Concussion Management Protocol to Support Recovery of CH Students

Each year, approximately25,975

children in Pennsylvania sustain a concussion /traumatic brain injury

Source: The Brain Injury Association of Pennsylvania

How Common is Traumatic Brain Injury in Children in

Pennsylvania?

A Child’s Brain…

• Under-developed• Unlike other organs, the brain needs time &

experience to mature. • Easily injured• New abilities build on ESTABLISHED skills over

time• Does not “bounce back” after injury

3 Things to Consider:

1. Children, unlike adults take LONGER TO RECOVER from concussions

2. Post Concussion Syndrome (past 7-10 days)

3. Second Impact Syndrome (when brain has not healed)

“When in Doubt, Sit Them Out”!

• Physically and MENTALLY!

March 2013 Article: “Rest is Best”

• Stress on athletes and students not to disappoint (attendance, grades, playing-time).

• “You break your arm, you put it in a cast and don’t use it. You hurt your brain, you can’t stop using it.”

• Delay recovery time• Quicker recovery = Complete Rest

What’s Happening?

Following CONCUSSION there are actual PHYSICAL, METABOLIC, &

CHEMICAL CHANGES that may take place in the brain

Should be Symptom Free at REST & during PHYSICAL EXERTION! (exertion added gradually)

AT LEAST 7-10 days during which time they experience No Symptoms

Getting A-Head of Concussion P. Hossler and R. Savage (2006)

When Should Students Return to School?

Commonly Recommended After Concussion

1. Restricted Physical Activities: recess, physical education

2. Academic Accommodations: Untimed, open book, take home, and/or shortened tests

Reduce class work and homework by 50%; shorten tests & projects (reduce 50 problems to 25 problems; 4 pages to 2 pages)

Frequent breaks from class when experiencing symptoms (e.g., go to nurse, put head down on desk)

Extended time on homework, projects

Full days of school as tolerated

Half days of school as tolerated(Pardini, Fazio, Taylor. 2008)

Concussion Management Team (CMT)

• Student• Parent / Guardian / Family• Coach, Athletic Trainer, Athletic Director• Physician, School Physician• School Psychologist• School Nurse• Guidance Counselor, Teachers, Support Staff• Administration• BrainSTEPS

Responsibilities Cont.

Student

• RECOVER !

• To clearly and honestly communicate their symptoms, academic difficulties and feelings

• To carry out any assigned recommendations by other team members to the best of their ability

Responsibilities of the Individual CMT Team Members?

Parent/Guardian • To submit all physician notes and instructions to

the school (nurse) in a timely manner

• To help the student maintain adherence to any medical and/or academic recommendations given to promote recovery

Athletic Trainer : To evaluate possible injuries and

make referrals communicate with school staff for student-athletes. To monitor symptoms and help coordinate and supervise a student-athlete’s safe return to play

Athletic Director: To oversee the athletic

department’s concussion management plan, including but not limited to: equipment management, policies, coach/athlete/parent education, etc.

School CMT Team First Contact School Nurse • Communicate injury / symptoms to school personnel

• To monitor in-school symptoms and health status changes

• To help determine if it is appropriate for the student to be in school or if the student needs

any health-related accommodations

School CMT Members

Teacher(s)• To help the student get the best education

possible given the circumstances and to follow recommended academic accommodations

Guidance Counselor • To help create (as needed) and disseminate

academic accommodations to the student’s teachers

Coach/Physical Education Teacher: To recognize concussion symptoms and remove a potentially injured player from practice or competition. To receive communication from health care providers, parent/guardian and school about readiness to return to play. To communicate with the school about the student’s progress

School Psychologist : To be the consultant for prolonged or complicated cases where long-term accommodations or more extensive assessment and educational plans may be necessary

Administrator: To direct and oversee the management plan and trouble shoot problems. To help create a change in the culture of the school regarding the implementation of programs, supports and policies

Academic Concussion / TBI Management Process at Cambria Heights:

Step 1: Concussion Reported

• Injury reported to CML (leader) as soon as possible.

• At the beginning of school year, CML should be identified to teachers, coaches, parents and administrators so the responsible adults know who to report injuries to.

• Anyone in the school community who suspects a concussion should contact the CML right away so the student can be referred for proper evaluation.

Step 2: Contact Student and Family

• Meet with student upon return to school.

• The CML should explain his/her role as the central communicator to both the student and the family and provide contact information for questions or concerns.

• The CML should also briefly explain the steps in the management process so the student and family know what to expect.

Step 3: Assess Medical Needs.• Has student see physician or athletic trainer?

Documentation? Assess symptoms and make attendance decision.

• The CML or ML will determine if the student has been evaluated by an athletic trainer or physician, and if the student has documentation from the provider concerning school/activity restrictions and accommodations.

• If no recommendations are available from the medical provider, the CML or ML should assess symptoms to determine if the student will benefit from being in school or if attendance is likely to be counterproductive.

Symptom Log

• If symptoms are significant or severe, the student may need to be sent home.

• If symptoms are manageable and not becoming significantly worse by attending school, the student may continue to step 4.

Step 4: Assess Academic Needs

• Consideration of general accommodations supplied by health care provider (if available).

If there are academic recommendations from the health care provider, the CML or AL should specify those general recommendations.

• If no recommendations are available, the CML or AL should assess the student’s academic needs.

Step 5: Distribute Accommodations

• Distribute accommodations / strategies to teachers & other relevant staff in writing.

• Contact family (and if applicable, coach and athletic trainer) with relevant academic/ medical updates and plan, as needed.

• Document as required.

Handout Packet: Examples

• Teacher @ Staff Notification Letter with Accommodations and Resources

• CH Student Transition Plan Following Injury• Academic Monitoring Tool for Teachers• Symptom Log Example• Teacher Follow Up Letter• Teacher Resolution Letter

Step 6: Determine Re-assessment

• Gain feedback from each team. Decide when to re-assess medical and academic needs.

• Identify appropriate timeframe for re-assessment of needs, and using feedback from teams, re-start process at step 3 or 4.

Re-assess Medical and/or Academic Needs When…

• New physician documentation arrives dictating a new course of action

• Symptoms have changed (and therefore the prior assessment needs to be altered)

• Symptoms have resolved and are no longer a barrier to school participation or attendance

• Teachers or parents identify problems in current plan that are not being adequately addressed

Questions?