Bumps, bruises, cuts, and scrapes are all part of growing up. As parents, we walk the fine line between not wanting to raise “crybabies,” while wanting to keep them safe and healthy. Few things equal the helplessness or watching your child get hurt. But, with today’s competitive school sports environments many parents find themselves cringing on the sidelines as their child crumbles to the turf. Sports injuries are part of life, but a recent study of injuries revealed a substantial number of popular high school sports where the most common injuries are head injuries. These include football, soccer, rugby, baseball, ice hockey, field hockey, lacrosse, horseback riding, and skiing. In fact, concussions represent over 10% of high school athletics injuries. Thankfully, many school sports programs have adopted much more rational and rigorous “concussion protocols.” And, while many of these include a Return to Learn (RTL) component, the response of the academic administration and teachers at most schools is lagging the proactive stance the sports programs are instituting. As a result, many parents find resistance when they seek appropriate accommodations to support their child through the often-lengthy concussion recovery process.
Make no mistake, concussions are much more than just “getting your bell rung.” The cartoon vision of whirling lines, stars, and chirping birds belies the fact that a concussion is a traumatic brain injury (TBI) and can and often will result in serious symptoms that impede a student’s access to the educational curriculum. Common post-concussion symptoms include headaches, nausea, and vomiting, blurred vision, balance problems, dizziness, sensitivity to light, sensitivity to noise, confusion, drowsiness, disorientation, insomnia, feeling “foggy,” memory issues, poor concentration, fatigue, anxiety, irritability, and sadness/depression. The recovery time and presentation of symptoms will vary dramatically from student to student but can be deceptively long. Much like other learning and developmental challenges, concussions are an “invisible” disability and many teachers may balk at providing necessary supports and accommodations for a student that “looks perfectly fine.” As parents, it will fall to you to advocate for the conditions that will allow your child to return to school and be successful. Because the injury and its impact will, hopefully, be transient, concussions often do not qualify as a “condition that substantially limits a major life activity” under section 504 of the Rehabilitation Act of 1983 due to the limited duration of the impact. Nonetheless, the 504 process is something most schools are familiar with and offers an appropriate structure for developing a support plan for a returning athlete suffering from post-concussion symptoms.
Generally, a return to school protocol should cover the four stages of recovery; Initial Physical Recovery, Limited Return w/ Accommodations, Phased in Return to Full Academics w/ Accommodations, and Full Academics w/ Phasing Out of Accommodations. Phase One involves medical care, rest, and rehabilitation (with strict limits on technology usage) until the student is symptom-free for 24 hours. Phase two is return with shortened days and limited classes. Avoiding heavy backpacks, limiting technology use, no physical education (or band, chorus, shop or other loud environments), no tests, shortened homework, extra time, rest breaks, etc. Phase three is the process of working back to full days, and a full class load. During this time those supports that are in place should remain. If symptoms return at any point, the student should revert to the prior phase. Finally, at phase four the student should be back full time and resume normal activities. The student should be encouraged to self-advocate and phase out supports so long as they remain symptom-free. Most challenging may be the social and emotional supports. Despite the well-documented impact of traumatic brain injury on emotional and behavioral health, the student may not accept that what they are feeling is a symptom of their injury. Behavioral and emotional supports should be as unobtrusive as possible, but should not be optional or depend on self-policing.
While concussion recovery may be as quick as 3-4 weeks, supports should be structured based on objective symptoms and not any set timeline. Setbacks should be expected, as should the frustration and possible anger at those setbacks. The student should be encouraged to honestly report symptoms, and not try to “tough it out.” Typical accommodations include:
Physical – Rest, shortened school day, avoid bright lights and loud environments, rest breaks, no heavy packs, no strenuous physical activity
Classroom – Preferential seating; Quiet environment for testing; No multiple exam days; Alternative to reading and screen time (Audio recording lectures/audiobooks); Provide notes, study guides and outlines; Extra time for in-class assignments and tests; Extra or extended breaks; Laptop w/spell and grammar check for notes and assignments; Reduced work quantity; Allow reference books and calculators.
Some schools may oppose the 504 accommodations on the basis it is a temporary condition, but the growing body of scientific evidence is against them.