Information About Concussion for School Staff

The following step-by-step considerations are intended to assist school personnel in developing temporary educational support plans for school-aged children and adolescents who have sustained concussions.

Step-by-Step Considerations for School Personnel

Step 1.  Understand Concussion in General

A concussion is a mild injury to the brain that temporarily changes how the brain normally works. It is usually caused by a sudden blow or jolt to the head, although children often bump or hit their heads without getting concussions. Signs and symptoms of a concussion include dizziness, headache, vomiting, confusion, acting dazed, forgetting what happened before or after the injury, and being “knocked out.” A person does NOT need to be knocked out or lose consciousness to have had a concussion. Other words or terms for a concussion include mild traumatic brain injury (mild TBI) and mild closed-head injury.

Step 2.  Identify a School Liaison Person to Communicate About the Student’s Concussion in Particular

At school, a concussion liaison person should be identified to coordinate communication among parents, classroom teachers, and healthcare providers. The liaison person could be a school nurse, counselor, psychologist, special educator, or the classroom teacher. When school personnel hear that a student sustained a concussion, the liaison person should:

a. Obtain information

• discuss the nature of the student’s injury, current status, and expected recovery course with the student’s parents and primary medical team
• find out when the student will be allowed to return to school and what initial supports will be needed within the school environment
• ask the medical team when the student will be allowed to return to Physical Education activities and sports (medical guidelines recommend that students NOT participate in risky physical activities while they remain “symptomatic” – which means physical, thinking, or behavioral changes caused by the concussion are still seen) 

b. Document information

• document the information in the student’s school record for later reference

c. Deliver information

• convey the information orally and in writing to all relevant school staff including teachers, administrators, and athletic personnel

Step 3.  Monitor the Student

Most young people will recover completely from a single concussion within two weeks. But, some students take longer to recover than others. Having all involved school staff carefully monitor a student for potential difficulties in the weeks after a concussion is very important. The liaison person should take responsibility for regularly checking in with classroom teachers and other relevant staff until problems are resolved or, if no problems are initially seen, for several weeks after the injury.

a. In general, school personnel should look out for: 

• any change in functioning within the school environment
• unexpected absences from school
• parent described problems at home

b. School personnel should also monitor the student more specifically for common postconcussive symptoms (PCS), including: 

Physical

• Headaches
• Sick to stomach or vomiting
• Dizziness or balance problems
• Low energy or being run down
• Trouble with vision/seeing
• Bothered by light or noise
• Sleeping problems

Thinking (Cognitive)

• Slowed thinking
• Trouble paying attention
• Difficulty remembering
• Acting like "in a fog"
• Easily confused
• School performance worsens

Behavioral or Emotional

• Irritability or grouchiness
• Easily upset or frustrated
• Nervousness
• Sadness
• Acting without thinking
• Any other personality change

Step 4.  Support the Student as Needed

If any problems are apparent, there are a number of ways school personnel can be helpful. One of the most important is to make sure the student and parents have spoken directly with their healthcare team and understand the nature and implications of the injury. The provision of appropriate information, reassurance, and advice after a concussion has proven quite beneficial. School personnel can also be supportive by minimizing academic demands and remaining flexible until the student is recovered fully.

A variety of other school-based supports might also be needed in the post-injury period. These supports can often be instituted informally. However, if problems are severe or lasting, support could be more appropriately formalized through a Section 504 Plan or Individualized Education Program (IEP), for which a referral to the special education team might be necessary. Because students’ responses to concussion will differ to some extent, a student-specific plan will be required. The following are potentially appropriate supports:

a. Possible general supports

• Re-integration into school occurs gradually (e.g., student returns part-time before building up to a full schedule)
• Student not asked to do all missed work, and extra help given to get student caught back up
• Extra check-in meetings provided with teacher
• Rest time or breaks provided during the day
• Overall homework and class work load reduced
• Cognitively demanding in-school tasks reduced (e.g., no more than one test each day)

b. Possible specific classroom-based supports

• Tests put off until recovery complete
• Extra time given to complete tests
• Flexibility allowed for assignment due dates
• Preferential seating provided to allow for closer teacher monitoring and decreased distractions
• Access to a model peer’s or teacher’s notes allowed

Step 5.  Refer to Healthcare Specialists as Needed

Serious complications after a concussion are rare and are generally seen within the first few days after injury. Problems warranting IMMEDIATE medical attention include a severe or progressive headache, repeated vomiting, extreme drowsiness, confusion, trouble walking or talking, or any other sudden change in the student’s thinking or behavior.

There are a number of more common situations when school personnel should consider involving medical or concussion specialists, if they are not already involved. The appropriate specialist will depend upon the nature of the problem and the services available in the community. Ongoing physical problems (e.g., headaches, dizziness) require physician involvement. In the face of lasting or significant cognitive, academic, or behavioral changes, consultation with a pediatric neuropsychologist can be helpful. If available, a multidisciplinary pediatric brain injury program is apt to be able to provide proper evaluation and treatment. In general, situations that should trigger consideration of a specialty referral include:

• problems after a concussion last more than two weeks
• cognitive or academic problems appear especially severe
• a student has sustained multiple concussions
• a student sustains a more serious brain injury (e.g., a “moderate” or “severe” TBI)