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What’s a Teacher to Do: When Students Return-to-Learn After a Concussion


Bonnie W. Bell, Ph.D., VODE TTAC@GMU and Clare Talbert, M.Ed., VDOE TTAC@ GMU

Concussions are real and they must be taken seriously. Mismanagement of concussions may result in serious long-term cognitive and neurological consequences and risk coma or even death (Brain Injury Association of Virginia, 2012). Conversely, proper management of a return-to-learn process following a concussion should lead to a good prognosis with minimal deleterious brain function effects (Lovell, Collins & Bradley, 2004).

Often, concussions are minimized or misunderstood, but all concussions are brain injuries (Centers for Disease Control, 2011). As educators, we play an extremely important role in the recovery and future functionality of our concussed students.

“When Mikaela’s post-concussion symptoms were at their worst, the normally bubbly 16-year-old would cry herself to sleep. If the piercing headaches, sensitivity to light, drastic memory loss and uncharacteristic mood swings weren’t bad enough, there were times she would sit and stare blankly at her homework. Her brain – her memory – betraying the honor student so completely she would crawl into bed, her eyes welled with tears, craving sleep.” This high school sophomore sustained her fourth concussion from taking a close-range shot off her temple during soccer practice (Comak, 2011).

Claire was also a high school soccer player. During a game, she fell down, lost consciousness briefly, got up and continued to play. The next day, her troubles started. At school, she was having difficulty concentrating and reading. When she got to math class and looked at her math test, she realized that something serious was wrong. She had no idea what it was. Eventually, Claire would be out of school for a year to recover from her head injury (Virginia Department of Health, 2011).

The most crucial pieces in reducing the recovery time from a concussion appear to be immediate physical and mental rest and increased sleep to allow the brain to heal (Moser, 2007). For educators, this understanding is vital to facilitate our students’ quick recovery and return to class.

Often athletes or their parents minimize or do not even report concussion symptoms because they want to tough it out, they do not know what a concussion is, or they are unaware of its inherent and potentially devastating dangers. As students, they do not want to miss class or fall behind. However, playing a sport with a concussion does not show courage or strength. It is simply not smart to jeopardize brain health by participating in sports or education too soon after a concussion (CDC, 2010). The risks are just too great.

A brain compromised by concussion affects learning. Initially, students will need to stay at home and rest with no homework or tests. Cognitive activity during a recovery from a concussion can not only delay healing, but it is often counter-productive. Students cannot remember information or think as clearly as they did prior to the injury. Thus, testing during this recovery phase does not assess how much the student actually knows. Also, the brain injury interferes with the learning of new material, so attempting to attend class, learn, or study is often ineffective or impossible.

To complicate the concussive experience, signs and symptoms may not appear or be noticed until hours or days after the injury (CDC, 2010). Therefore, it is important for educators to watch for changes in how students act, learn, perform, or feel. If an educator has concerns, s/he should report them to all interested parties associated with the student (parents, coaches, school nurse, counselor, administrators, etc.). The following references and resources are helpful for educators to recognize and understand the signs and symptoms of concussions and to manage a student’s return-to-learn plan.

Additional Return-to-Learn Resources

An Educator’s Guide to Concussions in the Classroom, Nationwide Children’s Hospital, 2nd edition, (n.d.) http://www.nationwidechildrens.org/Concussions-in-the-Classroom
This article contains:

Brain 101: The Concussion Playbook - Teacher Packet. (2011). ORCAS.
http://orcas-sportsconc2.s3.amazonaws.com/files/A_TeacherPacket.pdf
This packet includes:

Brain Injury and the Schools: A Guide for Educators, (2005). Brain Injury Association of Virginia. http://www.doe.virginia.gov/special_ed/disabilities/traumatic_brain_injury/brain_injury_schools.
This guide includes:

Concussion in the Classroom, (n.d.). Upstate University Hospital, Syracuse, NY. http://www.upstate.edu/pmr/healthcare/programs/concussion/pdf/classroom.pdf.
This guide includes:

LEARNet Problem-Solving System and Resource Website. (2008). Brain Injury Association of New York State. http://www.projectlearnet.org/
This resource includes:

REAP Concussion Treatment & Management Guidelines, Rocky Mountain Hospital for Children, http://www.rockymountainhospitalforchildren.com/sports-medicine/concussion-management/reap-guidelines.htm.
The REAP Project booklet (2011) includes:

Schilling, E. J., & Getch, Y. Q. (2012) Getting My Bearings, Returning to School: Issues Facing Adolescents with Traumatic Brain Injury, TEACHING Exceptional Children, 45(1), 54-63.
This article contains:

Returning to School After a Concussion: A Fact Sheet for School Professionals, (n.d.), US Department of Health & Human Services and Centers for Disease Control and Prevention. http://www.cdc.gov/concussion/pdf/TBI_Returning_to_School-a.pdf.
This fact sheet includes:

Working with Individuals with Brain Injury: A Professional’s Guide, (n.d.), Brain Injury Association of Virginia.
http://www.ttaconline.org/staff/s_resources/s_resource_detail.asp?aid=1188
This guide contains:

TTAC Online - Resource Content, (n.d.) http://www.ttaconline.org/staff/s_resources/s_resources_subcontent.asp?dis=13

References

Comak, A. Insult to Injury: A Look at Concussions. Cape Cod Times. January 30, 2011. Retrieved on August 30, 2012 from http://www.capecodonline.com/apps/pbcs.dll/article?AID=/20110130/SPORTS/110129759/-1/NEWSLETTER100.

Heads Up to Schools: Know your Concussion ABCs. (2010). Centers for Disease Control and Prevention (CDC), Retrieved on August 30, 2012 from http://www.cdc.gov/features/ConcussionABCs/.

Lovell, M., Collins, M., & Bradley, J. (2004). Return to Play Following Sports-Related Concussion. Clinics in Sports Medicine, 23. 421-441.

Moser, R. S. (2007). The Growing Public Health Concern of Sports Concussion: The newpsychology practice frontier. Professional Psychology: Research and Practice, 36 (6). 699-704.

Sports Concussion. (2012). Brain Injury Association of Virginia. Retrieved on August 28, 2012 from www.biav.net/Default.aspx?PageID=5586473&A=SearchResult&SearchID=496467.

Virginia Department of Health. (2011) Play Smart: Understanding Sports Concussion. DVD.
This resource is available for checkout from the Region 4 TTAC@GMU lending library, which can be accessed at http://kihd.gmu.edu/library and from the Region 5 TTAC@JMU lending library, which can be accessed at http://www.jmu.edu/ttac.