2. http://office.microsoft.com/en-us/images/healthcare-CM079001960.aspx#pg:5 | CONCUSSION MANAGEMENT IN THE SCHOOL SETTING By Lisa Coenen, RN

3. WHAT IS A CONCUSSION A concussion occurs when there is impact to the head region that causes injury to the brain. A concussion is a brain injury, that not only affects the anatomy of the brain, but also affects the mechanism of brain processing. (Center for Disease Control and Prevention, 2010, “Concussion” section, para. 1) Any student who has sustained any type of head injury should be evaluated for brain injury. Evaluation can include “neuro – imaging and neuro - psychological” testing (Gioia & Collins, 2006, p. 1).

4. For many years, concussion injury was considered a minor event, usually managed according to symptomatic presentation. According to The Center for Disease Control and Prevention( 2010 ) “Symptoms of a concussion may appear mild, but can lead to significant, life-long impairment affecting an individual's ability to function physically, cognitively, and psychologically” (“Heads Up” section, para 2). New scientific findings include the possible adverse and long- term neurological deficits a concussion can cause. According to Smith (2009) “Far from innocuous, invisible injuries, concussions confer tremendous brain damage…” ( para 6 ). CONCUSSION MYTHS AND MISCONCEPTIONS

5. THE STUDENT’S RETURN TO SCHOOL Once a student has been diagnosed with a concussion, a plan of post concussion care is established by the physician. This plan of care usually involves activity restrictions and modifications both at home and in school. During the post concussion healing phase, a patient’s progress is monitored through continued testing until the patient can fully resume normal activities. If a patient does not follow the physicians plan of care, the brain can sustain further injury and post concussion healing can be prolonged (Kirkwood, Yeates & Wilson, p. 1365, para. 1).

6. WHEN YOUR STUDENT RETURNS TO SCHOOL After a student is diagnosed with a concussion, the doctor will usually restrict the student from school for a period of time to keep the student on complete rest. When the student returns to school, possible restrictions and modifications from the doctor will be in place to protect the student during the concussion healing phase. The restrictions and accommodations will usually be listed on a standard concussion form. The student might have a 504 plan in place to formally support the temporary modifications during this time (Gioia & Collins, 2006, p. 2).

7. MAINTAIN COMMUNICATION WITH YOUR SCHOOL NURSE The school nurse is a primary contact in understanding and managing the care of a student who returns to school after sustaining a concussion. The school nurse will also help determine the student’s health status regularly and as needed. Ongoing communication with the school nurse, the student’s family and other designated school staff is an important part of concussion management in school (Kirkwood, Yeates & Wilson, p. 1366, section 2).

8. WHAT ACCOMMODATIONS AND RESTRICTIONS CAN YOU POSSIBLY EXPECT TO IMPLEMENT FOR YOUR STUDENT DURING THEIR RECOVERY PHASE?

9. MODIFIED SCHOOL HOURS DURING THE INITIAL PHASE OF THE STUDENT’S RETURN TO SCHOOL, THE DOCTOR MIGHT LIMIT THE SCHOOL DAY BECAUSE THE STUDENT MIGHT NOT BE READY TO ATTEND SCHOOL FULL TIME (Center for Disease Control and Prevention, 2010, “Concussion” section, para. 3).

10. CURRICULUM MODIFICATIONS, LIMITED TEST TAKING, AND RESTRICTIONS IN HOME WORK ASSIGNMENTS MEMORY FUNCTION INCLUDING SHORT AND LONG TERM RECALL COULD BE SIGNIFICANTLY IMPAIRED AND COULD TAKE WEEKS TO MONTHS TO RETURN…. THERE CAN BE LIFE LONG MEMORY DEFICITS ( Center for Disease Control and Prevention, 2010, What are the Potential Long Term Effects of TBI section, p. 1 ). THE STUDENT’S COGNITIVE DEFICITS WILL REQUIRE STAFF TO PERFORM ONGOING EVALUATIONS IN ORDER TO DETERMINE APPROPRIATE MODIFICATIONS

11. COMPUTER USE COULD BE RESTRICTED LIMITING COMPUTER USE WILL HELP AVOID BRAIN FATIGUE DUE TO OVER STIMULATION (Center for Disease Control and Prevention, 2010, “Concussion” section, para. 2).

12. PROVIDE A QUIET ENVIRONMENT DURING THE RECOVERY STAGE, STUDENTS COULD HAVE AN INCREASED SENSITIVITY TO BRIGHT LIGHTING AND NOISY ENVIRONMENTS (Gioia & Collins, 2006, p. 1). AVOID BRIGHT LIGHTS

13. EXERCISE AND SPORTS RESTRICTIONS DURING THE STUDENT’S RECOVERY PHASE, AVOIDING PHYSICAL ACTIVITIES IS EXTREMELY IMPORTANT IN PREVENTING A SECONDARY CONCUSSION THAT CAN CAUSE LIFETIME INJURY AND POSSIBLY DEATH (Center for Disease Control and Prevention, 2010, “Concussion in Sports” section, para.1). THE STUDENT WILL REQUIRE A DOCTOR’S CLEARANCE BEFORE THEY CAN RETURN TO EXERCISE, PHYSICAL ACTIVITIES AND SPORTS. CHECK WHAT YOUR SCHOOL DISTRICT’S POLICIES ARE.

14. NO HEAVY LIFTING which could cause further trauma to the brain REST PERIODS are an important part of recovery as the brain is healing (Gioia & Collins, 2006, pp. 1-2).

15. PROVIDE EXTRA FLUIDS AND SNACKS DURING THE POST CONCUSSION HEALING PHASE, EXTRA GLUSOSE (FROM FOOD SOURCES) AND HYDRATION ARE IMPORTANT TO HELP THE BRAIN TO HEAL (Gioia & Collins, 2006, p. 1)

16. EXPECT MOOD CHANGES MOOD INSTABILITY IS COMMON DURING THE POST CONCUSSION PHASE. IF YOUR STUDENT IS EXHIBITING MOOD CHANGES, THEY MIGHT BE OVER EXERTING THEMSELVES AND NEED A REST PERIOD OR THEY COULD BE EXPERIENCING HEAD ACHES. THIS WOULD BE A GOOD TIME TO CHECK IN WITH THE SCHOOL NURSE, AND REFER THE STUDENT TO THE NURSE FOR FURTHER EVALUATION (Kirkwood, Yeates & Wilson, p. 1360, section 3).

17. REMEMBER THE STUDENT MIGHT EXPERIENCE  DIFFICULTY CONCENTRATING  DELAYED RESPONSE TIME  COULD FATIGUE EASILY  COULD BE EVEN BE EXPERIENCING VISUAL DISTURBANCES ( Gioia & Collins, 2006, p. 1)

18. THE SCHOOL WILL NEED NOTIFICATION FROM THE STUDENT’S DOCTOR AS TO WHAT SPECIFIC ACTIVITIES THE STUDENT CAN RESUME NECESSARY INFORMATION

19. REFERENCES Center for Disease Control and Prevention. (2010, March). Heads Up: Brain Injury in Your Practice. Retrieved from Concussion: http://www.cdc.gov/concussion/HeadsUp/physicians_tool_kit.htmlhttp://www.cdc.gov/concussion/HeadsUp/physicians_tool_kit.html Centers for Disease Control and Prevention. (2010, August). Heads Up to Schools: Know Your Concussion ABCs. Retrieved from Injury Prevention & Control: Traumatic Brain Injury: http://www.cdc.gov/concussion/HeadsUp/schools.html Centers for Disease Control and Prevention. (2010, 08). Injury Prevention & Control: Traumatic Brain Injury. (N. C. Control, Editor, & G. 3. 1600 Clifton Rd. Atlanta, Producer) Retrieved from http://www.cdc.gov/concussion/index.html. Gioia & Collins. (2006). (Ace), Acute concussion Evaluation. Retrieved from Ace Care Plan, School Version: http://www.cdc.gov/concussion/headsup/pdf/ACE_care_plan_school_version_a.pdf Kirkwood, Yeates & Wilson. (2006). Pediatric Sports-Related Concussion: A Review of the Clinical Management of an Oft- Neglected Population. Pediatrics, 117, 1359-1371. Smith, S. (2009, January). Dead athletes' brains show damage from concussions. Retrieved from CNN Health: http://articles.cnn.com/2009-01-26/health/athlete.brains_1_concussions-brain-damage-traumatic- encephalopathy?_s=PM:HEALTH http://articles.cnn.com/2009-01-26/health/athlete.brains_1_concussions-brain-damage-traumatic-