Return To Learn & Why It Matters To Educators Beth Walters, MS, ATC, LAT

 Nothing to disclose  I am not a physician; I am a Board Certified, state Licensed athletic trainer & educator with a passion for the issue that arise with concussions.  The information within this presentation include to most recent research & “best practice” related to returning students to the classroom after a concussion

Topics/Objectives  Common s/sx in the classroom following a concussion  How to recognize & refer  Timeframe of symptoms  Importance of following doctor’s orders  Importance of parent/guardian involvement & rest at home  Adjustments/accommodations you may choose to adopt in the classroom.  Resources for you

Facts About Concussions  A concussion is a brain injury  All concussion are serious  Concussion CAN occur without loss of consciousness  They can occur in ANY sport  Early detection and appropriate care will help prevent further injury or even death  Young children and teen are more likely to get a concussion and take longer to recover

Facts About Concussions  Concussions can and will cause issues for the individual in all aspects of their life  Between 1997 and 2007, the number of number of TBI related ER visits tripled for youth athletes  173,285 children aged (< 19 years old) were treated for traumatic brain injuries (TBI) i.e., concussions in 2013

Myths About Concussions  If you weren't knocked unconscious, then you didn't’t have a concussion  Everyone gets better in two weeks  Once the headache goes away, everything will be fine  Most concussions occur in sports  If there’s no visible injury you, everything is ok  You should play through the pain- get back in the game/classroom!

Concussion Defined  A concussion is a type of traumatic brain injury (TBI) that results from a bump, blow or jolt to the head (or hit to the body) that causes the brain to move about in the skull. This action damages brain cells and causes chemical changes to occur in the brain

Symptoms of a Concussion

What to Look For in Your Classroom   problems paying attention   problems remembering or learning new information  Long time needed to complete tasks or assignments  Difficulty organization or shifting btwn tasks   irritability  Inappropriate or impulsive behaviors   ability to cope with stress   emotions compared to “normal”  Fatigue  Difficulties handling stimulation environments  Physical symptoms

Length of Recovery  Approx % of students fully recover in 1-3 weeks  Returning to school within hours is typical – once symptoms are improving and tolerable  Monitoring is KEY

The Team Involved

What Each Team Needs to Know  Family Team  Students, parents and others connected to daily care   sensory load at home  NO driving until medically cleared   rest and sleep

What Each Team Needs to Know  School Physical Team/Medical Team  Coached, ATC, PE edu, school nurse,  Safeguard student from any further potential brain injury/trauma  Remove from all physical activity  Rule out more serious medical issues  Support reduction in school demands and home/social stimulation  Encourage rest  “Monday Moring concussion”

What Each Team Needs to Know  Academic Team  Teachers, counselors, school physiologists, administrators, and others  Coordinate RTL protocol & appropriate academic adjustments to reduce/eliminate sx  One person should coordinate - ALL should understand effects of concussion on learning, how to best  cognitive demands during recovery period

What Each Team Needs to Know  Academic Team (continued)  Parents should return student when he/she can handle minutes of cognitive activity or stimulation – even if short day.  Then rest if necessary  Note specific classes that exacerbate sx  Increase work incrementally as sx improve & vise versa

What is Return-to-Learn  Similar to RTP  Gradual plan  No one approach will work for everyone; must be tailored to individual  What might it look like? Who is involved?

School Accommodations  Breaks as needed in a quite place  Preprinted class notes  Additional time for assignments  Excuse nonessential work, no double workload of make-up work and new work  Additional help & tutoring as needed  No testing until tolerating a full day of school, then untimed testing

General Guidelines/Policy

Special Considerations  Response to Intervention (RTI)  Good teaching & reasonable academic adjustments in general can support 80-90% of students with mild or temporary learning or behavior issues  Possible IEP  Parents & medical professionals need to seek a medical explanation for slow recovery

Resources  CDC website – returning to school after a concussion: fact sheet for school professionals  Nebraska Department of Education website – Bridging the Gap From Concussion to the Classroom  HeadSmart – A healthy transition after concussion  Sports Concussion Institute – Graduated Return to School Protocol  The Network for Public Health Law  Boston Children’s Hospital – Schooling concussion: Return to learn for the student athlete  UPSTATE university hospital: Concussion management program – Concussion in the Classroom  Sports Medicine – An Educator’s Guide to Concussions in the Classroom – 2 nd

References  Collins MW, Lovell MR, Iverson GL, Ide T, Maroon J. Examining concussion rates and return to play in high school football players wearing newer helmet technology: A three-year prospective cohort study. Neurosurgery,2006; 58:2, 275–286.  Guskiewicz KM, Bruce SL, Cantu RS, et al. National Athletic Trainers’ Association Position Statement: Management of Sport-Related Concussion. J Athl Train, 2004;39:  Halstead ME, et.al.: Returning to Learning Following a Concussion. Pediatrics, 2013; 132(5):  Halstead M: Sports Concussions: The Role of a Return to Academics Plan. Webinar. Brain Trauma Foundation. Available at: webinar/. Accessed December 2,  Halstead ME, Walter KD, Council on Sports Medicine and Fitness. Pediatrics, 2010; 126(3):  Herring SA, Cantu RC, Guskiewicz KM, Putukian M, Kilber WB: Concussion (Mild Traumatic Brain Injury) and the Team Physician: A Consensus Statement – 2011 Update. Med Sci Sports Exer, 2011; 43:  McAvoy K. Return to Learning: Going Back to School Following Concussion. NASP Communiqué, 2012; 40:6. Available at: n-to-learning.aspx. Accessed 12/3/12.  Mrazik M: Sport Concussion. Webinar. Available at: a/files/association/St.%20Albert%20Dr.%2 0Martin%20Mrazik2.pdf. Accessed December 2, 2016.