Teachers’ Desk Reference:                     Practical Information for Pennsylvania’s Teachers                           ...
Teachers, school professionals and parents should          •	 Becomes sensitive to light or noise    be alert for any of t...
Sleep Changes                                                needs warrant ongoing adjustments and accom-                 ...
•	 Standardized tests should be avoided during    BrainSTEPS                                                             t...
•	 Provide the student with teacher notes when           •	 Facilitate consistent contact with the family,    notes are pr...
Review    As a classroom teacher, you should be aware of the               •	 Upon return to school, it is critical that t...
COMMONWEALTH OF PENNSYLVANIA                 Tom Corbett                    Governor    DEPARTMENT OF EDUCATION           ...
PA Dept of Education and BrainSTEPS: Concussion Teacher's Desk Reference
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PA Dept of Education and BrainSTEPS: Concussion Teacher's Desk Reference


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PA's BrainSTEPS and PA Department of Education Concussion Teacher's Desk Reference. Fantastic compilation of what schools can do to manage student concussions immediately and follow them through the first 4 weeks of recovery until

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PA Dept of Education and BrainSTEPS: Concussion Teacher's Desk Reference

  1. 1. Teachers’ Desk Reference: Practical Information for Pennsylvania’s Teachers C o n c u s s i o n u ry ) (Mild Tra u m a t i c B ra i n I n j m illion sports- and recreatio n- that almost 4 ions occur every year. erence provid es information ncuss t and related co uring contacThis Te achers’ Desk Ref jury (TBI), specifically Concussion s can occur d s organized sports, ic brain in aabout traumat effects of TBI o na ctivities, such ss. potential noncontact a , or physical education claconcussion , and the emic perform ance. ss ugh avior and acad l play time, rece also occur if there is eno tly student’s beh ters for Diseas e Contro Concussions can body, withou ve t direc ing to the Cen uring the last decade, rce to jolt the o Accord ntion (CDC), d external fo the brain to m is the and Preve sits for sport s- and ead, causing hitting the h e skull. An example of this of emergency department vi ing concussions, th lt lated TBIs, incl ud by rapidly inside y seatbelt restraint as a resu e recreation-re creased db to th adolescents in jolting cause ven an apparent mild hit amon g children and d adolescents are among a car accid ent. E ildren an 60 percent. Ch risk for concussion, and the y very serious. head can be ssion those at great est ry than toms of concu recover from brain inju Sig ns and symp diately or may not take longer to oint during your can show up imme the s. At som ep oncussio ns can occur or days after adult er, it is likely that you C and non- appea r until hours report experi - teaching care t during contact any students ast one studen es, such as injury. M hed mental e nergy, will teach at le d this type of contact activiti encing diminis ively fatigued more ne who has sustai TBI). organized sport s, play becoming co gnit ssed traumatic brain injury (m se the concu mild time, rece ss, or ph ysical easily. This is becau cover. ork hard to re on class. brain has to w ptoms of educati Signs and Sym es of sympto ms Concussion r main categori There are fou ssion: TBI is a ty pe of brain ly followin g concu A concussion/m es the way the brain normal ering g e nd Rememb injury that chan ncussion is derived from th • Thinking a co e works. The term tere, which means, “to shak ncu in’s cells • Physical Latin word co cussion, the bra called wing a con violently.” Follo ges, metabolic chan n,” which • Emotional undergo chemical and f concuss io olic cascade o s • Sleep th e “neurometab rain function. The CDC report al b interrupts norm
  2. 2. Teachers, school professionals and parents should • Becomes sensitive to light or noise be alert for any of the following signs or symptoms • Experiences blurry or double vision that were not present prior to the student hitting or jolting his or her head. The presence of one symptom • Experiences ringing in the ears can signify a concussion. • Does not “feel right” • Experiences numbness or tingling Symptoms Commonly Reported by School Professionals Thinking and Remembering Changes Initial Signs or Symptoms Observed After The student: Trauma to the Head • Feels confused or “foggy” The student: • Mixes up time and/or place • Appears dazed or stunned • Has lower attention or concentration • Can’t recall events prior to the hit, bump, or fall • Is daydreaming more than usual • Can’t recall events after the hit, bump, or fall • Has difficulty completing homework • Loses consciousness (even briefly) • Has difficulty organizing thoughts, words, • Moves clumsily materials • Misunderstands In-class Behaviors • Reacts and responds slowly The student: • Thinks slowly • Exhibits behavior or personality changes • Is forgetful, has difficulty with memory • Answers questions slowly • Has trouble remembering to do things on • Repeats himself/herself time • Is forgetful • Experiences difficulty learning new concepts • Displays confusion about daily schedule, or ideas assignments, environment • Has difficulty making decisions • Is unable to cope with stress or stressful events • Has difficulty planning, starting, doing, and • Is more emotional than usual finishing a task Emotional Changes Symptoms Commonly Reported by the Student The student: • Feels restless or irritable Physical Changes • Is impulsive The student: • Becomes easily upset and/or loses temper • Experiences a headache or “pressure” in the head • Feels sad or depressed • Becomes dizzy or lightheaded • Feels anxious or nervous • Vomits or has nausea • Experiences mood swings • Loses balance, drops things, trips • Feels more stressed than usual • Feels worn out or exhausted, tires easily2
  3. 3. Sleep Changes needs warrant ongoing adjustments and accom- modations, or whether an evaluation should beThe student: conducted by the LEA to determine the need for • Feels drowsy during the day more formal, intensive accommodations and/or modifications. If further formal educational supports • Sleeps less than usual are thought to be necessary, a referral for a multi- • Sleeps more than usual functional evaluation should be made. • Has trouble falling asleep Once the concussed student returns to school, the • Experiences restless sleep LEA should employ academic accommodations to enable the student to remain successful at school. Encouraging the student to “push through” symp-Potential Impact on Class Performance toms, rather than managing symptoms, can prolongConcussions/mTBIs are invisible* injuries that recovery and intensify symptom severity. Over time,suddenly impact a student’s typical thinking, learn- it is crucial to gradually increase a student’s cognitiveing, and behavior. Classroom teachers and school activity while monitoring the student to ensure thatnurses are often the first educational professionals he or she remains below the individual symptomto notice these changes in a student. The symptoms threshold. For example, if the student becomesa student experiences that impact thinking and symptomatic with an increase in cognitive activity,recall, as well as physical and emotional well-being, cognitive activity should be reduced.may impact the student’s academics temporarily,and in some cases permanently. It is important torecognize the signs of concussion and to under-stand how to assist a student’s recovery while atschool by utilizing proper accommodations acrossall settings.The student should be medically evaluated and Annually in Pennsylvania, approximately 4,000 childrenfollow treatment recommended by a physician who sustain moderate to severe traumatic brain injuries,has experience in managing concussions. This treat- which are significant enough to require hospitalization.ment may include remaining at home on total rest Each year, over 20,000 children sustain concussions infor the first several days after concussion occurs. The Pennsylvania. Acquired brain injuries include any injuryrisk of sustaining a second concussion before the to the brain that is sustained after birth, and includes allfirst concussion has healed can have devastating traumatic brain injuries (injury is caused by an externallong-term consequences, such as long-term force and includes concussions) and nontraumatic braindisability. injuries (e.g., strokes, tumors, seizures, aneurysms).The majority of concussions resolve within 4 weeks; Pennsylvania’s BrainSTEPS (Strategies Teaching Educators,however, many symptoms may linger for months Parents, and Students) Brain Injury School Re-Entryor even last a lifetime. If a student does not recover Program has been designed to consult with school teamswithin the typical 4-week trajectory, the student and families in the development and delivery of educa-should be referred to the BrainSTEPS Program for tional services for students who have experienced anylocal educational agency (LEA) assistance with indi- type of acquired brain injury. BrainSTEPS is funded jointlyvidualized accommodation selection, consultation, by the Pennsylvania Department of Health and theand training. If the student continues to remain Pennsylvania Department of Education, Bureau of Specialsymptomatic past 4 to 8 weeks, the LEA should con- Education. BrainSTEPS is implemented through thesider whether the student’s academic or behavioral Brain Injury Association of Pennsylvania to work with tudents who have sustained a new brain injury, as well*Concussed individuals tend to look physically normal; as with students who have been previously identifiedhowever, each person is unique in their recovery and mani- as having a brain injury and who may begin to developfestation of symptoms. It is important to remember one educational effects over the years as the brain maturescannot “see” symptoms such as a headache, fatigue, light and develops.and noise sensitivity. Continued . . . 3
  4. 4. • Standardized tests should be avoided during BrainSTEPS the initial weeks post-concussion, while the continued . . . student is symptomatic. • BrainSTEPS teams are based out of the intermediate • Tests should be delayed if scheduled during units across the state and several large school districts. the initial 1 to 2 week(s) post-concussion. BrainSTEPS consultants are available to provide various • The student should be required to complete brain injury presentations to educational professionals only one test or quiz per day, as tolerated. in Pennsylvania. Training opportunities offered include: • Rest periods in a quiet area may need to be • Student specific brain injury training for added to the student’s daily schedule. district teams • Additional time should be provided for the • LEA in-service training on all student to complete homework and severities of acquired brain injuries and classwork. resulting educational impacts • All assignments should be provided to the • BrainSTEPS consultants provide training and consulta- student in writing. tion to school teams and families pertaining to: • Assignments should focus on essential key • Identification and management of acquired content while student is recovering. Remove brain injury symptoms within the school nonessential classwork/homework. setting, utilizing accommodations and • Assignments should not be repetitious. Once modifications a concept has been mastered, grade the work • School re-entry planning that the student has completed. Fifty percent of the student’s typical workload is often • IEP and 504 development times recommended during recovery (for example, the student would be responsible • Intervention selection and implementation for completing 25 of the 50 math problems • Ongoing monitoring of students assigned). • Provide the student with alternatives to writ- The BrainSTEPS Program: www.brainsteps.net ten output for tests, assignments, projects. • Encourage the student to use word banks, timelines, calculators, and open notes/book. Typical Accommodations Based on Sensitivity to Light, Sensitivity to Noise, and Presenting Symptoms Headaches The following are common concussion accom- • Allow the use of sunglasses or ball caps to modations that should be considered during the shield light. initial weeks of recovery to alleviate cognitive • Seat the student in a dim area of the class- fatigue and facilitate the cognitive rest needed for room, away from windows. recovery. • Allow the use of headphones/earbuds to • The student should be medically managed block noise. by a physician who is experienced in the management of concussions. • Temporarily excuse the student from loud classes (e.g., music, shop, band). • The student should not participate in physi- cal education, sports, or physical activity • Provide a quiet environment for the student during recess until the student is medically to eat lunch (e.g., nurse’s office, guidance cleared. office). • Mental work should never be substituted for • Give the student prior notice for a fire drill, physical activity (such as during physical edu- tornado drill, etc. cation or recess).4
  5. 5. • Provide the student with teacher notes when • Facilitate consistent contact with the family, notes are presented using Power Point, a pro- student, teachers and physician during jector, or a SmartBoard. recovery.Dizziness • Make a referral to the BrainSTEPS Program if a student is 4 weeks post-concussion and • Allow the student extra time to get to class is still experiencing symptoms or if the before the halls become busy. student’s classroom performance and/or • Ask a peer to walk with the student. attendance has been impacted. Referrals to BrainSTEPS can be made earlier if a student • Have a peer carry the student’s books to and has a concussion that is not progressively from class. resolving during the first several weeks, or if • Allow the student to use the elevator, the student has a history of any of the follow- if available. ing “concussion modifiers”: • Provide the student with teacher notes to pre- • Past concussion(s) vent up and down shifting of the student’s • Migraine headaches eyes; and, have the student follow along with a highlighter for key concept recognition. • Depression or other mental health issuesFatigue • Attention deficit hyperactivity disorder (ADHD) • Build strategic rest breaks into the student’s schedule, not just as needed. Provide a 5 to • A learning disability 10 minute break every 30 to 45 minutes, • Sleep disorders initially, to alleviate fatigue. Allow the student to put his or her head down on desk or rest How to Make a BrainSTEPS Student Referral his or her eyes. for Consultation and Training • The student may initially require a half-day The BrainSTEPS Program works with students modified schedule in the morning or after- who have sustained any severity of acquired brain noon, dependent upon the level of fatigue. injury. Students can be referred to the BrainSTEPS Program at any point until graduation, if the injury • The student may only be able to attend is causing educational impacts by following these school for 1 to 2 core classes or 1 to 2 specials steps: initially. 1. Go to the BrainSTEPS website:The Local Educational Agency’s Role in www.brainsteps.netStudent Recovery 2. Click on “Make a Student Referral” link on • Ensure that teachers have a solid understand- the top right side of the page. ing of how concussions impact classroom performance. BrainSTEPS consultants 3. A document will open. Choose the correct are available to conduct LEA training and BrainSTEPS Team in your region by student-specific training. county. • Establish an LEA response to concussion 4. Call or email the appropriate team leader by adopting the BrainSTEPS Returning to make a student referral. to School After Concussion: Recommended Protocol and establishing a Concussion Management Team with the assistance of the regional BrainSTEPS team. • Allow the student to use accommodations to alleviate cognitive fatigue and facilitate cognitive rest, so the brain can heal. 5
  6. 6. Review As a classroom teacher, you should be aware of the • Upon return to school, it is critical that the basic facts about concussions and mTBIs, as well as student focus on new learning and not the physical, cognitive, and emotional signs that missed work, due to the potential for pro- may become apparent in a student who has sus- longing recovery by inducing cognitive tained a concussion/mTBI: fatigue. • All concussions are serious. • Prior conditions such as attention dis- orders, learning disorders, and emotional • Concussions can occur without directly disorders tend to become exacerbated by hitting the head. a concussion. • Chemical and metabolic changes occur in the • Be aware that many students with lingering brain during a concussion, interfering with concussion symptoms may develop symp- normal brain activity. toms of depression and/or anxiety. • Most concussions (90 percent) occur without • Pushing through concussion symptoms such loss of consciousness. as headache and fatigue can prolong recov- • Concussions are not like short-term illnesses ery and increase symptom severity. (e.g., the flu). Initially, if a student is home for • The Pennsylvania Department of Education, a period of time following concussion, it is to Bureau of Special Education, in conjunction ensure that total rest occurs. No cognitive with the BrainSTEPS Program, has created activity such as television, texting, video a step-by-step Returning to School After games, studying, homework or reading Concussion: Recommended Protocol, which should occur. During this acute period of is available to assist LEAs in Pennsylvania. total rest, teachers should not send missed work home. • Expecting a student with a concussion to complete typical school work and homework can result in a significant increase in symp- toms and delay the recovery process. Cognitive overload causes cognitive fatigue. Information included in this Teachers’ Desk Reference was adapted from published work by the U.S. Department of Health and Human Services: Centers for Disease Control and Prevention. www.cdc.gov/concussion/ HeadsUp/schools.html For further BrainSTEPS Program information or to discuss setting up a Concussion Management Team supported by BrainSTEPS within your district, please contact: Brenda Eagan Brown, M.S.Ed., CBIS Brain Injury School Re-Entry Program Coordinator Brain Injury Association of Pennsylvania eaganbrown@biapa.org (724) 944-65426
  7. 7. COMMONWEALTH OF PENNSYLVANIA Tom Corbett Governor DEPARTMENT OF EDUCATION Ronald J. Tomalis Secretary Carolyn C. Dumaresq, Ed.D. Deputy Secretary,Office of Elementary and Secondary Education John J. Tommasini Director, Bureau of Special Education Patricia HozellaAssistant Director, Bureau of Special Education For more information, visit the PaTTAN website at www.pattan.net or simply scan the QR code with a smartphone. Vol. 4 No.1 1/13