What is a concussion?
A concussion is a type of mild traumatic brain injury (TBI) caused by a forceful blow or jolt to the head that temporarily disrupts how the brain normally works. Usually the signs and symptoms are immediate.
As it relates to concussions in kids, keep in mind:
- A person does not need to be knocked out or lose consciousness to have a concussion.
- At least 80 to 90% of TBIs are concussions.
- Most children and teens recover completely from a concussion within a few days to a few weeks.
- Concussion symptoms often are most problematic in the initial hours or days and gradually improve.
What is a traumatic brain injury (TBI)?
A TBI occurs when an external force causes injury to the brain.
- Mild TBIs are not associated with brain damage, and problems are generally temporary.
- Moderate to severe TBIs often require extended hospitalization and frequently result in brain damage. This can lead to lasting cognitive, academic and psychological problems.
Severity of a brain injury
The majority of TBIs are mild injuries or concussions and generally result in only temporary problems. Severe brain injuries often require extended hospitalization and frequently include damage to the brain.
Symptoms of a concussion
Concussion symptoms vary from kid to kid. For most children these symptoms will be temporary.
Physical concussion symptoms:
- Blurred vision
- Noise or light sensitivity
- Balance difficulties
- Sleep changes
Cognitive concussion symptoms:
- Difficulty sustaining attention
- Difficulty concentrating
- Difficulty following through on tasks
- Difficulty following directions
- Mental "fog"
- Slowed thinking
Behavioral/Emotional concussion symptoms:
- Sadness or anxiety
Is it more than "just" a concussion?
The following could indicate a child suffered a more severe brain injury than a concussion and needs immediate medical attention:
- Significant drowsiness or inability to wake up
- A headache that is especially severe or gets worse
- Weakness, numbness or tingling in arms or legs
- Repeated vomiting
- Slurred speech
- Convulsions or seizures
- Increasing confusion, restlessness or agitation
- Unusual behavior
If you notice any of these behaviors, call 911 or go to the nearest emergency room.
The truth about concussions
Problems caused by concussions don't last long
Most young people recover completely from a concussion, and it can take a couple of days to weeks. Problems can last longer, but this is rare. Persistent problems can be related to the severity of the injury and to non-injury factors like stress.
Students can go back to school even with symptoms
With the involvement of a healthcare provider, along with appropriate monitoring at school, the concussed student may return to school even with some symptoms. Severe symptoms require additional medical follow-up. Keeping a child out of school for a long time often causes unintended academic, social and emotional problems.
Complete rest isn't necessary
In the first few days of recovering from a concussion, it may be helpful to reduce stimulation to help manage symptoms. However, watching TV or texting won't affect recovery. In fact, too much rest often does more harm than good.
Temporary adjustments usually suffice
In the vast majority of cases, students do not need special education services after a concussion. Short-term, informal adjustments for academic support are usually enough.
A Concussion Comeback Plan is a great way to make those adjustments while also allowing kids to return to normal activities following a concussion.
The Concussion Comeback Plan
Create a Concussion Comeback Plan to help your student transition successfully back to school. Every student and concussion are different, so these steps serve as general guidelines. Each student will need a concussion recovery plan tailored to his or her specific needs and circumstances.
Know the basics.
- Symptoms from a concussion are most problematic in the first few hours and days following the injury. These symptoms should gradually improve.
- Right after a concussion, rest and decreased activity can be helpful.
- After the first few days, students can gradually return to daily routines, like going to school. They may need to adjust their schedules to ensure success. There is no harm in reading, writing or completing school work.
- Athletes should only return to play after a concussion under the supervision of a qualified healthcare provider.
FACT: After the first few days, it's important to return to normal daily routines like going to school. If a student is well enough to participate in leisure activities and socialize, then he or she should be well enough to attend school.
Assign a comeback coordinator
Your student's comeback coordinator could be a school nurse, counselor, psychologist, special educator or classroom teacher — someone at school who takes the lead in communicating and partnering with the student, family, school staff, athletic personnel and healthcare providers.
A comeback coordinator:
- Helps gather information. They understand and can discuss the nature of the student's injury, current status and expected recovery course with the student, the student's caregivers and their healthcare team.
- Documents. They will keep a record in the student's school and athletic files for reference.
- Communicates with school personnel. They will convey information verbally and in writing to all relevant school staff, including teachers, administrators and athletic personnel.
- Communicates outside the school. They inform caregivers and involved healthcare personnel of any symptoms, as well as the student's management of school demands, so that involved personnel can support as needed.
Support the student
The educational team is important in providing a "soft landing" when returning to school after a concussion. For students who could benefit from a gradual transition, returning for an hour or two at first may be worthwhile before building up to half days, then full days. The educational team should remain flexible with the student’s schedule and workload expectations while the student is recovering.
The student may also need a variety of school-based supports. These are typically informal and temporary, and can include:
- Excusing the student from classes or activities that require strenuous or risky physical activity, such as physical education and recess, until cleared by medical personnel.
- Having a comeback coordinator meet with the student regularly to monitor school adjustment, assist with communication inside and outside school, coordinate and monitor accommodations and ensure the workload is manageable for the student.
- Providing rest time or breaks during the day. For example, allow the student to go to the healthcare office when experiencing headaches.
- Allowing preferential seating to facilitate close monitoring and focused attention.
- Giving copies of teachers' or peers' notes to the student.
- Providing individualized after-class or after-school follow-up to ensure successful learning.
- Reducing or modifying homework assignments or excusing missed, non-essential assignments.
- Granting additional time for homework, exams and assignments.
- Possibly rescheduling upcoming standardized tests (such as state testing and college entrance exams).
Monitor the student
All involved school staff should carefully monitor the student for potential difficulties in the weeks following a concussion. The comeback coordinator should take responsibility for regularly checking in with classroom teachers and other relevant staff until symptoms have resolved. If any problems are apparent, the comeback coordinator should notify the parents and healthcare team.
In general, school personnel should look for:
- Any change in functioning within the school environment
- A drop in academic performance or grades
- Social or emotional changes
- Unexpected or prolonged absences from school
Know when to consult a healthcare provider
It's rare to see serious complications after a concussion. If they do occur, they're generally apparent within the first few hours or days after the initial injury. However, there are some situations in which you may need to consult with outside healthcare professionals or brain injury specialists:
- Significant problems after a concussion lasting more than two or three weeks
- Uncertainty about which physical or athletic activities are medically safe
- Cognitive or academic problems that appear especially severe
- Student has sustained multiple concussions
- Student has sustained a brain injury that involves an abnormal CT or MRI scan
- Student sustains a moderate or severe TBI
Which specialist to consult will depend upon the nature of the problem and the services available. Ongoing physical problems like headaches or dizziness warrant involvement from a qualified concussion expert. Lasting or severe cognitive or emotional problems warrant involvement from a neuropsychologist.
504 plans for students with concussion
What about students who are slow to recover from a concussion?
A minority of students may display persistent problems after a concussion that could interfere with school performance. A concussion specialist who has expertise in cognition and behavior, such as a neuropsychologist, should evaluate these students to better understand why they are not recovering as expected. Complicating factors such as underlying emotional, social, learning or attention challenges often play a role. These students may require formal accommodations at school, such as those implemented through a 504 Plan.
What is a 504 plan?
A Section 504 Plan is part of the civil rights law that prohibits discrimination against individuals with disabilities. Section 504 formalizes accommodations and modifications to ensure students with disabilities have equal access to a free and appropriate education. A 504 Plan is different than an Individualized Education Program (IEP), a more extensive special education program. IEP and 504 Plans are rarely needed for children recovering from a concussion.
Does every student who has had a concussion need a 504 Plan?
In the rare cases of prolonged post-concussion symptoms, a 504 Plan might be helpful. Prior to implementing a 504 Plan, the student should undergo evaluation by a specialist to understand whether concussion or non-injury factors best explain lingering problems.
To schedule an appointment with the Concussion Program at Children's Hospital Colorado, call 720-777-2806.