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Concussion in the Classroom

Concussion in the Classroom . Dr. Sarah Levin Allen, PhD, CBIS. Executive Director, Brain Behavior Bridge Assistant Professor, Philadelphia College of Osteopathic Medicine Pediatric & School Neuropsychologist www.brainbehaviorbridge.com. A presentation for Students Parents Teachers

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Concussion in the Classroom

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  1. Concussion in the Classroom Dr. Sarah Levin Allen, PhD, CBIS Executive Director, Brain Behavior Bridge Assistant Professor, Philadelphia College of Osteopathic Medicine Pediatric & School Neuropsychologist www.brainbehaviorbridge.com

  2. A presentation for • Students • Parents • Teachers • Nurses • Guidance counselors • School psychologists • Other school staff

  3. Concussion in the Classroom More than 1 million Americans sustain a concussion each year. Academic problems are common after concussion, and helping students as they return to the classroom is just as important as helping them return to sports

  4. Concussion myths and facts

  5. Concussion myths and facts

  6. What is Concussion?

  7. Concussion is a mild traumatic brain injury that occurs when a blow or jolt to the head disrupts the normal functioning of the brain. Some people lose consciousness after a concussion, but most do not. After a concussion, the person is often dazed or confused and may not remember what happened.

  8. How long does it take to get better? Most people recover completely from a concussion in a matter of days or weeks, but symptoms can last much longer. Over-exertion, re-injury and academic or emotional stress can aggravate symptoms and prolong recovery

  9. Effects of Concussion

  10. After a concussion, a student may experience one or more symptoms that cause difficulties in the classroom.

  11. Some symptoms show up right away, but others may not appear for days or weeks. The number and severity of symptoms and the speed of recovery will be different for each student.

  12. Physical symptoms • Headache • Nausea • Lack of physical and mental energy • Dizziness, light-headedness, loss of balance • Blurred or double vision and sensitivity to light • Increased sensitivity to sounds and ringing in the ears • Change in sleep patterns, such as waking up a lot or sleeping too much

  13. Cognitive symptoms • Difficulty concentrating and paying attention • Trouble with learning and memory • Problems with word-finding and putting thoughts into words • Easily confused and losing track of time • Slower in thinking, acting, reading and speaking • Easily distracted • Trouble doing more than one thing at a time • Lack of organization in everyday tasks

  14. Social and emotional symptoms • Mood changes including irritability, anxiousness, and tearfulness • Decreased motivation • Easily overwhelmed • More impulsive • Withdrawn and wanting to avoid social situations

  15. Concussion is an invisible injury Changes in a student’s thinking, learning and behavior may be blamed on other causes. For example, mental fatigue or difficulty concentrating might be misinterpreted as laziness or disinterest.

  16. A student with concussion may: • Get tired easily in class • Be bothered by fluorescent light or loud noises • Be easily distracted • Have trouble doing more than one thing at a time • Take longer and need more repetition to learn new material • Remember something one moment but then not recall it later

  17. Concussion and Mental Stamina In general, concussion affects mental stamina more than intellectual ability. This is because the injured brain must work harder to accomplish anything, and so the student gets tired more easily. Fatigue and overexertion will often be accompanied by a temporary worsening of post-concussion symptoms.

  18. Concussion and physical safety If a student sustains another concussion while still recovering from a previous one post-concussion symptoms may be worse and last longer. • Recreational activities such as collision sports should be avoided until the student is fully recovered. • As symptoms improve, students can often return to light exercise where there is low risk of re-injury.

  19. When Is it safe to return to sports after concussion? The decision to return an athlete to play should only be made by a qualified professional. In general, athletes should not return to play until they are no longer experiencing concussions symptoms both at rest and with mental or physical exertion.

  20. NJ Concussion Law & Model Policy The New Jersey Concussion Law, signed into law on December 7, 2010, outlined the establishment of a policy to address procedures for return to play for student athletes. The model policy created by the NJ Department of Education outlines graduated return to play guidelines for student. For more information: • Law: http://www.njleg.state.nj.us/legislativepub/ldoa/ldoa.pdf • NJ Department of Education: http://www.state.nj.us/education/aps/cccs/chpe/concussions/

  21. Return to the classroom The Model Policy outlines not only the importance of return to play guidelines, but the importance of cognitive rest following concussion, and the need for temporary accommodations in the classroom.

  22. Helping in School Teachers and other school staff play an important role in a student’s recovery from concussion.

  23. A Team Approach • It may be helpful to designate a single person to take the lead in communicating with parents, teachers, staff and medical professionals. • If current staff have had little pre-concussion contact with the student, talking to previous teachers can help clarify how post-concussion symptoms might be affecting current learning and behavior.

  24. Classroom Strategies

  25. General strategies • Reduce schoolwork demands, including reduced homework • Schedule rest periods and provide the student with a calm quiet place to take a break • Extend time on tests and assignments • Break information and assignments down into manageable chunks

  26. General strategies • Offer preferential classroom seating to minimize distraction and allow better monitoring of student • Allow the student to eat lunch in a quiet room with one or two friends rather than in a crowded, noisy cafeteria • Remove the student from recess and physical education activities where there is an increased risk of head injury

  27. StrategiesAttention and concentration Issues • Use short, specific instructions and assignments, and be sure they are written in the student’s planner • Remove unnecessary distractions in the classroom (limit items on desk, etc.) • Be alert to when the student’s attention drifts and use visual or verbal cues to redirect attention without appearing to single him/her out

  28. StrategiesComprehension and Memory Issues • Provide an overview or outline of material • Use a recorder to capture lesson notes • Reinforce lessons with visual images • Allow the use of fact sheets to help reduce the demand on memory • Encourage the student to restate information in his/her own words

  29. StrategiesComprehension and Memory Issues • Help the student relate new information to what she/he already knows • Teach the student to use mnemonic devices, rehearsal, repetition, association, chunking, and mental visual images to help memorize material • Use multiple choice or open book tests to minimize retrieval demands

  30. StrategiesExecutive functioning Issues • Use diagrams, time lines, and a daily planner to organize information, assignments and activities, and keep these tools in a single place • Encourage goal setting and self monitoring for progress toward goals • Encourage the student to pay attention to time • Provide feedback more frequently

  31. StrategiesVisual and Auditory Processing Issues • Provide copies of notes prior to class to reduce demands on visual tracking (moving back and forth between blackboard and notepaper) and auditory processing • Check the student’s comprehension of directions or test questions • Encourage strategies to improve visual tracking such as using a ruler

  32. StrategiesSocial, Emotional and Behavioral Issues • Avoid putting the student on the spot unless he or she volunteers • When a student is frustrated or over-stimulated, allow the student to leave the classroom to go to a pre-arranged spot to regroup • Encourage the student to seek help when needed • Monitor the student’s peer relations • Prepare the student for changes and transitions and possibly rehearse new routes and procedures

  33. The role of the school nurse

  34. School Nurse The school nurse plays an important role by helping to monitor the student’s symptoms and recovery. The nurse’s office is often a place where the student can return to rest or take a break when they are tired by concussion symptoms.

  35. Medications In some cases, prescriptive medications may be prescribed to help with sleep, emotional control, mental stamina, attention/concentration or other post concussive symptoms. It is important to be aware of the side effects of those medications and how they might affect other post concussive symptoms. NOTE: This information is being provided for informational purposes only and should not be considered medical advice or direction. Students should receive care under the direction of their physician.

  36. Age and Grade level How does the grade of the student make a difference in understanding concussion?

  37. Elementary School • Students are more likely to complain of physical problems. • They might misbehave in response to cognitive overload or fatigue • The student’s teacher or parent can talk to classmates about the student’s injury so they understand that it is not contagious or life threatening.

  38. Middle School • Peer relations are very important, and students can be overly sensitive to being different. They may try to minimize symptoms so as not to stand out • The demands on executive functioning—such as setting goals and planning ahead—are much greater than in elementary school

  39. High School • Extra-curricular activities and homeworkkeep students very busy, so prioritizing and reducing overall demands is important • The high school student may be more likely to lose track of assignments or have difficulty planning how to approach school projects • Good communication among school staff is helpful so that a student’s difficulties do not go unnoticed

  40. College • College students are most often independent from parental oversight and expected to take care of themselves • Alcohol consumption is a concern, as drinking while experiencing post-concussion symptoms puts the student at increased risk for another brain injury • The college student can seek out support from the college office that assists students with disabilities

  41. Thank You! Dr. Sarah Levin Allen, PhD, CBIS Presented by the Brain Injury Alliance of New Jersey, in collaboration with the Brain Injury Association of New York State and Upstate University Hospital’s Concussion Management Program

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