Suggestions For Return To _________

In light of Tracey Meyer’s post about her son and his plight with a concussion, in particular the academic setting, I feel it is a good time to highlight the work of Don and Flo Brady.  Don is part of the National Association of School Psychologists, and with is wife wrote an article about Sport-Related Concussions.

Below is the excerpt about the return to Play from the NASP Communique, Home, School and Social Settings;

Suggestions for Returning to Play, School, Home, and Socializing

The complex, varying, and individual central nervous system response to a brain insult and resultant concussion injury not only justifies but also requires a comprehensive assessment from a readily available and qualified multidisciplinary team of healthcare providers (McKeag, 2003). The utilization of a multidisciplinary team is particularly essential since consequences of a concussion include both neurological and nonneurological effects. Suggested members of this healthcare team may include the following: physician, neurologist, neurosurgeon, psychologist, neuropsychologist, school psychologist, teachers, school administrators, optometrist, ophthalmologist, coaches, athletic trainer, speech pathologist, occupational therapist, and physical therapist. Equally important is the carefully gathered input from close family members and significant others to assist in the concussion assessment and return-to-various-activities decision- making process. In order to fully protect the student-athlete’s health and corresponding safety, return to play, school, home, and socializing risks also need to be comprehensively assessed and thoroughly explained by the team.

Individual accommodations. Physical, cognitive, and emotional caution should be exercised for the injured student. The student component of the student-athlete should be prioritized over the athlete component: The student’s performance within the classroom setting should return to normal before engaging in any athletic related activities. Pressures to prematurely return to and succeed on the athletic field, in school, in part-time employment, and in socializing must be minimized. The amount of energy possessed by the concussed individual for each area of function has been reduced since the injury occurred (Wrightson & Gronwall, 1999). To allow for adequate breaks, a quiet area should be provided in each setting that the student is present. Nurse’s offices are often a hub of activity and overstimulating for the person who requires a low-traffic and tranquil setting. The new 3Rs apply to the essential ingredients of a tranquil setting: Relaxing, Reenergizing, and Refocusing (Returning to adequate focusing). It may even be advisable for the athlete to initially convalesce exclusively within a tranquil and low-stimulation setting at home to effectively obtain physical, cognitive (neurocognitive), and emotional rest.

Adjustments to school program. Suggested school adjustments include an initial meeting and periodic ongoing parent meetings with all teachers and administrators regarding the implications of the concussion on the student and ongoing communication between the school staff and family pertaining to the student’s level of functioning. Reduced course work (and possible withdrawing or taking incompletes from some courses) may be necessary to diminish cognitive demands and potential accompanying emotional stress. Adjusting the number of school days and hours attended each week, participating in less cognitively demanding classes, and putting into place individualized special education accommodations or 504 plans may also be necessary. Overlapping individualized concussion management plans should be written for return to play, school, home, and socializing to provide a consistent approach for the injured and suffering athlete. Furthermore, extensive concussion education is an essential cornerstone of effective concussion management within the school and home settings, and for the suffering student. Counseling formats may also need to be adapted to the presenting symptoms. For example, a shorter than usual session or the use of a low stimulation and/or noise-free counseling room may be necessary due to the reduced ability of the student to sustain attention and concentration.

Social activities. Numerous social activities may also have to be modified or eliminated. Participation in afterschool activities such as dances, house parties, memberships in various organizations, part-time employment, driving an auto or riding a bike, at-home responsibilities, and use of various modern technology such as cell phone talking and texting, computer and videogame use, music volume, and iPod use need to be closely scrutinized and discussed with the injured student. Physical, cognitive, and emotional demands could be excessive within all these various activities. Typical demands of adolescence also need to be revisited and discussed in a gentle manner. The serious implications of alcohol use and other street/recreational drugs after sustaining a concussion need to be shared by parents with their concussed child.

This article has been linked in the “Current Concussion Management” page and on the left under Management Links.  We highly encourage you to take a look a the entire article and see the great work done by the Brady’s.

2 thoughts on “Suggestions For Return To _________

  1. Paul LaDuke, ATC September 21, 2011 / 10:02

    Outstanding information once again Dustin! I forwarded a link to this article to my school nurses who are the frontline defense for my athletes in school. Teachers still don’t understand the implications of an athlete with a concussion and this has become a missing link in our concussion management protocol. Thanks for posting.

  2. Michelle February 13, 2013 / 21:48

    My son sustained 3 concussions from football last year during his freshman year. It was to the point where he couldn’t spell his name or remember things. He has to be out of school for the entire year. He has now improved and is back in school but is struggling. I have met with his teachers and a 504 plan has been put into play (which I don’t feel is enough).

    He spends hours studying at home my husband and I watch him and help him and then his test grade will be failing. This is very discouraging to him as well as us. This is controlling our life because like any parent we want our child to succeed. He stays after school for extra help but his seems to not be enough. He has never been a straight A student but a c or better is his norm. I am in the process on having his 504 plan revised but I am not sure how much the school will revise it enough. I am looking for any advice to help make his high school years sucessful. Please feel free to contact me with any information you may have. Thanks

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