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IN THE SPOTLIGHT
Concussion Management: Are You Best Serving Your Injured Student?
By Jared Maisel 24-Apr-19
When you have a student with an orthopedic injury, you and your institution provide appropriate accommodation, right? Take, for example, a student with an ankle sprain or a broken arm; your school would provide assistance, correct? Of course, the student would be provided with an elevator pass, crutches, wheelchair, a buddy to carry their backpack, an excuse from PE class. Then why wouldn’t an educational institution provide academic accommodation for a brain injury? Concussions have gained increased notoriety in media, sports, and academia over the last 10 to 20 years. This is for good reason. Researchers have found a correlation in risk for neurological disorders with chronic blows to the head and concussion mismanagement. There is a neurometabolic cascade that occurs following a traumatic blow to the head, causing a concussion. The brain’s cellular processes and functions must normalize back to equilibrium. Our student population is even more susceptible to these types of dangers than are professional athletes. Children and adolescents have an increased risk of head injury complications because their physical and neurological development is not fully complete. “Second Impact Syndrome” is an acute and catastrophic condition. This occurs when an initial concussion has been sustained and the young patient returns to athletics before the issue has fully resolved. The patient then takes a second blow and instantly expires or suffers severe and permanent neurological disability. This second impact is usually reported as observably minimal or caused by an apparently insignificant amount of force—just enough to “jolt” the head. Another concussion complication is known as “Post-Concussion Syndrome.” This arises when a patient returns too quickly to physically exertive and cognitively demanding activities. The patients ignore their concussion-related symptoms, sometimes due to internal or external pressures. The student and family may also be misinformed about head injuries or simply misdiagnosed. The symptoms then become more profound in intensity and extended in duration. Typically, the average concussion symptomology resolves in about seven to 10 days. With Post-Concussion Syndrome, however, the symptoms may be prolonged for weeks, months, or even years. Academic accommodation is a critical component of a student’s recovery following a concussion. During this time, the brain must rest to fully recover. It is recommended that the student be allowed a period of physical and cognitive rest following a concussion until the associated symptoms significantly improve. Unfortunately, there is no diagnostic test or imaging to conclusively “visualize” a concussion. The majority of the diagnosis is based off of physical examination and subjective reporting, occasionally with additional neuropsychological testing, if available. When I moved abroad in 2014, I found the lack of awareness of concussion management in the international athletics and school communities most disconcerting. Research over the past two decades has concluded the myriad dangers to individuals in head injury mismanagement. As a Certified Athletic Trainer (ATC), I am a healthcare professional specializing in the evaluation, treatment, management, and rehabilitation of the physically active. You can find ATCs working with athletes in clinics, hospitals, performing arts, professional sports, universities, and high schools. It’s becoming more common to find ATCs in the international school setting. I recently concluded four years of service as the inaugural ATC of Concordia International School Shanghai. In addition to providing high-quality and cost-efficient care to students and staff, ATCs can have a comprehensive and beneficial impact in an international school community. This may include: wellness coordination, teaching IB sport science or PE class, serving as a strength and conditioning coach, working as a member of the health office staff, and serving in other various capacities. Even if your organization does not employ an ATC or have a concussion management policy in place, there are a few simple steps teachers, administrators, coaches, and athletic directors can take to safeguard children. Identification: • Provide basic concussion awareness education to the entire school community. • Report changes in behavior or concussion-like symptoms following a head injury to school nurse (i.e. headache, dizziness, light headedness, nausea, fatigue, difficulty in concentrating/memory, blurred vision, balance problems). Management after diagnosis or suspicion: • Provide flexibility and accommodation on student assessments and assignments. • Monitor how the student is feeling once back at school following a concussion. • Report any changes in behavior or academic performance to school nurse, counselor, and parent. • Be aware of student’s entire workload in other classes to provide reasonable accommodation. • Collaborate with teacher and counselor colleagues to modify student assessments and assignments. There are many free resources available to international schools in the interest of better educating their community on concussion pathology and management. I have selected and organized a number of these on my resources webpage (https://www.goodpracticellc.com/resources). Institutions that provide students with the opportunity to participate in sports should understand the risks inherent in these activities. We should be reasonably prepared to manage and handle all injuries that are “part of the game.”
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