A concussion is a type of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head or body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.

It's important to know that you don't have to lose consciousness to have a concussion. Even what seems like a minor bump can be a serious injury.

Signs Observed by Others (Coaches, Teachers, Parents):

• Appears dazed or stunned

• Is confused about events

• Answers questions slowly

• Forgets instructions

• Repeats questions

• Can't recall events prior to or after the hit, bump, or fall

• Shows changes in mood, behavior, or personality

• Loses consciousness (even briefly)

Symptoms Reported by the Student:

• Thinking/Remembering: Difficulty thinking clearly, feeling "foggy," trouble concentrating or remembering, feeling slowed down.

• Physical: Headache or "pressure" in the head, nausea or vomiting, dizziness or balance problems, blurry or double vision, sensitivity to light or noise, fatigue.

• Emotional: Irritability, sadness, nervousness, more emotional than usual.

• Sleep: Drowsiness, sleeping more or less than usual, trouble falling asleep.

Danger Signs: Seek Immediate Medical Attention

While most concussions are not life-threatening, a student with a head injury should be taken to the emergency department right away if they exhibit any of the following danger signs:

• Headache that gets worse and does not go away

• Repeated vomiting or nausea

• One pupil larger than the other

• Is drowsy or cannot be awakened

• Slurred speech, weakness, numbness, or decreased coordination

• Increased confusion, restlessness, or agitation

• Convulsions or seizures

• Loses consciousness (even briefly)

Concussion management at school is a team effort aimed at ensuring a student's safe and successful recovery. It goes beyond the athletic field and extends into the classroom, focusing on both physical and cognitive rest. 

It is important that any instructions received from a healthcare provider during follow-up appointments be communicated to the school before the student returns the next school day. 

1. Immediate Action: Any student with a suspected concussion is immediately removed from the activity and should not return the same day.

2. Medical Evaluation: Parents are notified, and the student is advised to be evaluated by a healthcare professional. A formal diagnosis and a recovery plan are crucial for guiding the school's response.

3. Return to Learn (RTL) Protocol: This is the academic counterpart to "Return to Play." It is a gradual, step-by-step process that allows students to ease back into schoolwork as their symptoms improve. This often includes:

   • Rest: An initial period (24-48 hours) of physical and cognitive rest is recommended, which may involve staying home from school and limiting screen time, reading, and homework.

   • Accommodations: As the student returns, temporary adjustments are made to their academic workload to prevent symptoms from worsening. These can include:

     • Rest breaks during the school day.

     • Reduced workload or extended time for assignments and tests.

     • Providing class notes to reduce the need for multi-tasking.

     • Allowing students to work in a quiet, low-distraction environment.

4. School Nurse's Role: The school nurse is a central figure in concussion management. They serve as a liaison between the family, healthcare provider, and school staff, monitoring the student's symptoms throughout the school day and ensuring that accommodations are in place and working effectively.

5. Return to Play (RTP) Protocol: Once the student is symptom-free at rest and with full academic load, and has been medically cleared, they can begin a graduated return to physical activity, starting with light aerobic exercise and progressing to full-contact practice only after each step is tolerated without a return of symptoms.

We use a tool called ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). This is a computerized test that measures a student's cognitive skills, such as memory, reaction time, and processing speed.

• Baseline Test: For athletes, a baseline test is often taken before the start of the season. This provides a snapshot of the athlete's healthy brain function. It is administered to each student, every 2 years.

• Post-Injury Test: If an athlete sustains a suspected concussion, they may take a post-injury ImPACT test to compare their current cognitive function to their pre-injury baseline.

For students who have completed a baseline ImPACT test, it is important that they schedule a time with the school nurse to take a post-injury test. This should ideally happen within 72 hours of the injury and before their first medical follow-up appointment. 

Having these results ready to share with their healthcare provider will ensure the most accurate assessment of the injury and help guide their recovery plan. This step is critical for a smooth and effective "Return to Learn" and "Return to Play" process.

Please Note: ImPACT testing is a tool that can aid a healthcare professional in their evaluation; it does not diagnose a concussion on its own. A diagnosis can only be made by a licensed healthcare provider.

Second Impact Syndrome (SIS) is a rare but life-threatening condition. It happens when an individual sustains a second head injury before fully recovering from an initial concussion. This can cause rapid and severe brain swelling, which can be fatal. The brain is especially vulnerable after the first injury, and a second hit, even a small one, can have devastating consequences. When in doubt, sit it out!

CDC HEADS UP: CLICK HERE 

Concussion Alliance: CLICK HERE