What does concussion in sports have to do with me?

Teachers know aspects of their students that parents, coaches, athletic trainers, and peers may not know. They are in a unique position to observe and interact with students as they learn, allowing them a glimpse into the way each one’s brain processes information. Some students are quick to raise their hands to answer a question while others are more thoughtful to be sure they have the correct answer before raising their hand to answer. Some students always finish a test first and have excellent grades while others may finish first and fail the test. Certainly parents, coaches, athletic trainers, and peers are well aware of other aspects of these same students that teachers are not. Teachers can usually see when one of their student’s cognitive or academic behaviors has changed and will usually begin asking questions of the student and parents to determine the cause of the change. But how often does a teacher pause to think that the cognitive or academic changes they are seeing might be a consequence of a physical injury like a concussion?

Concussion causes physical, cognitive, and emotional symptoms that last for a varying amount of time. Some symptoms show up right away, but others may not appear or be noticed for days or weeks after injury. Likewise, some symptoms might resolve fairly quickly, but others—especially fatigue—can persist much longer. The number and severity of symptoms, the speed of recovery, and the impact of symptoms on academic functioning or other activities will be different for each student.

What are the cognitive effects of a concussion?

The cognitive effects of concussion can include difficulty concentrating and paying attention, trouble with learning and memory, problems with word-finding and putting thoughts into words, being easily confused and losing track of time and place, being slower in thinking, acting, reading, and speaking, being easily distracted, having trouble doing more than one thing at a time and/or a lack of organization in everyday tasks. It is easy to understand that any of these consequences can have an effect on learning and behavior in the classroom.

When you have a student in your class who has recently sustained a concussion you become an important member of the team of individuals who can help facilitate recovery once you have become informed about appropriate academic management of concussion.

Teachers need to be informed when one of their students has sustained a concussion. You may observe some of the following signs that cognition has been affected.

For example, the student might…

  • Get tired easily in class and over the course of the day
  • Be bothered by bright fluorescent light in the classroom or loud noise in the cafeteria
  • Be easily distracted
  • Have trouble doing more than one thing at a time, such as listening to the teacher while also taking notes
  • Take longer and need more repetition to learn new material
  • Remember something one moment but not recall the same thing another time
  • Be easily overloaded, especially with a steady flow of information
  • Read more slowly due to difficulty with comprehension
  • Have a headache that develops or worsens with concentration
  • Feel dizzy after sudden movement or lose her balance more easily
  • Have trouble organizing and remembering homework
  • Lose track of time
  • Get lost or have trouble finding his way around
  • Get frustrated or irritated more easily, especially if overloaded.

In general, concussion affects mental stamina more than intellectual ability. This is because the injured brain must work much harder to accomplish anything, and so the student gets tired more easily. Fatigue and overexertion will often be accompanied by a temporary worsening of symptoms.

Concussion is an invisible injury. Because of this, changes in a student’s thinking, learning, and behavior may be blamed on other causes.

For example:

  • Mental fatigue or difficulty concentrating may be misinterpreted as laziness or disinterest.
  • Students themselves might wonder if they’re “crazy” because they can’t see or feel the brain injury, only its effects.
  • Pressures to return to sports or other activities before complete recovery may cause the student, parent, coach, or teacher to minimize concussion symptoms.

If current teachers and staff have had little pre-concussion contact with the student, then talking to others who worked with the student before injury can help to clarify how post-concussion symptoms might be affecting current learning and behavior. Teachers’ sensitivity and understanding toward the student is critical. Teachers might want to think of ways to monitor progress and focus on improvements rather than on the symptoms themselves.

What can I do to help?

After concussion, the most significant problem for the student tends to be a decrease in mental energy, like a battery that runs down much quicker than before. The student’s energy level will also be more variable due to injury, so what’s manageable one day is not necessarily manageable the next. It is usually not one specific subject or activity that causes fatigue, but the combined demands over the course of the day or week.

If concussion symptoms start to get worse, it usually means the student has reached the point of over-exertion and needs a break. Some students may need only a short break in the middle of the day, whereas others might need to rest or nap for a couple of hours in the afternoon.

Some of the most simple yet most important accommodations that can be made for the student are:

  • Reduce schoolwork demands to a level that is manageable for the student, including reduced homework and, if necessary, reduced course load
  • Schedule rest periods and provide the student with a calm and quiet place to take a break or a nap
  • Remove the student from recess and physical education activities where there is an increased risk of head injury—especially any contact or collision sports—until he/she have recovered; substituting mental activity for physical activity is not recommended, and light exercise (after medical clearance) that does not aggravate symptoms may actually be beneficial
  • Allow the student to eat lunch in a quiet room with one or two friends rather than in a crowded and noisy cafeteria

Additional general strategies include:

  • Extending time on tests and assignments to allow for slower processing speed, especially if there is a significant reading demand.
  • Providing a quiet room in which to take tests to minimize distraction.
  • Offering preferential seating to minimize distraction and allow better monitoring of attention and energy level.
  • Reducing light sensitivity by allowing the student to wear sunglasses or a hat with a visor in class.
  • Breaking information and assignments down into manageable chunks.
  • Helping the student to stay organized such as keeping track of homework assignments.
  • Reducing confusion and the chance of falling in crowded hallways by having the student change classes with a buddy (leaving class a few minutes early when the hallways and stairwells are less crowded is another option, but less preferable because the student tends to feel singled out or different from other students).

Most individuals recover completely from a concussion in a matter of days or weeks, but symptoms can last much longer. Over-exertion, re-injury, and academic or emotional stress can aggravate symptoms and prolong recovery. Early intervention after concussion can help to minimize the risks of re-injury and over-exertion, both of which can complicate recovery. In many cases, education about the injury and advice about how to best manage the symptoms may be all that is needed. In about 10 to 20 percent of cases a concussion can take months to resolve. In these cases a teacher is an essential member of the team that includes the physician, student, parents, coaches, athletic trainers, peers and others. The members of this team provide essential information to treating clinicians that assists in monitoring and managing recovery. A neuropsychological evaluation may become important when the symptoms of a concussion persist and the physician refers the patient to a neuropsychologist for further evaluation. This evaluation can provide detailed information about which brain functions have been affected and determine treatment to remediate the affected functions. In some cases a 504 Plan may be advisable to support a student through a long-term recovery from concussion.

Do you know your school district’s policy on concussion?

The New Jersey Concussion Law was passed in December 2010 requiring that school districts develop a policy for how to manage concussions in their schools. Currently all school districts in New Jersey should have developed and implemented a policy on concussion. Mandates from the Law and Policy need to be implemented and it is advisable that clear procedural guidance is provided for school staff including nurses, educators, and administrative staff.

Generally the Law applies to all public and nonpublic schools in New Jersey and applies to student-athletes in grades K – 12 who play interscholastic sports. The New Jersey Concussion Law primarily focuses on interscholastic sports with the exception that any youth sports team organization (one or more sports teams organized pursuant to a nonprofit or similar charter or which are members teams in a league organized by or affiliated with a county or municipal recreation department) that operates on school grounds must sign a statement of compliance with that school district or nonpublic school’s policies for the management of concussions and other head injuries. This article in the Law provides the youth sports team organization with immunity from liability when they sign the compliance statement.

The Model Policy developed by the New Jersey Department of Education expands the Law regarding return to play decisions to include grades K-12 with certain differences for grade K-8. It states that “Younger students (K-8) should observe the 7 day rest/recovery period (after they are symptom free at rest) prior to initiating the Graduated return-to-play Protocol” outlined in the Consensus Statement from the 2008 International Conference on Concussion in Sport. The Policy also states that the Graduated return-to-play Protocol should be monitored by a physician trained in the evaluation and management of concussion as well as the parents/guardians of the student-athlete and that school nurses may serve as advocates for communicating signs and symptoms to physicians and parents/guardians.

School districts can choose to provide guidelines for elementary and middle schools to follow in the event that a concussion occurs to a student outside of interscholastic sports.

It would be optimal to include physical education teachers in interscholastic head injury training because of the contact sports they facilitate daily, and the risk of students sustaining a concussion during gym time. In addition, many students with concussion return to school with gym restrictions, because of the risk of contact sports and sustaining a second concussion making it imperative for the physical education teacher to be on the same page as other staff. Including a requirement for teachers to attend trainings in concussion will reinforce the relationship between concussion and cognition, academic accommodations, and physical activity restrictions that are typically necessary following a concussion.