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Wednesday, October 29, 2014

Role of School Staff in the Recovery of Students with Concussions

From Charles P. Fox, Esq.'s
Special Education Law Blog

By Charles P. Fox, Esq.
October 22, 2014

We are hearing a lot about concussions in the news these days. To the recent disbelief of sports commentators and fans, a University of Michigan football coach left a 20-year-old quarterback in a game after a blow to the head despite his stumbling in the field immediately after impact.

Meanwhile, NFL players have regularly been making the news for, to put it delicately, behaving badly. There is speculation that some of the domestic violence in which these players have engaged may be the result of head trauma, a hypothesis deemed plausible by a Univ. of Pennsylvania professor known as a “neuro-criminologist.”

The fact remains, however, that concussions are traumatic brain injuries. Although most patients with concussions are expected to recover fully, young children and teens, because of their developing brains, along with the elderly, are most vulnerable to the effects of concussion. Thus, these children will need careful monitoring as they return to school and other activities.

According to the Centers for Disease Control (CDC), an estimated 248,418 children were treated in emergency rooms in 2009 for sports and recreational-related injuries that included a concussion. A concussion is defined as a bump, blow, or jolt to the head. Concussions are considered a “mild” traumatic brain injury because they are usually not life-threatening. Yet the effects of concussion can be serious and long-lasting with symptoms lasting for days, weeks, or longer.

A study published recently in Radiology showed that even one concussion can structurally change the brain, leading to increased risks of cognitive problems and depression. The most commonly affected areas of the brain include those sites responsible for executive function-- memory, attention, judgment, and higher-order thinking--as well as sites related to depression, anxiety, and post-traumatic stress disorder.

The four categories into which symptoms fall--cognitive; physical; emotional/mood; or sleep related—obviously can affect a student’s ability to learn.

As delineated in a brochure from the CDC on “Returning to School After a Concussion: A Fact Sheet for School Professionals, the effects on learning are vast: increased problems paying attention, memory issues or difficulty learning new material; longer time needed to complete work; difficulty organizing and shifting between tasks; inappropriate or impulsive behavior, difficulty dealing with stress; emotional lability; fatigue; sensitivity to noise and light; and such physical symptoms as headache, nausea, or dizziness.

Yet according to the CDC, these symptoms can be difficult to sort out and may be missed, particularly when the student appears “well.”

Unfortunately, parents may not recognize when their children are having difficulty. A recent symposium on pediatric sports medicine at the American Academy of Pediatrics (AAP) National Conference cites the “misconceptions” parents had regarding concussions.

According to this report, about half of parents whose children were being treated for concussion knew that concussions could cause headaches and difficulties in concentration for their children. Another 92% knew that children needed to stop playing a sport and be evaluated by a physician when a concussion was suspected. However, only 26% of parents were familiar with guidelines for the resumption of sports and school work.

This lack of information can affect the treatment or recovery of a patient. Using a brain that is “concussed” can worsen symptoms or prolong recovery. Cognitive activities can further stress the brain, which is why a balance between cognitive exertion and rest is sought during recovery. An article entitled Returning to Learning Following a Concussion in Pediatrics discusses the need for academic “adjustments” during recovery.

Typically, students will need shortened days, class notes, supplemental tutoring, or reduction of assignments or expectations. Additionally, teachers should consider administering weekly symptom check lists to identify areas that may need more targeted intervention. Students, depending upon their age, can self-rate such symptoms as headaches, pain, dizziness, difficulty concentrating, decreased attention, or memory issues.

Students whose recovery is prolonged past three weeks may well need to be considered for 504 Plans or formal IEPs. Thus, the role of school staff is paramount during recovery from concussion.

Chances are that the most children with concussions had never previously been identified as students with disabilities who required either special education or accommodations. I believe that all children who have had a concussion should go through a screening and be considered as a possible candidate for a case study at an appropriate time post injury. Hopefully these children will be able to recover fully and return to school and other activities without special education or a 504.

But for those students for whom this is not the case, their parents are very likely unfamiliar with the world of special education IEPs or 504 Plans. Thus, the educators, along with parents and the doctors, will need to watch the progress of these students carefully and if warranted, begin more formal evaluations to ensure the delivery of appropriate services.

The previously mentioned CDC Fact Sheet on "Returning to School after a Concussion" may prove invaluable to school staff. School staff have a vital and proactive role in this process.

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