Concussion in the Schools

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Concussion in the Schools

• Larry Lewandowski, Ph.D.
• ljlewand_at_syr.edu
• Syracuse University
• Paper presented at ISPA
• Athens, Greece July 16, 2005

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Concussion?

• Who knows about concussion?
• Most of us have little to no formal training on
  Concussion
• Not addressed in School Psychology
• Not part of Continuing Ed
• More common than autism, Down Syndrome, CP, deaf,
  blind, etc., yet

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The Numbers

• Each year, approximately 1.5 million people in
  the US sustain a traumatic brain injury (TBI)
• 80 of all TBIs are mild (concussion)
• 24-84 suffer from PCS 3 months from injury
• 300,000 sports-related concussions
• Risk of TBI is 3 times greater after one injury,
  and 8 times greater after two

Estimates are hampered by diagnostic problems
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Importance for School Psychologists?

• Symptoms affect school personal well-being
  
• Personality irritability, self esteem
• Cognitive attention,memory, stamina
• Physical headache, nausea, sleepy
• Screening, Monitoring, Management
• Students may need modifications accommodations

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What is a Concussion ?

• Concussion Is a mild traumatic brain injury
  that occurs when a blow or jolt to the head
  disrupts the normal functioning of the brain.
  Some people lose consciousness after a
  concussion, but others may be just dazed.
• seeing stars. . .dinged. . .getting your bell
  rung
• Induced by blow to head or body abrupt momentum
  shift
• usually normal CT scan
• LOC?, amnesia?,neurologic symptoms?, altered
  state?

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Primary Mechanisms of Injury

• Head trauma causes. . .
• the brain to shake, twist, and strike the inside
  of the skull
• sudden chemical changes
• stretching and tearing of brain cells

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Diffuse Axonal Injury
Axons are the wires that connect one brain cell
to another
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• Emotionality
• Feeling more emotional
• Sadness
• Nervousness
• Irritability

THE MANY FACES OF CONCUSSION

• Somatic Symptoms
• Visual Problems
• Dizziness
• Balance Difficulties
• Headaches
• Light Sensitivity
• Nausea

• Cognitive Symptoms
• Memory dysfunction
• Fogginess
• Fatigue
• Cognitive slowing
• Attention Problems

• Sleep Disturbance
• Difficulty falling asleep
• Sleeping less than usual

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Natural Recovery

• 80 of persons with mild TBI will recover
  completely, but this can take days, weeks or
  months
• Up to 18 months or longer before maximum recovery
  is reached
• Recovery is faster in the beginning and slows
  down over time
• Little is known about recovery in children

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When symptoms turn into a Syndrome

• A group of physical, cognitive, and emotional
  problems that can persist for days, weeks,
  months, or indefinitely after a mild traumatic
  brain injury
• DSM-IV definition for Post Concussional Disorder
• an acquired impairment in cognitive
  functioning, accompanied by specific
  neurobehavioral symptoms, that occurs as a
  consequence of closed head injury of sufficient
  severity to produce a significant cerebral
  concussion.

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Concussion in the Classroom

• How might the symptoms of concussion affect a
  students academic performance?
• What can we do to help the student who is
  struggling in school while recovering from a
  concussion?

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Symptoms with School Implications

• Mental stamina fatigue
• Poor concentration attention
• Easily overloaded/overwhelmed
• Memory language loss
• Disorganization Homework
• Slow processing speed Cant multi-task
• Irritability Hyper-emotional Relationships

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Assessment Issues

• Because academic achievement scores do not
  adequately characterize the academic difficulties
  that youth with TBI experience in the classroom
  setting, it is important to expand assessment of
  academic skills to include a broader range of
  academic variables. -Ewing-Cobbs et al,
  (2004)
• Students symptoms will range in type and severity
• IQ scores and academic achievement scores are not
  sensitive to mTBI
• Neuropsychological evaluation is necessary

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Neuropsychological Testing
MANOVA plt.000000 (ImPACT Test Battery)
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Diagnosis Management

• Classifications
• TBI ?
• OHI? ADHD?
• 504 plan for transient symptoms (7-10 days)
• IEP may be necessary if symptoms are severe
  and/or persistent

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Services Accommodations

• Out of school- home tutoring
• Preferential seating
• Numerous rest breaks or naps
• Resource room assistance
• Intensive one-on-one tutoring
• Reduced work load
• Counseling
• Provided notes, advance organizers
• Modify monitor homework

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Monitoring

• Case coordinator role
• Home-school communication
• Class modifications accommodations
• Ongoing assessment via (ImPact, CogStat,
  Headminders, etc.)
• Self-esteem, social interactions,
  extra-curricular activity

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School Psychologist Functions

• Become knowledgeable on concussion/TBI
• Develop baseline testing program for athletes
• Ongoing assessment of concussed students
• Consultation with teachers parents
• Input on intervention, 504 or IEP plans
• Counseling re social/personality issues
• Referrals to other specialists (PT, OT, Med)