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Understanding and Managing Mild Traumatic Brain Injury in Students

Learn how to identify and support students with mild traumatic brain injury (MTBI) and the impact on academic performance. Discover the need for academic accommodations during recovery and review commonly used strategies. Education and patience are key to managing MTBI.

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Understanding and Managing Mild Traumatic Brain Injury in Students

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  1. Cathy O’Connor AT, MD, FACS Goodall Hospital Maine Concussion Management Initiative

  2. Educate about Mild Traumatic Brain Injury • How to identify a student with potential injury • How brain injury affects academic performance • Understand the need for academic accommodations during MTBI recovery. • Review more commonly used academic accommodations.

  3. No spare brains available • Long lasting consequences if not managed properly in kids • Education and patience is the key No spare brains available Long lasting consequences if not managed properly in kids Education and patience is the key

  4. Mild Traumatic Brain Injury (MTBI) • Same injury and mechanism as what we see in military veterans who are victims of IEDs • Throw out all previous assumptions about “concussion”- new game

  5. Brain Metabolism is Related to Recovery • Over 200 High School Athletes Studied using fMRI • Hyperactivation predicts CLINICAL recovery time • Resolution of hyperactivation correlates with recovery

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

  7. 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.

  8. 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 not able to focus, pay attention, fails quiz or test, odd answer to verbal question, appears to have problem with lights

  9. Physical • Headaches • Fatigue/tiredness • Dizziness with movement or mental exertion • Nausea • Light/noise sensitivity • Ringing in the ears

  10. Cognitive • Inability to focus • Limited concentration • Inefficient short-term memory • Slowed thinking • Feeling mentally “foggy” • Poor reading comprehension

  11. Sleep difficulties • Trouble falling asleep • Overnight awakening • Oversleeping/undersleeping • Feeling tired in the morning despite long hours in bed

  12. Mood disruption • Irritability • Sadness • Nervousness • Anxiety • Depression

  13. COGNITIVE • Fogginess • Concentration • Memory deficits • Cognitive fatigue SLEEP DYSREGULATION Falling asleep Fragmented sleep Too much/too little sleep SOMATIC Headaches Dizziness Light/noise sensitivity Tinnitus MOOD DISRUPTION Irritability Sadness Anxiety Adapted from Camiolo Reddy, Collins & Gioia, 2008

  14. 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

  15. Controls for individual factors such as LD, ADHD, medications, etc. • Can be done in large groups with educational seminars • Orients athletes to concussion issues at start of season • Annually for injured athletes; every 2 years for those with no concussion history • Baseline and post injury testing

  16. CASE 1: KICK-OFF RETURNER DAY 3 6 10 13 14 Exertion

  17. Improve with rest… • Physical/sports exertion • Mental exertion • Sustained attention in class and during school day • Reading • Homework • Tests/quizzes

  18. Temporary? • Short-lasting? • Improves more quickly with proper management • Complete recovery typically expected

  19. Athletic Trainer • Monitoring of symptoms • Periodic neurocognitive testing • School Nurse • Daily clinical evaluations • Rest & recovery area • Medication • Guidance counselor • Coordinates academic accommodations

  20. Teachers • Adjust work according to changing status • Reassurance • Psychologists • Specific input for LD-ADHD students • Social Workers • Adjustment support - especially in longer recoveries

  21. Consistent Message to the Student: 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

  22. Individualization • Accommodations • Key staff • Innovation • Integration/Team work • RN – ATC • Guidance – Teachers • Psychologists – Social Workers • Parents • Fluid situation that will change over time

  23. 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?

  24. Rest periods during the school day • School nurse’s office • Go to rest before symptoms become too intense • Take Tylenol/Advil, etc. as recommended by doctor • Return to classes if feeling better • Early dismissal if rest does not help

  25. Extension of assignment deadlines! • Homework, papers, projects • According to student’s capacity • Removes major source of pressure • Allows student to prioritize sleep & rest!

  26. Excuse from some assignments ? • More common in lower grades • Less catch-up to do during/after recovery • Consolidate work into more manageable units

  27. Postponement of quizzes & tests • 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

  28. Accommodation for light/noisesensitivity • 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

  29. 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

  30. 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

  31. Outermost layer • Learn new info • Form thought • Make decisions • Memory function

  32. Recent memory • Emotions • Concentration • Ability to learn new info and retain it • Storage of motor patterns and voluntary activity

  33. Processing of sensory input • Sensory discrimination • Body orientation

  34. Processing of all visual input

  35. Expressed behavior: childish, irritable, agitated • Information retrieval • Receptive speech/auditory input processing

  36. www.cdc.gov/concussion • www.impacttestonline.com • www.sportsconcussion.net • www.sportslegacy.org

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