Concussion Management

A Team Approach to Concussion Management

At Penn Charter we employ a multidisciplinary team approach to management of concussion in our students. Our management team aims to provide smooth transition from injury to returning to academics and athletics. The team includes:

• athletic trainer
• school nurse
• division director
• divisional learning specialist

What is a concussion? 

A concussion is a brain injury caused by a blow or jolt to the head or body that causes the brain to shake. The shaking impairs the function of the brain, and not the structure of the brain. For this reason, a concussion cannot be detected with normal diagnostic testing (X-ray, MRI, CT Scan).

What Happens if Your Child Sustains a Concussion

When your son or daughter sustains a concussion many questions will arise.

• Should we take them to the ER?
• Should they stay in their darkened bedroom?
• Can they go to school the very next day?

At Penn Charter we pride ourselves on a comprehensive, evidence-based concussion management protocol. If your child is diagnosed with a concussion you should expect the following to occur:

Diagnosis

If suspected of a concussion your child will be removed from play and evaluated by the athletic trainer. If a concussion is diagnosed the student-athlete’s parent or guardian will be notified by a member of the school healthcare team. When a student-athlete is diagnosed with a concussion the athletic trainer will notify the school nurse, division heads, athletic directors, and advisors in order to ensure each staff member involved with student’s health and well-being is aware of the current situation.

Treatment

Initial treatment of concussion is rest, both physically and mentally. Physical rest is easy for most adolescents, however, mental, also known, as cognitive rest proves more difficult. Cognitive rest includes minimizing stimuli that requires brain energy to comprehend.

Examples of things to avoid during cognitive rest include:

• Homework
• Cell Phone Use (texting, reading, web browsing)
• Computer Use
• Video Games
• Television

Return to Learn

When a student’s symptoms have subsided, or the student has remained on cognitive rest for a week, the student will begin gradually attending school as symptoms allow. The return to learn process is monitored closely by the school nurses, divisional learning specialists, and the student’s advisors. A detailed synopsis of the return to learn protocol can be found below.

Return to Play

After a student has been attending school and has a plan to make up missed academic work the return to play progression will commence. The return to play progression is a gradual increase in exercise intensity, which will assess the student’s level of healing. Exercising taxes the brain’s blood supply which causes it to work harder in order to function properly. The progression occurs over five days and during each step the student is assessed for and lingering signs or symptoms of concussion. Review an example of the five-day progression below.

Return to Learn

When a student’s symptoms have subsided, or the student has remained on cognitive rest for a week, the student will begin gradually attending school as symptoms allow. The return to learn process is monitored closely by the school nurses, divisional learning specialists, and the student’s advisors. Review a detailed synopsis of the return to learn protocol.

Concussion Information For Parents

A concussion is considered a mild traumatic brain injury (mTBI) caused by a blow or jolt to the head or body that causes the brain to shake inside the skull.  This shaking of the brain can cause a metabolic event producing some serious symptoms. 

The first 24 hours after a concussion are considered a critical healing phase for the brain, since concussions are a considered a metabolic “mismatch” in the brain neurons. The brain needs rest at this time, and the “cognitive rest” guidelines are the prescribed treatment.

PC Concussion Management Team (CMT)

The concussion management team is responsible for transitioning your child’s safe return to the school learning environment and athletic participation.

Debra Foley, RN, CRNP - Coordinator of Health Services/School Nurse (pre-K to 12)
Jessica Rawlings, MS, LAT, ATC - Athletic Trainer (grades 6-12)
Divisional Learning Resource Specialist (grades 6-12)

When can my child return to school?

Each child’s injury is unique and requires careful observation from both parents and your concussion management team. You can promote recovery and prevent ongoing symptoms by following a “return to learn” plan. Academics and school attendance are the first priority. A return to sports is initiated once the child is fully tolerating school and an academic make-up plan is in place.   

Return-To-Learn Plan

Step 1: Home- Total Rest

After a confirmed concussion, your child should remain at home on the  “cognitive rest” guidelines until the symptoms subside or do not increase with light cognitive exertion. 

• Cognitive rest = No homework, no reading, no screen time (including computer/video games), no texting, no noisy environments
• Light cognitive activities can include watching TV, listening to audio books, drawing and cooking. If symptoms increase, cease the activity and rest.
• Graded Symptom Checklist (GSC) - This useful parent tool allows the student to grade symptoms on a discomfort scale of 0-10. The GSC gives specific feedback to parents on your child’s progress.

 Step 2:  Home: Light Cognitive Activity

Once your child’s symptoms have significantly improved, your child may resume some light cognitive activities that do not cause symptoms to get worse. 

• Initially, your child may only tolerate 5-15 minutes of light cognitive work, such as reading. The time of cognitive activity is increased as long as symptoms do not worsen significantly.  
• Once your child can accomplish 2-3 hours of school-specific work at home with breaks without a significant increase in symptoms, they may return to school for a half-day.

Although recovery times can vary, the majority of students will remain at home for no longer than one week.

Step 3: Half Day of School with Accommodations

• Student reports directly to Health Office (D. Foley) for evaluation and management plan.
• Academic accommodations in place to ease transition to school as facilitated by divisional learning resource specialist and D. Foley.
• Missed work is NOT expected to be made up immediately upon return to school.
• Student remains at school unless a significant escalation of symptoms occurs.
• Student may take breaks or rest in health office as needed throughout the day for minor elevation of symptoms.

Step 4: Full Day School with Accommodations

• Symptoms continue to be monitored during school, students may take rest breaks as necessary
• Students may be initially excused from band/chorus and cafeteria as advised by CMT.
• No physical education, intramurals or athletic participation until the Return-To-Play protocol completed and cleared by physician.

 Step 5: Return-To-Play (RTP)

• The RTP protocol is facilitated by the athletic trainer once the student tolerates a full symptom-free day of school and has progressed forward in the academic make-up plan. 
• Students are required by PA state law to be evaluated and cleared by an appropriate medical professional before athletic participation.

Concussion Return to Play Policy

If your child is injured and has been seen by an emergency room technician, doctor or sports injury specialist (or will be out of school or practice for any length of time due to an injury sustained in either a practice, game or an out-of-school athletic activity), a note from that physician is needed to clear the athlete for full participation. If full clearance cannot be granted, all limitations must be listed for proper rehabilitation to take place by the Penn Charter ATCs, if able. Students will not be allowed to participate in athletic activities without a doctor’s note. Under no circumstances will a parental note suffice for return to participation.

• Day 1: Light aerobic activity, such as a light stationary bike ride
• Day 2: Hard aerobic activity, such as a thirty minute interval bike workout
• Day 3: Full body workout, weight room activities or body weight exercises
• Day 4: Non-contact practice and conditioning exercises
• Day 5: Full contact practice If a student suffers concussion symptoms during any of the steps of the return to play progression that step is discontinued and tried the next day, pending resolution of symptoms.