Post-Concussion Recovery:  Information Form for Educators and Parents

What is a concussion?

A concussion is a type of traumatic brain injury or 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 and forth. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious (CDC.gov).

 

The impact of school and learning on your student’s symptoms

• Both physical exertions and COGNITIVE exertion (thinking) can have negative effects on the student. Cognitive Exertion and the added stimulation of the school environment can significantly increase symptoms, even when the student has begun to recover.
• Research has demonstrated generalized hyperactivation with a concussion that is likely related to symptom increases when returning to school. 
• Symptoms may increase due to the following: testing, group work, movies, shop class, overhead lighting, background noise (cafeteria, movement during and between classes), taking notes (especially off of a projector), sustained attention, etc. (www.impacttest.com).

 

What do we know today that we did not know just a few years ago?

• Concussion manifestations vary from individual to individual, and student to student.
• There may be a significant risk if there is a return to school (or play) too quickly. 
• Concussions seem to have more symptoms and last longer in females.
• Younger athletes (in high school or in lower grades) have been shown to exhibit longer recovery times when compared to college and professional athletes.
• A gene may exist that causes some individuals to be more susceptible to concussions. What we now know is that each concussion should be treated individually depending on the symptoms and the neuro-cognitive test results (www.impacttest.com).

 

What is really going on in the brain after a concussion?

• Due to the metabolic imbalance that occurs following a concussion, it has been shown that increased blood flow to the brain during recovery may slow down the recovery process and worsen the symptoms of concussion. 
• Most patients do not need to be placed on bed rest unless they are having severe symptoms (severe headaches, marked photophobia, disorientation, balance problems, extreme fatigue, etc.). 
• After a few days, the student may participate in any activity that doesn't cause increased symptoms (i.e., headaches). In some cases, activities such as reading, watching TV, working at the computer, taking hot baths, and having heated discussions with others may increase symptoms.
• If patients develop increased symptoms while doing a specific activity, that activity should be discontinued. Continuing activities, or exercise that increases symptoms, can delay the recovery from the concussion.
• Many concussed individuals may be unable to concentrate (focus). They may not be able to read or absorb material and may develop an increased headache while doing so. When this occurs, they might be able to participate in an activity for only a few minutes before symptoms increase. If a rest break can be interspersed between those few minute intervals, these activities can be done. As the symptoms abate, longer intervals can be spent reading, watching TV and using the computer (www.impacttest.com).

 

School attendance and activities may need to be modified

While some individuals may be able to attend school without increasing their symptoms, the majority will probably need some modifications depending on the nature of the symptoms. Trial and error may be needed to discover what they can and cannot do.

• If students are unable to attend school for an entire day without symptoms, they may attend for a half-day. Some students may only be able to attend for one period, some not at all, due to severe headaches or other symptoms. 
• Frequent breaks with rest periods in the nurse's office may be necessary. Often, alternating a class with a rest period may be helpful. Math causes more symptoms in patients than other subject classes. As recovery proceeds, hours spent in school may be gradually increased. 
• Depending on their symptoms, some students may need to be driven to school to avoid walking and should be given elevator passes to avoid stairs. They should not attend gym or exercise classes. 
• Workload and homework may need to be reduced. Frequent breaks while doing homework may be helpful. Term papers should be postponed. Pre-printed class notes and tutors may help to relieve the pressure of schoolwork. 
• Tests: If there are concentration and memory problems, quizzes, tests, PSAT tests, SAT tests and final exams should be delayed or postponed. If test results are poor, a note to the school should request that the scores be voided. Extra time (un-timed tests) may be necessary initially when test taking is resumed. 

• If noise causes increased symptoms, students with concussions should not listen to loud music (in cars or with earbuds). They should avoid attending dances, parties, music concerts and sports events until the noise sensitivity abates. 
• If light causes increased symptoms or students have photophobia they should avoid bright sunlight and exposure to flashing lights (e.g., computer games). Sunglasses may be necessary (www.impacttest.com).

 

School Liaison

• A “school liaison” to communicate the student’s concussion to classroom teachers and other school personnel is critical.  This person may be a school principal, assistant principal, school nurse, school counselor, special education coordinator, athletic trainer, or a concerned teacher (www.impacttest.com).

 

The Role of the Teacher

The classroom teacher should be aware of the student’s condition. Moreover, if any unusual behavior is noted, the teacher should report this information to the school liaison.  Examples of unusual behavior include:

• Poor attention, concentration frustration, reduced short term memory recall or delayed processing, disproportionate reactions to situations, sensitivity to light, etc.  (Children’s Hospital, Aurora, CO)

The classroom teacher may need to implement strategies based on the student’s condition. These may include changes in environment, curriculum, methods, organization, and/or behavior. See list below.  (Hossler, P. Concussion Carry-Over in the Classroom, NATA News, July 2007)

 

 

References/ More information:  

www.texashealth.org/benhogan

www.impacttest.com

www.cdc.gov