Returning to School After a Concussion

1. Returning to School After a Concussion Debbie Pfeiffer, Ed.D., CBIS Virginia Department of Education

2. Virginia Trauma Registry • In 2011, • 3004 • birth – 19 year olds were seen in Virginia hospitals for head injuries. • Of these, 1162 (of the 3004) were adolescents (13 – 19 years old); • 260 (of the 3004) were classified as concussions.

3. The TBI Continuum Mild Moderate Severe } } } Traumatic Brain Injury { Concussion

4. When is it safe for a student to return to school? • A health care professional can make decisions about • a student’s readiness to return to school based on the number, type and severity of symptoms experienced by the student; and • appropriate levels of cognitive and physical activity.

5. How long will symptoms last? • Concussions affect people differently. • Most students will have symptoms that last for a few days or a week. • A more serious concussion can last for weeks, months or even longer.

6. How can concussion effect learning? • a concussion can affect multiple aspects of a student’s ability to participate, learn, and perform well in school. • In turn, academic activities that require concentration can actually cause a student’s concussion symptoms to reappear or worsen

7. Utilize team monitoring. The team includes: • the student • parents/guardians • all educators and related service providers involved with the student • physicians/health care providers • other care providers (after school care, etc.) The team plays a critical role in managing concussions!

8. Identify a lead person to • serve as point of contact, communicating with all team members, • advocate for student needs, and • share resources.

9. Concussion Symptoms • Cognitive: • Difficulty thinking clearly • Difficulty concentrating or remembering • Feeling more “slowed down” • Feeling sluggish, hazy, foggy, or groggy • Physical: • Headache or “pressure” in head • Nausea or vomiting • Balance problems or dizziness • Fatigue or feeling tired • Blurry or double vision • Sensitivity to light or noise

10. Concussion Symptoms • Emotional: • Irritable • Sad • More emotional than usual • Nervous • Sleep-related: • Drowsy • Sleeps less than usual • Sleeps more than usual • Has trouble falling asleep

11. Resultant challenges with learning • Cognitive: • speed of reading, • difficulty with multi-step problems (math), • maintaining consistent attention and/or distractibility. • Physical symptoms (ex. - headache, fatigue, increased sensitivity to lights or noise) may impair the effectiveness of their learning. • Problems with emotional control can result in: • irritation/agitation • feelings of being overwhelmed and frustrated by learning challenges.

12. Develop a Plan for Cognitive Rest • Limit cognitive activity to a level that is • tolerable and • does not worsen or result in re-emergence of concussion symptoms. • Limit activities that require concentration • Homework, schoolwork, studying for or taking exams, texting, computer or TV usage, video games, etc. • A change in the academic schedule may be needed (shortened day, rest periods)

13. Implement necessary interventions Reynolds, 2012

14. If symptoms persist… • a Response to Intervention (RtI) protocol may be used • a 504 Plan may be considered • The student may be referred for special education services

15. The key is education… (Stay tuned for an update this afternoon on VDOE initiatives to increase competencies regarding TBI!)

16. Resources • Virginia Dept. of Education http://www.doe.virginia.gov/special_ed/disabilities/traumatic_brain_injury/index.shtml • U.S. Department of Health and Human Services Centers for Disease Control and Prevention Heads Up to Schools: Know Your Concussion ABCs initiative at www.cdc.gov/Concussion • Project Learnethttp://projectlearnet.org/project_learn.html • Center for Brain Injury, Research and Training http://cbirt.org/