1. Returning Student-Athletes to a Learning Environment

2. Support Team The student-athlete Parents/Guardian Teachers/Coaches Physician/Athletic Trainer School Nurse School Counselor Speech Language Pathologist School Administration

3. The First 48 Hours After a Concussion – Physical AND cognitive rest – Avoid tasks which increase symptoms “overstimulation” of brain Simplify brain inputs – “live like the Andy Griffith show” – Some symptoms may evolve especially headache, concentration

4. The First 48 Hours After a Concussion Reassess by practitioner trained in concussion management NO role for ImPACT testing in this stage – May increase symptoms – Practice effect – Does not change plan If no symptoms for 24 hours can attempt return to class – If symptoms worsen in class should rest and may need to return home

5. Parent/Guardian’s Role First 48 Hours Let the student-athlete sleep – Do not them wake up regularly Limit cognitive activity around the house – Computer time, phone/texting, video games, and television Limit physical activity – We do not want to elevate the heart rate. No driving

6. Returning to School School specific activity should be increased gradually. – When able to tolerate 1-2 hours of homework at home, without symptoms, probably ready to return to school. Start with ½ days back at school – Light load – Monitor for symptoms When ½ days are tolerated, the student can return to full school days.

7. Returning to School If symptoms develop, the student should take a break until symptoms resolve. If symptoms do not resolve, the child should continue to rest or go home.

8. VSCC School Accommodations Please consider the following concussion-related recommendations: Gym Class recommendations: ____No gym class ____Restricted gym class as specified___________________________ Recommended Academic accommodations: ____Untimed tests ____Open note/Open book or Oral tests ____Tutoring ____Reduced workload when possible ____15 minute rest breaks from class every ____ hour(s) ____Modified/reduced homework assignments ____Extended time on homework/projects ____Tape record class lectures ____Should not return to school until concussion symptoms are resolved ____Other recommendations_____________________________________

9. Strategies to Help in the School Setting Sign/Symptom Headache Adjustments Frequent breaks Planned rest periods in the nurses office or quiet location Identify aggravators and reduce exposure to them

10. Strategies to Help in the School Setting Sign/Symptom Dizziness Adjustments Allow student to put head down if symptoms worsen Give student early dismissal from class to allow extra time and to avoid crowded, busy hallways

11. Strategies to Help in the School Setting Sign/Symptom Visual problems: Light sensitivity Double vision Blurry vision Adjustments Reduce brightness on screens; use sunglasses Turn off fluorescent lights Seat closer to the front and center of the room for blurry vision Cover one eye with a patch for double vision

12. Strategies to Help in the School Setting Sign/Symptom Noise Sensitivity Adjustments Allow student to have lunch in a quiet area with one classmate Limit band, choir, shop Ear plugs if possible Early dismissal from class to avoid noisy hallways

13. Strategies to Help in the School Setting Sign/Symptom Difficulty Concentrating Adjustments Avoid testing or major projects Extra time on tests Postpone standardized testing

14. Strategies to Help in the School Setting Sign/Symptom Difficulty Remembering Adjustments Consider 1 test per day Consider open notes or oral testing

15. Strategies to Help in the School Setting Sign/Symptoms Sleep Disturbances Adjustments Allow for late start or shortened school day to catch up on sleep Allow rest periods

16. Formal Support Services Response to Interventional Protocol (RTI) – Used for students who need adjustments for an extended period of time. – Uses a multi-step approach that allows for monitoring progress through increasing levels of the intervention. – At each level, school officials reassess to determine continued needs of the student.

17. Formal Support Services 504 Plan – For students with persistent symptoms. – Will describe modifications and accommodations to help student return to pre-concussion performance levels. – Examples of modifications: Environmental modifications Temporary curriculum modifications Behavioral modifications

18. Formal Support Services Individualized Education Plan (IEP) – For students with certain classifications of disabilities that affect educational performance – Small percentage of concussed students will need IEP’s (Chronic cognitive/emotional disability) – These students generally require significant help Adjustments to workload Adjustments to teaching/learning methods Adjustments to environment/curriculum