Concussions and the Classroom

Image result for concussion classroom

The uniqueness of the brain, its developmental process, and its functions are not lost on healthcare providers when it comes to concussion. Concussions are defined as a traumatic brain injury (TBI) which impair neurological and cognitive (mental) functions (McCroy et al, 2017). Youth-athletes that sustain a concussion have been a recent area of focus in concussion research due to the nature of the developing brain at those ages and the unknown long-term consequences that could be associated to sustaining a brain injury at that young age (McAbee, 2015).

Traditional treatment options for concussed student-athletes asked for a 24-48 hour rest period to allow for symptoms to lessen then once the patient had returned to their baseline on neurocognitive tests (ImPACT, ANAM, CRI, etc.) they could initiate a graduated return-to-play (RTP) protocol that over six steps slowly exposed the patient to increasing levels of physical stress to see if symptoms could be elicited to qualify the patient to be fully returned to activity.

Image result for return to play protocol

However, more recent research has looked at the importance of slowly re-integrating the patient into the classroom. As an example of this, Halstead et al (2013), as part of the American Academy of Neurology, suggested that premature return to the classroom for a concussed student could present with major cognitive difficulties including learning new tasks or remembering old tasks. This is of major concern for any student-athlete or parent of a student-athlete as there is potential for decline in GPA associated to these issues. Decline of GPA can affect acceptance to college/university for a high school student, potentially throw off SAT/ACT scores, and have the ability to disqualify a student for potential grants and scholarships!  For the collegiate student-athlete, a decline in grades and GPA could affect their eligibility to play, standings on the team, and Image result for concussion learningboth athletics and academic scholarships. All of these potentially affect the long-term goals of student.

This concern for the student-athlete has become such a major issue in the field that for the first time in 20 years of international consensus statements being published, the fifth consensus statement in Berlin published an example Return-to-School graduated protocol (McCroy et al, 2017). This example protocol, shows potential academic accommodations that can be given to a student-athlete to facilitate the best possible environment for their recovery and long-term health and well-being. However, each concussion is unique, in-fact, research in 2014 suggested that there are actually six different clinical trajectories, of which each have different academic accommodation needs specific to the trajectory (Collins et al, 2014).

Image result for return to school protocol

I know you may be thinking, “What about 504 Accommodations?” Well, TBI is one of the 13 qualified disabilities for an official 504 academic accommodation to be set into Related imagemotion. The issue surrounding this is that the symptoms associated to a concussion typically subside after 7-10 days (McCroy et al, 2017), and due to state-variance in the 504 process the student-athlete may already be recovered by the time the official 504 is put into effect to protect their recovery needs. Further, collegiate student-athletes do not fall under the 504 or IEP process, these student-athletes have a separate process at the institution of learning.

Where do we go from here? In the case of the process taking far too long to be beneficial for the student-athlete’s recovery, there can be developed a local policy to abbreviate the process or establish a collegiate level process unique to the student-athletes. Administrators can work together to establish a plan of action, if your high school, college, university, or academy has an Athletic Trainer then they should be involved in the process, along with a Team Physician, Neurologist, Pediatrician, Guidance Counselor, Academic Advisor, School Nurse, Teachers/Professors, intervention specialist, etc. All of these stakeholders can bring a unique approach/intervention to the care of the concussed student-athlete and pre-establishing this group can lead to an effective abbreviated process.

From the Athletic Trainer’s perspective implementation should look like this:

  1. Concussion Diagnosis
  2. 24-48 Hours of Cognitive and Physical RestImage result for concussion learning
  3. Notify Team of Concussion Players
  4. Implement Academic Accommodations
  5. Daily Symptom Checks
  6. Full Return to School/Learning/Academics
  7. Baseline on Computerized Neurocognitive Test
  8. Initiate Return to Play Protocol
  9. Return Athlete to Sport

As can be seen, the student-athlete must complete their academic accommodations and be fully returned to school prior to initiating the graduated Return to Play Protocol. This is important as the use of academic accommodations should be seen as the patient still being technically symptomatic for concussion. Overall, we must put in the due diligence to take care of this vulnerable population. The research still is unsure of what potential long term effects could come with a history of concussion, particularly when referencing the youth-athlete population. It’s always better to play it safe then to risk the health and well-being of the student-athlete!

 

By: Jeremy D. Howard, MS, LAT, ATC, CSCS, CES, PES, ITAT

 

References

Collins, M.W., Kontos, A.P., reynolds, E., Murawski, C.D., & Fu, H.H. (2014). A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion. Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA, 22 (2), 235-246.

Halstead, M.E., McAvoy, K., Devore, C.D., Carl, R., Lee, M., & Logan, K. (2013). Returning to learn following a concussion. Pediatrics, 132(5), 948-957.

McAbee, G.N. (2015). Pediatric concussion, cognitive rest and position statements, practice parameters, and clinical practice guidelines. Journal of Child Neurology, 30(10), 1378-1380.

McCroy, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., …, and Vos, P.E. (2017). Consensus statement on concussion in sport– the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of  Sports Medicine, 0, 1-10.

 

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