Who should play a play a part in the school concussion management team?

• Teachers

• School Nurses

• Guidance Counselors

• School Psychologists

• Athletic Trainers

• Coaches

What types of strategies can schools use to fulfill academic recommendations from a physician?

Testing Modifications

We now know that students who fall behind can experience stress and anxiety in an effort to "catch up," causing delays in their recovery. Students with concussions can also have increased memory and attention problems. They may not be able to learn as effectively or quickly while recovering [1]. Some testing modifications may include:

• No testing

• Giving extra time for testing

• Reducing the frequency of testing

• Replacing tests with shorter quizzes

• Avoiding Scantron® tests due to visual processing issues

• Allowing tests to be taken orally

• Testing alone in a quiet room

Workload Reduction

Recovery from concussions can take longer when students attempt to work through their symptoms. Therefore, cognitive and physical activity should be reduced, and students should keep activity at a level that does not lead to a worsening or reappearance of symptoms. This level will be different for everyone, and will change during the course of recovery. [1] 

Classroom Modifications

There may be certain modifications that can be made in the classroom in order to avoid exacerbating concussion symptoms during the recovery period. Some recommendations may include:

• Providing notes on a topic before class, or allowing a student to copy a classmate's notes. Note taking may be difficult due to the increased cognitive burden of listening and writing at the same time.
• Limiting computer work. For students having stronger visual symptoms, using a tablet to enlarge print in a text or using audio books will allow the student to follow along without provoking symptoms.
• Allowing the student to use dictation software. [1]

Attendance

Based on symptomatology and cognitive function, attendance recommendations may include no school, half days, or full days with modifications. If half days are recommended, students may be advised to alternate mornings and afternoons in order to avoid missing the same classes each day. The goal is to progress the student back into full days with modifications. If no school or half days are recommended, it is usually for a short time frame. [1]

Other Modifications

• Eating lunch in a quiet environment

• Allowing extra time between classes to avoid crowded hallways

It is important to reduce chances of a second head injury, so all physical activity is restricted, including PE classes, sports, and recess until fully cleared by a physician. It is possible that a student's symptoms will increase throughout the school day. If this happens, it is recommended that the student be allowed to put their head on their desk. For worse symptoms, they may need to go to the nurse's office to "reset" prior to returning to class.

As a teacher, if you ever suspect that your student may have a concussion, notify the school nurse as soon as possible. The school nurse will contact the student's parents, and the student will be advised to have a concussion evaluation with a physician.

References

Sady MD, Vaughan CG, Gioia GA. School and the Concussed Youth - Recommendations for Concussion Education and Management. Physical medicine and rehabilitation clinics of North America. 2011;22(4):701-719. doi:10.1016/j.pmr.2011.08.008