Concussions and the Road Back to the Classroom

Slides:



Advertisements
Similar presentations
Sports related concussion: Assessment and management P. Jeffrey Ewert, Ph.D., ABPP Carolina Neuroservices/The Head Injury Center Neuropsychologist – Charlotte.
Advertisements

Concussion Management Protocol to Support Recovery of CH Students.
1 1 Student-Athlete Protection Act Senate Bill 652 Vanessa Wigand, Principal Specialist for Health and Physical Education, Driver Education and Athletics.
SCHOOL PSYCHOLOGISTS Helping children achieve their best. In school. At home. In life. National Association of School Psychologists.
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH Presentation on Regulations 105 CMR : Head Injuries and Concussions In Extracurricular Athletic Activities.
SPORTS-RELATED CONCUSSION MANAGEMENT. Recognizing that concussions are a common problem in sports and have the potential for serious complications if.
Concussion Management
Concussions: From the Field to the Classroom Robert Jones, M.D. Medical Director UNC Charlotte Student Health Center.
Concussion Management Training Guidelines and Procedures for Dealing with Potential Concussion.
Overview: New tool that helps coaches and parents to recognize the signs/symptoms of a concussion and to respond quickly and appropriately.
Concussions in Youth Sports The Parents James Cocivera.
Barnahús – The Children´s House · Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Thorbjorg Sveinsdottir MSc Psychology Barnahus 31. mai.
CONCUSSIONS: How do we help the concussed student get back to activities of daily living? Caroll Craig RN, BSN, CSN November 2011.
Coaches Understanding Sports-Related Concussion
Altoona Area School District In cooperation with.
BrainSTEPS Return to School Concussion Management Teams (CMT) Brenda Eagan Brown, M.S.Ed., CBIS Program Coordinator
Student Health Services School District of Holmen.
 Concussions Dillon Kelly.  The Issue Advancements are continuing to develop within neurology on the subject of concussions and athletic departments,
Concussion Education. Tragedy opens the door for education, increased awareness, and law In North Carolina… –Gfeller-Waller Law passed in June 2011 Three.
Concussion Update Wayne A. Gordon, Ph.D., ABPP Jack Nash Professor & Vice Chair Department of Rehabilitation Medicine 1.
Successful Return-to-Learn after Concussion Kristi Pardue, MS, CCC-SLP, CBIS Manager, St. Luke’s Sports Medicine Concussion Clinic IATA Annual Summer.
Concussion Management Protocol Purpose: The purpose of this policy is to establish a protocol for defining concussions, recognizing symptoms of concussions,
What teachers need to know. Not every student with a concussion (TBI) will have signs/symptoms affecting their learning For those that do it is not always.
 Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces.  Simply put,
HEADS UP Concussion in Youth Sports.  A traumatic brain injury which results in a temporary disruption of normal brain function  Occurs when the brain.
Assessing & Managing Concussion If a brain or head injury is suspected, our evaluation process is on the leading edge Annemarie Francis, MS, ATC, VATL.
Brain Injury Association of New Jersey’s Statewide Campaign Concussion in Sports
Concussions in Sports: An informational guide for athletes By: Michael Raletz.
Concussions: The real ethical debate Tamerah Hunt, PhD, ATC Sports Medicine.
August 2011 BCPS Concussion Management Program. Case 14 yo high school female varsity soccer goalie dives to save a shot. During dive, strikes top of.
WPIAL Athletic Directors March 7, 2012 Safety in Youth Sports Act.
Concussion Training Cambridge. Overview A. Concussion LAW B. What is a concussion? C. Detection D. Intervention E. Prevention F. Questions.
Concussions *A traumatic brain injury which results in a temporary disruption of normal brain function *Occurs when the brain is violently rocked back.
CONCUSSION FACT SHEET Did you know?  Youth athletes are more susceptible to concussion and recover more slowly than collegiate or professional athletes.
Concussion Management athletico.com. Concussion In a Nutshell Prevention Baseline Evaluation Communication Return to Participation Vestibular Physical.
DUNDEE-CROWN HIGH SCHOOL Changing the Mindset Around Concussion Injury in Sports.
Concussion Management Kari Nelson MS, LAT. Concussion Definitions *A mild traumatic brain injury (MTBI) *Injury caused by direct or indirect force to.
Concussions.
1 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH Presentation on Regulations 105 CMR : Head Injuries and Concussions In Extracurricular Athletic Activities.
“Sports-Related Concussions” Damon Jefferson.  “Every year the US Center for Disease Control and Prevention estimate that 300,000 concussions are sustained.
+ Return to Learn (R2L) Shaylon Rettig, MD, MBA. + Return to Learn Brain injury is a leading cause of death and disability in children and adolescents.
Management of Concussions in Children – the ED approach Sujit Iyer, M.D. DCMC Emergency Department.
PARENT AND ATHLETE INFORMATION St. Francis High School Concussions:
Computerized neurocognitive testing. Scientific evaluation.
What you need to know. A type of brain injury that changes how the brain normally works. Kids and Teens are at greatest risk.
Gfeller-Waller Concussion Awareness Act Law requires that all athletes, coaches, volunteers, parents & school nurses be made aware of concussion dangers.
Grayslake Central High School Changing the Mindset Around Concussion Injury in Sports.
IHSAA CONCUSSION MANAGEMENT. Definitions: Health-Care Professional: An Indiana licensed health care provider who has been trained in evaluations and management.
Debbie Pfeiffer, Ed.D., CBIS Virginia Department of Education.
| CONCUSSION MANAGEMENT IN THE SCHOOL SETTING By Lisa Coenen, RN.
Concussions Education: Dangers You Should Be Aware Of.
CONCUSSION MANAGEMENT Don Bohnet Risk Management South Texas and Region III.
 ources/lifestyle_community/community&id= ources/lifestyle_community/community&id=7.
School Nurse Guide to Concussions KATIE LEIBLE, MED, ATC, LAT SSM HEALTH CARDINAL GLENNON CHILDREN’S HOSPITAL SPORTSCARE OUTREACH MANAGER.
Concussion Guidelines in the GAA
Sports Concussion Education for Coaches, Parents, and Athletes
Management of Concussion in the Community College Athlete
Concussions in Youth Sports
Appoquinimink School District
Concussions What Should I Be Looking For?
Oxbridge Health and Wellness Clinic
Concussions in Intercollegiate Athletics
Concussions What Should I Be Looking For?
Return-to-Learn After Concussion
Myth or Fact? Everyone with a concussion needs a CT scan or MRI right away? A concussion requires loss of consciousness? Male and female athletes have.
Return-to-learn after concussion
Concussions What Should I Be Looking For?
A new model for the diagnosis and treatment of concussion
Limestone College Concussion Policy
Referees and Concussions
Presentation transcript:

Concussions and the Road Back to the Classroom Gerard A. Gioia, Ph.D. Pediatric Neuropsychologist Chief, Division of Pediatric Neuropsychology Director, Safe Concussion Outcome, Recovery & Education (SCORE) Program Children’s National Medical Center Washington, DC

Disclosure Test Author Behavior Rating Inventory of Executive Function (BRIEF) Psychological Assessment Resources, Inc. Tasks of Executive Control (TEC) Pediatric Immediate Post-Concussion Assessment and Cognitive Testing (Pediatric ImPACT) Acute Concussion Evaluation (ACE) Concussion Recognition & Response App Concussion Assessment & Response (CARE) App

Plan for the Day Concussion 101: What is it? Effects of Concussion on School Learning & Performance Effects of School Learning & Performance on Concussion Recovery Strategies for Supporting Recovery Q&A Break Small Groups: Examining your concussion policies & procedures, developing/ expanding Large Group: Discussion of policies & procedures; Q&A

“Your Brain is Your Future” (and the source of your parents’ retirement…)

A concussion is a brain injury

Brain injuries threaten the Child’s future

Concussion Care for Kids: It’s a TEAM Sport!

Who’s on the Team?

Four Corners Approach to Concussion Care Medical Systems Family Pre-Hospital (EMS) Emergency Urgent Primary Care Specialty Care Child/ Teen (Student, Athlete, Son/Daughter, Friend) Certified Athletic Trainer Certified Athletic Trainer School Athletic/ Recreational Administrators Teachers Certified Athletic Trainer Administrators Coaches Officials Parents Teammates School Nurse/ Counselor Psychologist

What is a Concussion? A concussion is an injury to the brain caused by a direct blow to the head, face, neck or elsewhere on the body that causes the head and brain to move rapidly back and forth. A concussion results in the onset of impaired brain function, producing a set of clinical signs and symptoms (physical, cognitive, emotional, sleep) that may or may not involve loss of consciousness.

What is a Concussion? Recovery of the clinical and cognitive symptoms typically follows a sequential course over a period of days to weeks. In a small percentage of cases, post-concussive symptoms may be prolonged for months or longer. Typically, no abnormality on standard structural neuroimaging studies (CT, MRI) is seen in a concussion.

Effects of Concussive Forces on the Brain Typically, the “software” of the brain is affected Neurometabolic/ neurochemical processes Physiological Not the “hardware” Structure

Neurometabolic Cascade Following Traumatic Brain Injury (Giza & Hovda, 2001) 2 6 12 20 30 24 3 10 minutes hours days 500 400 300 200 50 100 % of normal Calcium K+ Glucose Glutamate Cerebral Blood Flow UCLA Brain Injury Research Center

Signs You May See (Acutely)

Recovery From Concussion: How Long Does it Take? WEEK 5 WEEK 4 WEEK 1 WEEK 3 WEEK 2 N=134 High School athletes Collins et al., 2006, Neurosurgery

Focus on School Return & Support

"You can't educate a child who isn't healthy, and you can't keep a child healthy who isn't educated."    Joycelyn Elders

Effect of Concussion on School Learning & Performance Effect of School Learning & Performance on Concussion Recovery

School Kid’s Major “Job” New Learning/ Acquiring Knowledge Academic Social Practicing incompletely learned knowledge Mental/ Cognitive exertion is essential to new learning/ practice 22

School professionals should watch for students who show increased problems Paying attention Problems remembering or learning new information Inappropriate or impulsive behavior during class Greater irritability, less ability to cope with stress Difficulty organizing tasks Fatigue in class Onset of or worsening headaches

Concussion’s Effects on School Learning & Performance 80 students with concussions “Which specific types of problems are you experiencing in school?” Students reported an average of 4 problems below. Headaches interfering 71.3% Can’t pay attn in class 62.5% HW taking much longer 59.5% Difficulty studying for test/quiz 51.9% Too tired 50.6% Diffic understanding material 44.0% Difficulty taking notes 28.8%

Concussion’s Effects on School Learning & Performance “Which classes are you having the most trouble with?” (Percent reporting trouble in class) Parent Student Math 60.3% 73.7% Reading/LA 38.1% 46.1% Science 38.1% 47.4% Soc Stud 38.1% 40.8% Foreign Lang 38.1% 38.2% Music 6.3% 17.9% PE 7.9% 10.5% Art 3.2% 5.3% -None 25.4% 6.6%

Effect of School Learning & Performance on Concussion Recovery

Cognitive Demands of School Worsen Symptoms N= 72 Gioia et al., 2010

British Journal of Sports Medicine 2009 43 (Suppl I) i76-i84.

Sources of Mental/ Cognitive Activity? Prolonged concentration Prolonged homework Prolonged classes (block scheduling) Prolonged days Excessive TV, computer, socializing… These sources and degrees of activity are likely to vary from person to person

Keys to Recovery Ways to over-exert Resting the brain & getting good sleep No additional forces to head/ brain Managing/ facilitating physiological recovery Avoid activities that produce symptoms Not over-exerting body or brain Ways to over-exert Physical Emotional Cognitive! (concentration, learning, memory)

“Physical rest alone fails to address another key aspect of brain function in youth – mental exertion associated with school activities.” Athletic Therapy March, 2010

What is cognitive “rest?” The concept of cognitive exertional activity (and rest) viewed along a continuum of activity No activity/full rest Full activity/no rest In reality, no cognitive activity/full cognitive rest not practical/likely (unless asleep or comatose) Therapeutic goal is to limit cognitive activity to a level that is tolerable, and does not exacerbate or cause the re-emergence of symptoms Cognitive Management

Supporting student recovery requires collaborative approach among school professionals, health care professionals, athletics, parents, and students. All school staff should be educated/ informed about the returning student’s injury and symptoms School staff must assist with transition process and making accommodations for student.

Manage exertional activity, safety Purpose of Care Plan Guide recovery Educate Manage exertional activity, safety

Return to School

Return to Sports

Summary Concussions can have a significant effect on the injured student’s school learning School learning can potentially have a significant effect on recovery from concussion Schools and school personnel play an important role in assisting the student with concussion. Understanding and monitoring the student’s symptoms is critically important

Summary Assisting the symptomatic student by reducing demands – physical and cognitive Gradual increase in academic demands as symptoms reduce Return to sports participation, PE, or any other risk activity requires clearance from a health care professional with training in concussion evaluation and management 15

Q & A

Questions for Schools to Ask and Prepare for When a student is identified with a concussion, what is your response? High school, middle school, elementary school What/ who is the team? Who does the parent contact? Who will connect with the teaching team? Method to disseminate student needs with accommodations/ strategies Who will do what? What will you do? How will you monitor the moving target of recovery, and adapt the accommodations as needed (i.e., this is not a black & white situation) What is program for in-servicing teachers about concussion and its effects?

Support / Accommodations Procedures Managing expectations for school demands in a student that is there in school “looking OK” When does a student stay home, when does a student return to school (criteria for partial vs full day) How are you monitoring recovery across the day and across the week (hint – use a sx monitoring tool) Where/ how will you provide key accommodations? Rest breaks Managing tests, Assignments Grading

What can I do to prepare for a concussion? Prepare a concussion action plan. To ensure that concussions are identified early and managed correctly, have an action plan in place before the start of the school year. This plan can be included in your school or district’s concussion policy. Be sure that other appropriate school and athletic staff know about the plan and have been trained to use it.

What can I do to prepare for a concussion? Educate parents, teachers, coaches, and students about concussion. Parents, teachers, and coaches know their students well and may be the first to notice when a student is not acting normally. Encourage teachers, coaches, and students to: Learn about the potential long-term effects of concussion and the dangers of returning to activity too soon. Look out for the signs and symptoms of concussion and send students to see you if they observe any or even suspect that a concussion has occurred.

What can I do to prepare for a concussion? Keep students with a known or suspected concussion out of physical activity, sports, or playground activity on the day of the injury AND until a health care professional with experience in evaluating for concussion says they are symptom-free and it is OK for the student to return to play.

What can I do to prepare for a concussion? Monitor the health of your student athletes. Make sure to ask whether an athlete has ever had a concussion and insist that your athletes are medically evaluated and are in good condition to participate in sports. Keep track of athletes who sustain concussions during the school year. This will help in monitoring injured athletes who participate in multiple sports throughout the school year.

Small Group Work

Small Group Work

Small Group Work

Concussion/ mTBI CDC Educational Materials Heads Up: Concussion in High School Sports Heads Up: Concussion in Youth Sports Heads Up: Concussion in Your Practice Heads Up to Schools: Know Your Concussion ABCs www.cdc.gov/concussion

Educational Materials Coaches, Parents, Student-athletes Video Education: www.nanonline.org www.concussion.orcas.com www.usafootball.com www.nfhslearn.org Fact Sheets Clipboard stickers

Public Awareness & Education

Video Education Coaches, Parents, Athletes .                              USA Football NAN-NATA w NFL/NHL Raising Concussion Awareness Educational DVD, "Concussions in Football (Hockey): Signs, Symptoms and Playing  Safe" Play Smart: Understanding Sports Concussion ACTive: Free Concussion Training for Sports Coaches

Concussion Clipboard

Electronic Clipboard

Coach/ Parent Electronic Clipboard

Using Technology to Assist Concussion Symptom Management

Alert: Your symptoms are worsening. Time for a rest break. 9:30am Alert: Your symptoms are worsening. Time for a rest break.