Sara is a high school sophomore in a local private school. She is an above-average student and plays on her school’s basketball team, which is currently in second place. She was running down the stairs in her house one morning and fell, hitting the back of her head on the staircase. Her symptoms were not apparent at first, but that night she developed a terrible headache, dizziness and nausea. Her parents noted that these symptoms were indications of a possible concussion and brought her to the doctor, who confirmed the diagnosis. Sara was advised to stay home from school for a couple of days to let her brain rest and then slowly return to school. The doctor gave her a note for school that indicated that she had a concussion and needed accommodations in school until she fully recovered. What is Sara’s school going to do with this information?

Are the administrators and teachers ready to set up a plan for Sara to gradually return to her full academic and athletic participation?

Sara was fortunate—her school already had a Concussion Management Program in place. The designated administrator was notified when Sara’s parents called the school and immediately set up a phone conference to determine Sara’s needs and the accommodations required for her to begin her Return to Learn protocol. The school administrator then communicated in a seamless way with all of Sara’s teachers and the school nurse, setting up the team that Sara needed for full support at this critical time. Sara’s school was aware that a concussion, a mild traumatic brain injury, requires individualized support for a student to recover and they had already established methods of communication and management so that in the case of an injury, students would be set up for targeted, efficient and appropriate help.

Sara and her parents were given information about the process of carefully returning Sara to full academic participation. The team helped them set up appropriate modifications, such as no tests or homework initially and allowance for breaks in the nurse’s office when needed, so that Sara was able to start back to school (or her “Return to Learn”) with confidence.

A concussion is a brain injury, often referred to as a mild traumatic brain injury, which results in a cascade of changes beginning with an energy crisis in the brain. This alters the way the brain functions and results in symptoms. Concussion can be caused by a direct blow to the head or an indirect force that causes a jolt to the body or head. The brain undergoes a rapid acceleration/deceleration or a rotational force depending on the blow that has occurred. Loss of consciousness may occur, but most often does not, which makes it more difficult to recognize when a concussion has been suffered.

A concussion is a serious injury. It is a brain injury, albeit mild, and must be taken seriously and handled properly from the time the injury occurs. While a concussion may mean that a student misses days in school, homework and tests, it does not have to mean risking their GPA or other academic standings. Just as in an ankle sprain or a knee injury, activity must be monitored and accommodations must be made while healing takes place. The school’s Concussion Management Team collaborates with the student, family and medical providers to optimize recovery.

In your child’s school, there is a designated team with a plan to manage any student with a concussive brain injury. One call to the school results in the activation of their system. This will typically include alerting a trained administrator or medical staff person who will start by having a conference with the family and student to assess what the student’s status is and what modifications are needed. There is then communication to the student’s teachers, school nurse and coaches or others involved in the student’s daily school-based activities.

For some schools, a Concussion Management Program will also include baseline testing for their competitive athletes. This consists of a few different assessments to establish the student’s normal baseline functioning. Knowing this information helps medical providers to more accurately and specifically assess a child’s concussion and their progress towards recovery. Many high schools now administer the ImPACT computerized neurocognitive test, as well as some basic balance and oculomotor tests for their athletes. Baseline testing can be easily organized within the school so that parents do not have to make private arrangements. If your school does not offer baseline testing, it can usually be found privately at local facilities.

Concussions are a common injury among school-aged children, especially athletes in contact sports. There is a strong likelihood for every school to have a small percentage of children affected by concussions each year. Concussions are called the invisible injury since there is no change in the appearance of the individual with the injury. This can make it very difficult for a student since their peers and teachers can’t see that they are suffering from symptoms such as headaches, dizziness, fogginess, sensitivity to light or noise or busy environments. Having knowledgeable staff to assist the student can provide critical support during this vulnerable time, diminishing the emotional and psychological impact of the injury, as well as minimizing the student’s recovery time and its impact on their academic, sport and social lives.

A student that has sustained a concussion is unable to perform at his/her usual level in any given area—academics, social involvement, physical activity, homework etc. It is an automatic stressor for students to realize that this injury means taking time from school life and technically falling behind in their subjects. Missing tests, falling behind on homework, not making it to practice—these are all sources of stress to the student. Attempting to return to school life before ready (based on symptom presentation and response to activities) can have serious results such as increasing anxiety, affecting the student’s already disrupted sleep cycles and causing the student to try to push through symptoms to get work done. This is not an injury that will resolve if “pushed through.” Quite the opposite, it has been demonstrated repeatedly that ignoring symptoms prolongs recovery time.

Though rest is required, especially in the acute period after a concussion, after 24-48 hours (depending on symptoms), it has been demonstrated that an active rehabilitation approach is best. This means that gradual integration of typical activities will promote recovery.¹ Schools that have an established Concussion Management Program protect their students by promoting appropriate, supervised and monitored progression while returning to school. By having an established line of communication with the student’s family and with the student’s medical provider, the student has a team to facilitate return to school life. By teaming with all the key players in the student’s life, a safe, individualized plan for recovery is formulated for the student. Consistent messaging with all these team members provides understanding and support, as well as guidance to all involved, allowing the student to feel confident in recovery and potentially avoid secondary symptoms such as anxiety or depression to develop.

So the question for all the parents preparing their kids for back to school, whether it is middle school, high school or college, is this: Does your school have a Concussion Management Program? Is your school ready for back to school?

1. Womble, M.N., Wertz, J.A., Gustman, B., Castor, E. (2016). Acute Management of Concussion: The Role of Regulation versus Rest. ImPACT Research Report: Volume 5.

Danit Macklin PT, DPT has a doctorate degree in physical therapy as well as advanced certification in vestibular and concussion testing and treatment. She has been affiliated with Hackensack University Medical Center for over 10 years in the pediatric physical therapy department where she provides inpatient care in the neonatal and pediatric intensive care units as well as outpatient services.

 She is pleased to now be offering specialized services in concussion and vestibular rehabilitation in a life-span private practice, Balance & Concussion Therapy Center, in Teaneck. Go to mybalancecenter.com for more information.

 By Danit Macklin