Alan Kulberg, MD, medical director of the BMC Concussion Evaluation and Rehabilitation Clinic, has worked with members of the Massachusetts Brain Injury Association to develop an educational program about concussions for educators in Berkshire County as well as helping each school create a Concussion Management Team (CMT) which will help injured students return to the learning process in a safe, comfortable manner when they return to school after their concussion.
Description of the process
Consider the following: • A 17-year-old male “A+” student tries to read a passage in a book but after three tries gives up; they are “just words” he says
• A 15-year-old female develops an incapacitating, throbbing pain in both temples after doing computer work for only 10 minutes
• An 8-year-old boy was tackled playing football and landed on his head. That night he had a migraine headache and vomited multiple times. Five days later he still could not read more than 5-10 minutes without getting a headache and feeling fatigued
These are common scenarios involving students who have sustained a concussion. These students are hurting, they are struggling, and without accommodations that recognize their challenges, they will not thrive and their symptoms will worsen.
For students re-entering school after a concussion, incorporating a school-based concussion management team (CMT) is considered a best practice method of monitoring the students and adapting the accommodations to their changing needs, as well as promoting frequent dialogue between concerned parties.
Through careful and frequent monitoring, the school’s CMT will help ensure that teachers and other staff follow the return-to-school plan to help the student reach optimal recovery in a way that is comfortable for the student and will not exacerbate existing symptoms. If a student has been evaluated and treated at the Berkshire Medical Center Concussion Evaluation and Rehabilitation Clinic, he/she will return to school with a set of suggested accommodations like those found in the attached document titled Return to School: Post-Concussion Academic & Physical Modifications. The accommodations will address academics, attendance and physical activity.
A school’s CMT will typically comprise of three people: the principal or vice principal (Administration), the school nurse (the Symptom Monitor) and a staff member familiar with the student, such as a guidance counselor (the Academic Monitor). The Concussion Management Team should meet weekly for the first few weeks upon a student reentering school, initially inviting the student and family to be present. Subsequent CMT meetings may include an athletic coach and/or P.E. teacher.
A student’s concussion will be a “moving target” for the first few weeks of recovery and he/she may experience a wide range of symptoms that change week to week. Post-concussion monitoring tools are available to track a student’s symptoms and academic progress. Symptoms and academics should be reviewed once per week by members of the CMT, including athletic staff as needed.
The symptom monitoring tool for school nurses and the symptom monitoring tool for students are designed to rate the severity of 22 common post-concussion symptoms. It is recommended that symptoms be checked two times per week for the first two weeks after school re-entry and weekly after that, and that the school nurse/Symptom Monitor choose different times of the day to meet with the student to better understand the student’s fatigue levels throughout the day. Often symptoms are worse later in the day. The student will fill out the symptom monitoring tool for students and the school nurse/Symptom Monitor will record responses on the symptom monitoring tool for school nurses to be faxed to the student’s physician. The academic monitoring tool is for the teacher(s) to fill out weekly and for the designated Academic Monitor to collect. The Academic Monitor will review academic progress and discuss findings with other CMT members weekly.
The symptom and academic reports should be faxed weekly to the Berkshire Medical Center Concussion Evaluation and Rehabilitation Clinic at 413-445-7089 or to the student’s physician if other than the BMC clinic. Based on the feedback from the school’s Concussion Management Team, the physician may alert the school to a change in suggested accommodations. Eventually the accommodations should ease as the concussion resolves, however, in some cases it may be necessary for a formal 504 Plan or IEP to be developed to continue accommodations. The mission of the Berkshire Brain Injury Collaborative is to help schools make autonomous, fluid and flexible decisions for students by eventually building capacity through education and experience.
The Concussion Management Team is an essential component of the broader team that manages a student, which also includes parents and medical and rehabilitation professionals. The school-based concussion team is positioned to make sure the suggested accommodations are appropriate to the student’s needs during a very fluid period of recovery.
The ultimate objective of using these tools and protocols is to help the student achieve optimal recovery by helping all parties involved understand the nature of any ongoing challenges that student may face.