a student and a pe teacher walk into your office……
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A Student and a PE teacher walk into your office……. Why is this important to you?. No one worried in the good old days about non-athletes Child abuse Domestic violence “Extreme sports”. Time course of recovery. Collins, et al. Neurosurgery 58:275-286, 2006. - PowerPoint PPT PresentationTRANSCRIPT
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A Student and a PE teacher walk into your
office……
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Why is this important to you?
No one worried in the good old days about non-athletes
Child abuse
Domestic violence
“Extreme sports”
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Time course of recovery
Collins, et al. Neurosurgery 58:275-286, 2006
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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 complains of symptoms
How can I tell if a student is hurt?
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Consistent message to the Student (and parents)
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
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COGNITIVE• Fogginess• Concentration• Memory deficits• Cognitive fatigue
MOOD DISRUPTIONIrritabilitySadnessAnxiety
SLEEP DYSREGULATIONFalling asleepFragmented sleepToo much/too little sleep
SOMATICHeadachesDizzinessLight/noise sensitivityTinnitus
Adapted from Camiolo Reddy, Collins & Gioia, 2008
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◦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
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◦Improve with rest… Physical/sports exertion Mental exertion Sustained attention in class and during school day
Reading Homework Tests/quizzes/standardized testing Computer vs iPad use
Post-injury Symptoms
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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.
Risk factors for prolonged recovery
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◦Temporary?
◦ Can be a PERMANENT problem
◦ Improves more quickly with proper management
◦ Complete recovery typically expected
Learning and attention disability
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Individualization
Innovation
Integration/Team work◦ RN – ATC◦ Guidance – Teachers◦ Psychologists – Social Workers◦ Parents
Fluid situation that will change over time
Implementing an Accommodation Plan
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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?
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Rest periods during the school day o School nurse’s office o Rest before symptoms become too
intenseo Take Tylenol/Advil, etc. as
recommended by doctoro Return to classes if feeling bettero Early dismissal if rest does not help sx
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Extension of assignment deadlines!
◦ Homework, papers, projects◦ According to student’s capacity◦ Removes major source of pressure◦ Allows student to prioritize sleep & rest!
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Excuse from some assignments ?
◦ More common in lower grades◦ Less catch-up to do during/after recovery◦ Consolidate work into more manageable
units◦ Allow independent work with alternative
ways to submit
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Postpone exams
◦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
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Light/noise sensitivity
◦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
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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
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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
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Athletic Trainer Monitoring of symptoms Periodic neurocognitive testing
School Nurse Daily clinical evaluations Rest & recovery area Medication
Guidance counselor Coordinates academic accommodations
Academic Care Team
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Teachers Adjust work according to changing status Reassurance Be careful of pressure
Psychologists Specific input for LD-ADHD students
Social Workers Adjustment support - especially in longer
recoveries
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Need clear team leader through whom all information flows
Hold the medical team to a standard of communication◦ Forms to complete/care plan to communicate◦ Feedback to medical re. symptoms, performance
Have clear policies in place to deal with parents who do shop around, “I’ll sign and take responsibility”
Policies in place for 504 Plan for mTBI◦ Academics must have priority
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Pressure from coaches (any kind)◦ “be there to support the team” “faking it”
Family◦ “when I played football” “we have a lot invested”◦ “just trying to get out of…” “my uncle is an EMT…”
?Friends and/or teammates◦ “faking it” “we lost because you were out”◦ Cyber bullying◦ Loss of social life if witheld from group activity
Beware of and protect from
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www.cdc.gov/concussion
www.impacttest.com
www.sportsconcussion.net
www.sportslegacy.org
Resources for education
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Questions?