S2: Episode 5 - Accommodating a Concussion in the Classroom

 

S2: Episode 5 - Accommodating a concussion in the classroom

Over the last 3-5 years, there has been extensive change in the treatment and support of pediatric concussion. So, what does this mean for our children? How can teachers better support kids with concussions in returning to and succeeding in school?

In this episode of The Sharing Experiences With Concussions/TBI podcast, Ryan Sutton sits down with Stephanie McFarland, an Occupational Therapist at Holland Bloorview Concussion Clinic, to talk about how to effectively accommodate concussions in the classroom. As one of the leading experts in the field of pediatric concussion, Stephanie works with students every day to build strategies for their recovery.

 

We asked teachers and educators across Ontario to submit their questions and experiences regarding concussion support in the classroom. Listen in as Stephanie answers these questions while busting myths and highlighting her best tips and advice for educators on creating accommodations in the classroom. 

 
 

How to listen

 
 
 

Episode Timeline/Highlights:

 

[04:17] Introducing our sponsor, host, expert guest, and the topic of today’s episode.

[09:51] What is the general return-to-school standard for a child with a concussion?

There is now a more active, less rigid approach with return to low-risk activities, or activities that don’t (or aren’t likely to) pose a risk of sustaining a concussion. We want kids to do these sooner rather than later, but without a rigid expectation of being symptom-free. Thus, it’s okay for kids to experience symptoms when they start socializing, engaging the brain, and being active again. Exercise is medicine when it comes to concussions, so the sooner you get active and start exercising the mind, the better you’ll heal. Also, everyone’s different, so we’re starting to realize that students and teachers truly know what’s best for them.

Participate, accommodate, prioritize. That’s what we focus on to get kids back in school.

[14:23] How can teachers accommodate students with concussions when the protocols aren’t modern or current enough?

On average, it takes about 7 years at minimum for evidence to be implemented in the best practice. Things have changed so quickly over the past 3-5 years that some guidelines and protocols in schools haven’t caught up. Covid has also put concussion accommodation on the back burner. Perhaps your school’s language is a bit more rigid, so you want to loosen it in your mind. Kids should be back in school about a week after recovery from a concussion, meaning they’re exposed to the school environment in some capacity. Prolonging the time they’re not in school can prolong their healing process and can increase anxiety. Consider their home environment, consult the guidelines, and listen to your students’ needs. Utilize your skills and use your best judgment.

[19:49] Can you debunk some concussion myths regarding the return-to-learn process?

  • Myth #1: Kids shouldn’t have symptoms while doing low-risk physical, cognitive, or social activities.

    No, they should do things as tolerated. For kids, symptoms can be labeled as green, yellow, or red, based on how well they’re functioning at something, like if a headache is inhibiting their performance. How much their symptoms are impacting their performance determines how much you should accommodate them.

  • Myth #2: Kids needs to completely return to all aspects of school before doing any form of physical activity.

    No! Kids should be fully back to school before competition or sport, but kids often need movement to focus better and have better mental health. Find what level of activity suits your kids/students during their unique recovery process.

  • Myth #3: Concussion accommodation is all about the environment of the school. 

    The Environment is important, but it’s not the only aspect of accommodating students with concussions. What’s more helpful is accommodating the workload. Putting fast-acting accommodations in place eliminates the non-essential workload they missed, enabling them to heal faster and better in the long-run.

  • Myth #4: Use “yes or no” rules to determine which activities are okay for recovering students to do.

    Protocols have yes or no rules which encourage avoidance of certain activities. Just because an activity is uncomfortable or causes a symptom does not mean you should avoid it completely. Do follow the strong no’s, like gym class and sport participation until the student is fully recovered.

[28:39] How do I identify what an individual student can and can’t do while they’re recovering from a concussion? 

It really depends on the student and their circumstances. We always encourage attendance first, but we shouldn’t wait until full attendance before encouraging the students to start learning again. Build up students’ efficacy and confidence by checking things off their to-do list. That makes them feel like they are progressing. 

Focus on learning over outputs. If a student is stuck in their work because they can’t tolerate long work periods, shorten the work periods and figure out what that student needs to learn the material (rather than memorize it). If a student is struggling because they have high performance expectations and are afraid of failure, remove some of the grading expectations initially and build them back in over time. I also encourage you to offer students opportunities to make-up work or tests.

[33:33] How can I address a student that does not reach the minimum requirements to pass my class? 

When we take more active approaches and accommodate kids quickly, we shouldn’t see this problem happen too often. Enforcing strict rules creates this issue. 

If it happens, regardless, treat them like any other kid. Consider if dropping the course and taking it the following summer would benefit the student’s well-being. Is the course a priority that supports their future goals? If it is, highlight all their options. Recognize that the pandemic has been a challenging time for kids and they may not be ready to take the next step in their education.

Note: It is not a good idea to suggest online learning for students with concussions, unless it is their only means of education.

[39:58] What factors impact teachers with students with concussions in a virtual classroom setting? How can they better navigate the virtual learning environment?

Teachers may have more opportunities for breaks (with less social awkwardness), they can use the 20/20/20 rule for eye breaks, support the use of natural light, use paper handouts and practice listening (without screens), and things of that nature. Kids with focus issues prior to brain injury can have a hard time with online learning and sometimes there is an expectation of self-directed learning, which can be super challenging. Recognize when students might need more 1:1 teaching time. 

[44:18] What can students do to accelerate their concussion recovery process?

They might benefit from a deeper understanding of how mood impacts their cognitive functioning. It’s often the stress, uncertainty, lack of confidence, and decreased self-efficacy that is impacting focus and cognition. Thus, students and teachers need to work together to focus their energy on the subjects that are of highest priority and importance while decreasing stress.

Kids can also benefit from doing some exercise before school work, improving sleep hygiene, and decreasing the demands/distractions in their life. These things matter JUST AS much as being productive at school.

[51:13] Mental health is your brain’s immune system.

If we’re making accommodations that are likely to decrease a student’s mental health, it can negatively impact their recovery, too. There are mental health challenges after concussions, but your pre-injury mental health sets the stage for how likely you are to struggle with a concussion (should you sustain one). That’s why it’s even more important to support the mental health of students, regardless of if they’ve been injured or not. 

[55:26] Listen to Stephanie’s response to this teacher’s strategies, including skills testing and IEPs, for students with (non-concussion) brain injuries.

[59:27] Is there a framework teachers can follow in creating an IEP for students with a concussion?

Stephanie suggests leaning on guidelines for accommodations you might implement for kids with anxiety, ADHD, etc, as those are accommodations that help students become more active in their schooling. You have to be willing and flexible to change them week by week.

 

Resources Mentioned:

Connect with us!

 

Facilitator:

 
 

Ryan Sutton

Executive Director, Headsup Concussion Advocacy Network, MA

Ryan Sutton is a passionate leader in the concussion space who co-founded the Headsup Concussion Advocacy Network (HeadsupCAN) in 2020 after sustaining multiple concussions throughout his life. He recently completed his Master’s of Arts in Applied Health Sciences at Brock University where he conducted a Phenomenological research project on the Sport Related Concussion Experience (SRCE). Ryan advises on different committees related to concussion as an active advocate and community representative for those who have experienced a concussion. Outside his work with HeadsupCAN, Ryan works with the Peterborough Family Health Team (PFHT) on a local concussion awareness project called Peterborough Athletics Concussion Awareness (PACA); he also works with Dr. Michael Hutchison on expanding the reach of the digital concussion care platform Rhea which emphasizes an active approach to recovery.

 
 

Expert Guest:

 
 

Stephanie McFarland

Occupational Therapist and Program Manager, Holland Bloorview Concussion Clinic

Stephanie McFarland has extensive experience and expertise in the holistic management of concussion in children, youth and families. Stephanie also has additional experience in inpatient rehabilitation for children and youth with moderate to severe brain injury. She currently manages projects to support hospital wide initiatives amongst clinical programs to Increase accessibility and equity of programs and services for marginalized populations and at-risk families. On top of all this, Stephanie also works as a Clinical Consultant, and consults with local, provincial and national sport/school organizations on the development and implementation sustainable concussion strategy for children/youth, parents, teachers, coaches and staff.

 
 

Episode sponsor

 
 

This episode is sponsored by Thomson Rogers Personal Injury Lawyers.

Learn more about them at www.thomsonrogers.com!

 
 

The Sharing Experiences With Concussions/TBI podcast is made possible by The Headsup Concussion Advocacy Network whose mission is to build collaborative networks and partnerships that work to innovate concussion education, research and awareness. The podcast is also made possible by The Ontario Brain Injury Association whose mission is to enhance the lives of Ontarians living with the effects of acquired brain injury through education, awareness and support. Thank you!

The following podcast may contain sensitive material that could be potentially be distressing or triggering to some people. If you require support, please call the OBIA Helpline at 1-800-263-5404.

 
 
Brain Injury Awareness, Podcast Show NotesRyan SuttonConcussion, schools, teachers, Concussion awareness, concussion education, high school, students, mental health, Brain Injury, acommodations, recoveryComment