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Information For Educators
Sports concussions are an expectable occurrence for many of today’s student athletes. It is important to recognize that students who are in concussion recovery may face certain challenges as they attempt to continue their studies in the days and weeks after injury. Even when the athletic trainer and team physician carefully manage a student athlete’s concussion, school personnel outside the athletic department are often not aware of the important role that guidance counselors, school nurses, social workers, psychologists and teachers can play to help minimize the academic consequences of the injury. The best management of these injuries requires intervention by a school at several levels.
Academic Support During Recovery
Post-concussion symptoms will often interfere with a student’s ability to do academic work. Physical symptoms such as headache, dizziness or lightheadedness, ringing in the ears,and noise or light sensitivity may make it difficult to participate in the classroom or complete homework. Fatigue and sleep disruption may leave the student without the mental energy to participate in a full day of class work and evening studies. Cognitive deficits, mainly involving difficulty focusing and remembering new information, can exist even when there are no persisting physical symptoms. Furthermore, the irritability and moodiness some recovering students experience may add stress to relationships with peers and parents.
For the student whose post-concussion symptoms last only a few days, this situation is not much different than being out sick with a bad cold, the flu, or other short-term illness. However, when symptoms are more intense and persist for weeks or longer, one cannot easily make up work by putting in extra time and effort. A dilemma then arises that requires the skillful involvement of teachers, the guidance counselor, the social worker, the psychologist and the school nurse, working in conjunction with the student and parents, to resolve.
The injured student will recover more quickly with rest, not only from physical exertion and athletic activity but also from the cognitive demands of academic work. Resting from academic work is usually a difficult proposition, however, because students are at risk to quickly fall behind and become unable to catch up in their classes if they remain academically underactive for too long. Most students, except those with more severe and long-lasting symptoms, are able to continue in their studies with some temporary accommodations. The goal is to support the recovering student in keeping up with academic demands in a way that does not overstress cognitive functions and unwittingly worsen symptoms. For each student this requires a careful balancing of rest with academic work and the development of an individualized plan that prioritizes academic work to be done and uses appropriate temporary accommodations that evolve during the recovery process in accordance with the student’s improving capabilities.
Implementing an Accommodation PlanStudent athletes recovering from a concussion are best supported in making the safest, fastest recovery when they receive a consistent message from their athletic staff, academic faculty, parents, and health care professionals.
The ideal message should include:
Accommodations can be put in place on a temporary, informal basis but many students benefit from having a 504 Plan written to outline the accommodations that are reasonable for a short-term medical condition of this type.
As soon as a concussion injury is identified by athletic staff, notice should be given to key members of the school staff, including the school nurse, guidance counselor, social worker, school psychologist and the student's teachers.
The school nurse plays a pivotal role in providing a rest and recovery area when the student becomes more symptomatic during the school day with headache, light/noise sensitivity, dizziness, etc. Recovering students should check in daily with the school nurse. The nurse’s record of daily contacts and symptoms provides a valuable tracking of the student’s progress and will also help identify any worsening symptoms, which may indicate the need to temporarily cut back further on the student’s academic demands or school attendance.
The student’s guidance counselor serves the key role of coordinating the academic accommodation process. A daily check-in between the student and guidance counselor will also help identify the need for further adjustments in the accommodations being given.
The social worker can be invaluable in helping support the recovering student emotionally. Students in the recovery process sometimes find it very stressful to try keeping up with academic demands while not feeling well physically or cognitively. They are also prone to irritability, anxiety, sadness, and depression. Students may be either upset or relieved to be held out of athletic activity and an opportunity to talk with a professional who understands their dilemma can facilitate their emotional adjustment to the situation.
The school psychologist plays a key role in assuring that appropriate accommodations are in place. For students who have been diagnosed with learning or attentional problems prior to a concussion, the psychologist may best understand how a concussion can complicate their learning difficulties and advise regarding work load and accommodations. In cases where a social worker may not be available to a student, the psychologist may also be able to provide short-term counseling through the recovery period.
Neuropsychological EvaluationThe assessment typically used for sports concussion injuries involves a brief and focused battery of testing (lasting about 25 minutes) designed to screen for predictable changes in cognitive efficiency. For students who show lingering cognitive deficits on post-concussion testing and persisting performance deficits in their school work, there is the possibility that concussions that have become too numerous or which have occurred too close in time may have led to longer term cognitive disabilities. More comprehensive educational and neuropsychological evaluation may therefore be indicated if recovery has not occurred by about three months post-injury.
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