIGNS & SYMPTOMS OF CONCUSSION

Emotional Mood• Irritability• Sadness• More emotional• Nervousness or anxiety

Sleep Disturbance• Sleeping more than usual• Sleeping less than usual• Trouble falling asleep

Concussion signs & symptoms• What the student might report:

– Headache– Concentration or memory problems– Nausea– Balance problems or dizziness– Double vision or fuzzy vision– Sensitivity to light or noise– Feeling sluggish– Feeling foggy or groggy– Confusion

Teachers who don’t understand impacts of concussion may think:• The student is:

– Lazy– Daydreaming– Spacey– Misbehaving– Rude– Not trying hard enough– Not studying hard enough– Taking too much time to answer

Understanding the Impact of Concussions

What this Means for the Classroom?

Today’s Goal• Understanding concussion signs and

symptoms

• Understanding the impact concussions have on school

• Understanding of the (CMT) Concussion Management Team’s role

• Understanding of the new monitoring tools Tennent will be using in working with students with concussions

How to Spot a Concussion? What Teachers May Observe:

• Difficulty multi-tasking

• Forgetfulness

• Slow thinking, processing, & answering

• Difficulty dealing with new situations

• Pain & symptoms may influence performance

• Inability to focus or sustain focus

• Behavior or personality changes

• Confusion about daily schedule & assignments

• More emotional

• Frustrates easily & unable to cope with stress

• Drifting off in class

• Reports feeling “Foggy”

Understanding the Impact of Concussions

What does this mean for the classroom?

Total Cognitive & Physical Rest

• No tv• No texting• No cell phones• No videogames• No reading• No parties• No computer• No loud music

Return to Learn

• While it’s true that an athlete must be 100% symptom-free to return to play, they do not need to be 100% symptom-free to return to learn.

• Although students may be able to handle some work while they are recovering, they should not push through the symptoms as it can greatly impact their recovery time.

Cognitive Exertion

Cognitive Exertion or thinking and the added stimulation of the school environment can SIGNIFICANTLY increase symptoms

Gradual Return to School Progression

• Each student’s return to school progression is individualized

• Some students may need to return to school in steps using the progression below

– Step 1: No school– Step 2: ½ day with accommodations– Step 3: Full day with accommodations– Step 4: Full school & activities without

accommodations

Return to School ProgressionStep 1: No school(Usually 1-3 days)

No homework sent home

Thinking restriction

Missed work excused or not expected to be made up as soon as student returns to school

If work can not be excused it should be MODIFIED to only include the most essential for when student returns to school

Step 2: ½ day w/Accommodations(Usually 1 day- 2 weeks)

Built in 10-15 minute breaks

Student’s work load should be reduced to 50%

Extended time

Multiple choice & word banks

Open note tests & quizzes

Bulleted main points in lieu of essays

Students are excused from Phys Ed.

Return to School Progression Cont.

Step 3: Full day with accommodations

Continue with modification plan as designated by the CMT

Step 4: Full day, full activities, no accommodations

Work on plan for missed work

Students should be cleared by their doctor to return to Phys Ed.

Athletes can return to play with proper clearance from their doctor

Factors that Impact Students

Cognitive Fatigue & Headaches

Sensitivity to Light & Noise

Dizziness

Students May Need the Following in School:

Work that can be completed in 30 minutes

Early dismissal to change class

Sunglasses

Warned before fire & evacuation drills

Headphones or ear buds

Avoid loud places

Teacher or copied notes

Lunch in a separate room with friends

Short 5-10 minute breaks from class

Gradual introduction of make-up work

Social & Emotional Concerns Counselors and Social Worker to Help With:

Early Worries

School in general

Falling behind academically

Not allowed to return to sports

Late Impacts

Fears that they are the only ones like thisAnxiety & depression

Adjustment

Social isolation

CMT Forms

The Concussion Management Team (CMT) in conjunction with BrainSteps has developed the following Forms that we will begin using here at Tennent

1. CMT Student Accommodation Form2. CMT Teacher Monitoring Form3. CMT Resolution Letter

One Last Thing…

Information about concussions will be posted to the Tennent website and Athletic site.

Your assistance with completing CMT forms will help better to support our students

If you have questions regarding today’s presentation please see a CMT member Ryan Mulford, Bonnie Zuckerman, Cyndi Detwiler, or Stacey Buterbaugh