• Video: Dealing with concussions.
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You'd never ask a kid who just sprained his ankle to go out and run a mile.
Yet it's common for students who have suffered concussions to be expected to go to school, solve algebraic equations, digest Shakespeare, quantify chemical reactions and bore through hours of homework, stressing and straining an already injured brain.
Nebraska education officials and health advocates are now recognizing the fallacy of such thinking. Just as established guidelines help determine when concussed student athletes can return to the field of play, the state is working on a game plan for how those kids should “return to learn.”
The key is easing concussed students back into the classroom through simple steps, such as breaks in the school day, decreased homework loads or breaking an exam into segments.
“It's an area that's really been overlooked,” said Rusty McKune, a sports medicine educator at the University of Nebraska Medical Center and member of a task force that helped draft a set of state recommendations. “People are realizing you can't just suck it up and sit through math class when your head hurts so much you can't see or think.”
Indeed, those who suffer concussions often struggle with symptoms that can seriously impair their schoolwork, including headache, blurred vision and an inability to concentrate or stay on task.
They can suffer emotional symptoms, too, including irritability, impulsive behavior and decreased motivation.
But kids frequently are asked to take on too much too soon after a concussion, only making matters worse. It often happens after it had previously seemed they were over their symptoms.
“The headaches, the dizziness and difficulty concentrating come back with a vengeance, and academically they do poorly,'' said Dr. Kody Moffatt, a sports medicine specialist at Children's Hospital & Medical Center in Omaha who served on the task force. “They're injured and their brain is impaired.”
Eric Diaz knows that frustration.
When the 15-year-old football player at Omaha's Burke High suffered a concussion this fall, the school had a plan to guide his return to the football field. But there were no plans or accommodations when it came to getting him back into the classroom.
The result was messy — and most likely prolonged his recovery.
Four days after his concussion, he returned to school and a full slate of classes, taxing his brain so badly, his head throbbed. He went home, slept for 16 hours and couldn't go back to school the next day.
Two days after that, he had to take a math test that his injured brain just couldn't handle. He flunked.
“I really didn't think it was fair,'' Eric said.
Eric had the sympathy of Burke athletic trainer Josh Nichter.
“Your brain is on crutches, yet you're being asked to do math problems and read English literature,'' he said.
Most teachers would be more than willing to accommodate such students, Nichter said. But with the large number of classes high school students attend each day, it would take schoolwide buy-in from the principal on down and a workable concussion recovery plan tailored to the student to get everyone on the same page.
Most schools aren't set up to do that right now, he said.
Advocates for brain-injured Nebraskans helped pass a state law in 2011 creating a return-to-sports plan for concussed athletes. But they also realized that the state lacked a return-to-learn process, so they set out last year to change that.
A task force with representatives from the Nebraska Departments of Education and Health and Human Services, the Nebraska Brain Injury Association and others started crafting a set of recommendations for schools, borrowing from similar plans put together by other states and the U.S. Centers for Disease Control and Prevention.
Nebraska's return-to-learn recommendations will call for a collaboration involving school personnel, parents and health care providers.
The mental recovery would begin at home, said Moffatt, who serves on the sports injury advisory board for the American Academy of Pediatrics.
“Cognitive rest'' is the key, with the student immediately after the concussion avoiding homework, reading, video games, texting or other activities that could tax the brain. Some TV could be OK, Moffatt said, as long as the viewing is passive and doesn't exacerbate symptoms.
Only after the student could tolerate mental activities would he return to school.
At school, a concussion management team would be set up, composed of a designated administrator, a parent and the consulting health care professional. Others on the team could include school nurses, school athletic trainers, teachers, coaches or counselors.
The team would assess the student's needs, craft an individual plan and communicate it to teachers.
Every concussion, just like every kid, is different, said Rose Dymacek, a consultant in the special education department of the Nebraska Department of Education.
Some students might need to take breaks during the day in a quiet place or have their day shortened. Many would need a reduced workload, with an emphasis on essential material and quality of work over quantity. Some students may need testing accommodations, such as taking a test in a quiet place or breaking it into parts.
The team would adjust the plan as the student progressed, paring back accommodations until the student was fully reintegrated into the classroom.
If mental exertion led to increases in symptoms, the team might need to step back and increase accommodations.
With a typical concussion, most students should be able to take on a full academic load within one to three weeks, Moffatt said. For some students with severe injuries or a history of concussions, it could take many weeks or months.
In no cases would students return to an athletic activity until they were back to doing regular classroom work, Dymacek said.
The Nebraska Department of Education briefed school administrators and nurses this summer on the working plan. The final recommendations for schools — “Bridging the Gap from Concussion to the Classroom: Return to Learn'' — will be available on the department's website sometime this fall.
Brain-injury support networks already set up within the state's regional educational service units also would assist school districts in implementing the recommendations.
A handful of schools in Nebraska are ahead of the return-to-learn curve.
At Lincoln Southwest High School, head athletic trainer Crystal Kjar became interested in return-to-learn a year ago and worked with administrators to set up a concussion management team in the school.
It meets every Monday, going over which kids are known to have suffered concussions, discussing accommodations and informing teachers.
About half the concussed students end up not receiving accommodations, either because they don't need them or don't want them. But it's always helpful to keep teachers in the loop, Kjar said.
They're able to see firsthand whether a student is struggling — something that could be missed if the teacher is unaware of the concussion.
“When you have a teacher personally go up to them and say, 'We can help you out, but you've got to let me know how you're feeling,' that really puts the kids at ease,'' Kjar said. “They realize they don't have to bust through this.''
Sometimes a teacher notices that a student is struggling and decides that he or she needs to take a break or even go home for the day. Teachers have been cooperative about working with those students to catch up on the studies they miss while out of school, Kjar said.
Kjar doesn't have any doubt that the school's return-to-learn plan has ultimately aided students' concussion recovery and helped them get back to speed in the classroom more quickly.
“It's a lot of work, but it's definitely worth it,'' she said. “We need to support these kids any way we can.''
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