1. Traumatic Brain Injury/Concussion Training
Brain Injury Management in the Thompson School District
Basic Training for Teachers

2. What is a Traumatic Brain Injury (TBI) as defined in our State (CDE)
Definition: An acquired injury to the brain caused by an external physical force resulting in total or partial functional disability and/or psychosocial impairment. A qualifying traumatic brain injury is an open or closed head injury, resulting in impairments in one or more areas, such as, cognition, language, memory, attention, reasoning, abstract thinking, judgment, problem-solving, sensory, perceptual and motor abilities, psychosocial behavior, physical functions, information processing and speech.
The term Traumatic Brain Injury, does not apply to brain injuries that are congenital, or degenerative, or to brain injuries induced by birth trauma. Anoxic events are not included.
Typical causes of brain injury in children are: bicycle or motor-vehicle accidents, bad falls, sports injuries involving hit to head and whiplash, and physical abuse.
TBIs can have severe, moderate, or mild effects a persons life. Some survivors may never walk or talk again, some may need more time to process information and need memory retrieval strategies, and some may only experience mild headaches, or have mild paralysis in a limb from time to time. It is quite varied and is not always proportional to the severity of the injury.

3. Definition of a Concussion
A direct blow to the head that cause a temporary, short-lived, mild brain injury (Concussion) that causes functional disturbance and chemical changes in the brain. These typically resolve in 3 -6 days, but often symptoms remain for up to 4-6 weeks, even when well managed. Symptoms often follow a sequential course, however, it is important to note, that in some cases, symptoms can be prolonged.
Common symptoms of a concussion: nausea, headache, vision disturbances, balance changes, difficulty with concentration, memory and focus problems, mental fatigue, “foggy brain” and slowed rate of processing. Sometimes people have a change in mood and sleep patterns.
A person does not always loose consciousness when they suffer a concussion.
A concussion cannot be determined/diagnosed by an X-ray or MRI. However, X-rays and MRI’s can detect a serious brain bleed.
The resolution of symptoms is often effected by prior health and behavioral status. (e.g. If student had attention issues before, the symptom will often be exacerbated by the concussion and may take longer to resolve.

4. Symptom Wheel: Brain Injury/Concussion with Academic adjustment strategies

5. What is Your Role as Teacher If you have a student with TBI or recent Concussion:
Watch and observe.
Report any concerns of a concussion or head injury that you hear students sharing with peers/adults to the school nurse.
Fill out any questionnaires that the nurse or counselor/academic monitor give you in a timely manner.
Communicate frequently with student, parent, nurse, and counselor about symptoms, academic adjustments, and progress.
Be willing to make temporary academic adjustments including rest breaks, schedule changes, modified work in class, and decreased work load. Keep in mind the “critical learning” and help students access this essential learning.
Attend meetings that are scheduled with parents and school staff.
If a student is an athlete: If you hear that the student has been cleared to return to play, yet you know they are not performing to pre-concussion status, and/or are having symptoms in your classroom, report your concerns in writing to the nurse and athletic department.

6. What is District Protocol Standard Operating Procedure?
*We have a Standard Operating Procedure for Brain Injury/Head Injury in the District on the TSD Website outlining the roles and protocol to follow.
Many people are involved:
Risk Management
Nursing
Brain Injury Team in District
Counselors
Coaches/Athletic Trainers/Athletic Director
Special Education Teams
SST Teams/Problem Solving Teams
**Teachers
Parents
Medical Professionals/Therapists

7. Typical Progression of Identification and Management
Parent, Teacher, Nurse, Coach, or Student report head/brain injury.
Nurses screen student/parent for information (Nurses send Head bump form home regarding school injuries)
Coaches and Athletic Trainers follow protocols and monitor for Return to Play if student is school athlete.
Teachers and Counselors monitor academic adjustments and grades/attendance.
After 4-6 weeks – Hopefully students and teams see full recovery, but if not….
Student referred to district Brain Injury Team (typically between 6th and 9th week depending on school holiday schedule and school team’s discretion.)
Parents/Student/Teachers/nurses hold meeting/s and create continued plan for monitoring academics, symptoms, and safety.
Decisions made on an individual basis regarding return to school, return to learn, and fading of academic adjustments as indicated by rate of recovery.
May refer for In a small number of cases, school teams may refer to Special Education for testing.
School functioning must be determined to be impacted in order for a student to be on a 504 or IEP.

8. Other Considerations
Be aware that a Brain Injury affects each student differently.
Many symptoms and problems are not apparent just looking at the student, because they
may appear to be physically fine.
They may have inconsistent symptoms from day to day and even from hour to hour.
Cognitive fatigue can bring on symptoms quickly. (e.g. They may drive their car to school and talk and laugh with friends in the hall, but with cognitive exertion, they may become exhausted and emotionally labile.)
A brain injury, no matter how insignificant the injury may seem, can be traumatic to the student as well as to their family. Teachers are often dealing with a student and family in “crisis” for months after the injury.
The student’s thinking and awareness is often different from their functioning prior to the injury. They may or may not be aware of these differences. For them to succeed it will be important to help them identify if they need academic adjustments, tutoring or decreased work load.

9. TSD Traumatic Brain Injury Team
BrainSTEPS (STEPS=Strategies, Teaching, Educators, parents, and Students) are consulting teams in the state/district specializing in Brain Injury School Re-Entry.
Many school districts in Colorado have BrainSTEPS teams and we are trained by CDE staff in the Traumatic Brain Injury Department.
TSD has had a Brain Injury Team for the last 20 years. We service students who have mild, moderate and severe TBIs/Concussions. We also work with those who have Acquired Brain Injuries (strokes, brain tumors, aneurysm, lack of oxygen, lightning strikes, chemotherapy/radiation impacts, seizure disorders, brain infections, toxic or metabolic injuries, and viruses.)
The team consists of Occupational Therapists, Speech Therapists, Psychologists, Nurses, Parent and Student consultants. Representatives on the TBI team attend state trainings on Brain Injury yearly.
The team helps with TBI identification, school re-entry, concussion management, IEP and 504 development, and staff training. They monitor students annually until graduation. They assist with district policy and putting precautions in place to prevent district liability of further injury to a student with a brain injury.
The team promotes prevention of brain injury.

10. Brain Injury Facts
Brain Injury is the leading cause of death and disability in children and adolescents.
Brain Injury can be caused by the head being jolted. Brain tissue can be impacted at the site of the “jolt”, by whiplash, contra-coupe injury, where damage is done opposite the site of contact.
Less than 90% of concussions involve loss of consciousness. 70% of concussions resolve in 4-6 weeks or sooner.
Effects of brain injury may not always be immediately apparent. They may not become evident until a student is challenged with academics or until he/she reaches a developmental stage that increases demands and executive functioning/ higher level skills requiring organization, social skills, problem solving, and independent functioning.
Doctors must give medical clearance in order for a student athlete to return to play.
A 504 should NOT be written for “concussion”, rather it should be written for the symptom they are still experiencing due to the concussion. (e.g. Slow work output and processing speed)

11. Contacts and Further Resources
Contact the Brain Injury team in TSD at: with referrals or questions, to request an observation or gain assistance in communicating with student and parents.
For more up-to-date brain injury resources for teachers and parents, go to:
Go to the Thompson School District Website – Brain Injury/Concussion section to see current team members, forms, referrals, and a more extensive resource list.

12. Question 1 Which of the following is an example of a possible TBI?
    a) Cognitive deficits due to Cerebral Palsy
    b) Falling off a swing set and hitting your head
    c) Experiencing a near-drowning in the backyard pool.
d) None of the above.

13. Question 2 Most concussion symptoms resolve in 70% of the students by:
a weeks
b months
c weeks
d days

14. Question 3
Strategic rests and scheduled breaks can help students with:
a. Cognitive fatigue
b. Emotional lability and outbursts
c. Physical symptoms and fatigue
d. All of the above

15. Question 4
Teachers should let the school nurse and counselor do all the communication with the parent so that communication doesn’t get too complicated.
a. True
b. False

16. Question 5
More information can be found on the Thompson School District Website including:
a. Brain Injury/Head injury Standard Operating Procedure
b. Names and contact information for the Brain Injury Team.
c. More resources and forms for families and teachers.
d. All of the above.

17. Question 6
Physical Abuse is a cause of some student’s brain Injury. This includes Shaken Baby Syndrome.
a. True
b. False

18. Question 7
Regarding Athletes, return to learn and return to play, and 504s.:
a. If a doctor does not give medical clearance, a student cannot return to play,
and they may not return to learn and be in school.
b. A student who is on a 504 plan should probably not be cleared to play
sports if the 504 was written in regard to symptoms they had from a head
injury.
c. Most student athletes who have concussions need to be on a 504 so that
they can pass their classes.
d. None of the above are correct.