Transcript Concussion Management Protocol at CH

Concussion Management Protocol
to Support Recovery of CH Students
How Common is Traumatic Brain
Injury in Children in Pennsylvania?
Each year, approximately
25,975
children in Pennsylvania sustain a
concussion /traumatic brain injury
Source: The Brain Injury Association of Pennsylvania
A Child’s Brain…
• Under-developed
• Unlike other organs, the brain needs time &
experience to mature.
• Easily injured
• New abilities build on ESTABLISHED skills over
time
• Does not “bounce back” after injury
3 Things to Consider:
1. Children, unlike adults take LONGER TO
RECOVER from concussions
2. Post Concussion Syndrome
(past 7-10 days)
3. Second Impact Syndrome
(when brain has not healed)
“When in Doubt, Sit Them Out”!
• Physically and MENTALLY!
March 2013 Article: “Rest is Best”
• Stress on athletes and students not to
disappoint (attendance, grades, playing-time).
• “You break your arm, you put it in a cast and
don’t use it. You hurt your brain, you can’t
stop using it.”
• Delay recovery time
• Quicker recovery = Complete Rest
What’s Happening?
Following CONCUSSION there are actual
PHYSICAL, METABOLIC, &
CHEMICAL CHANGES
that may take place in the brain
When Should Students Return to School?
 Should be Symptom Free at REST & during
PHYSICAL EXERTION! (exertion added gradually)
 AT LEAST 7-10 days during which time they
experience No Symptoms
Getting A-Head of Concussion
P. Hossler and R. Savage (2006)
Commonly Recommended After Concussion
1. Restricted Physical Activities: recess, physical education
2. Academic Accommodations:
Untimed, open book, take home, and/or shortened tests
Reduce class work and homework by 50%; shorten tests & projects
(reduce 50 problems to 25 problems; 4 pages to 2 pages)
Frequent breaks from class when experiencing symptoms (e.g., go to
nurse, put head down on desk)
Extended time on homework, projects
Full days of school as tolerated
Half days of school as tolerated
(Pardini, Fazio, Taylor. 2008)
Concussion Management Team (CMT)
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Student
Parent / Guardian / Family
Coach, Athletic Trainer, Athletic Director
Physician, School Physician
School Psychologist
School Nurse
Guidance Counselor, Teachers, Support Staff
Administration
BrainSTEPS
Responsibilities Cont.
Student
• RECOVER !
• To clearly and honestly communicate their
symptoms, academic difficulties and feelings
• To carry out any assigned recommendations by
other team members to the best of their ability
Responsibilities of the Individual
CMT Team Members?
Parent/Guardian
• To submit all physician notes and instructions to
the school (nurse) in a timely manner
• To help the student maintain adherence to any
medical and/or academic recommendations
given to promote recovery
Athletic Trainer : To evaluate possible injuries and
make referrals communicate with school staff for
student-athletes. To monitor symptoms and help
coordinate and supervise a student-athlete’s safe
return to play
Athletic Director: To oversee the athletic
department’s concussion management plan,
including but not limited to: equipment
management, policies, coach/athlete/parent
education, etc.
School CMT Team First Contact
School Nurse
• Communicate injury / symptoms
to school personnel
• To monitor in-school symptoms and health status
changes
• To help determine if it is appropriate for the
student to be in school or if the student needs
any health-related accommodations
School CMT Members
Teacher(s)
• To help the student get the best education
possible given the circumstances and to follow
recommended academic accommodations
Guidance Counselor
• To help create (as needed) and disseminate
academic accommodations to the student’s
teachers
Coach/Physical Education Teacher: To recognize
concussion symptoms and remove a potentially
injured player from practice or competition. To
receive communication from health care providers,
parent/guardian and school about readiness to
return to play. To communicate with the school
about the student’s progress
School Psychologist : To be the consultant for
prolonged or complicated cases where long-term
accommodations or more extensive assessment and
educational plans may be necessary
Administrator: To direct and oversee the
management plan and trouble shoot
problems. To help create a change in the
culture of the school regarding the
implementation of programs, supports and
policies
Academic Concussion / TBI
Management Process at Cambria Heights:
Step 1: Concussion Reported
• Injury reported to CML (leader) as soon as
possible.
• At the beginning of school year, CML should be
identified to teachers, coaches, parents and
administrators so the responsible adults know
who to report injuries to.
• Anyone in the school community who suspects a
concussion should contact the CML right away so
the student can be referred for proper evaluation.
Step 2: Contact Student and Family
• Meet with student upon return to school.
• The CML should explain his/her role as the
central communicator to both the student and
the family and provide contact information for
questions or concerns.
• The CML should also briefly explain the steps in
the management process so the student and
family know what to expect.
Step 3: Assess Medical Needs.
• Has student see physician or athletic trainer?
Documentation? Assess symptoms and make
attendance decision.
• The CML or ML will determine if the student has
been evaluated by an athletic trainer or physician,
and if the student has documentation from the
provider concerning school/activity restrictions and
accommodations.
• If no recommendations are available from the
medical provider, the CML or ML should assess
symptoms to determine if the student will benefit
from being in school or if attendance is likely to be
counterproductive.
Symptom Log
• If symptoms are significant or severe, the
student may need to be sent home.
• If symptoms are manageable and not
becoming significantly worse by attending
school, the student may continue to step 4.
Step 4: Assess Academic Needs
• Consideration of general accommodations
supplied by health care provider (if available).
If there are academic recommendations from
the health care provider, the CML or AL should
specify those general recommendations.
• If no recommendations are available, the CML
or AL should assess the student’s academic
needs.
Step 5: Distribute Accommodations
• Distribute accommodations / strategies to
teachers & other relevant staff in writing.
• Contact family (and if applicable, coach and
athletic trainer) with relevant academic/
medical updates and plan, as needed.
• Document as required.
Handout Packet: Examples
• Teacher @ Staff Notification Letter with
Accommodations and Resources
• CH Student Transition Plan Following Injury
• Academic Monitoring Tool for Teachers
• Symptom Log Example
• Teacher Follow Up Letter
• Teacher Resolution Letter
Step 6: Determine Re-assessment
• Gain feedback from each team. Decide when
to re-assess medical and academic needs.
• Identify appropriate timeframe for reassessment of needs, and using feedback from
teams, re-start process at step 3 or 4.
Re-assess Medical and/or Academic Needs When…
• New physician documentation arrives
dictating a new course of action
• Symptoms have changed (and therefore the
prior assessment needs to be altered)
• Symptoms have resolved and are no longer a
barrier to school participation or attendance
• Teachers or parents identify problems in
current plan that are not being adequately
addressed
Questions?