Communication is one of the most important factors when recovering from a concussion. This not only applies to parents and children, but also to your child’s school, physician, coaches, medical staff and teachers. Without proper communication between all parties affected by the injury, the process of recovery will be frustrating and more time consuming than necessary. This section explains how to speci”cally communicate with the doctor and school when managing a concussion. The methods listed can also apply to other persons or organizations your child is involved 110 Concussed! with. We called upon several experts to explain the need for communication between all parties, and Mark Goldberg put the information together.
Communicating with your doctor
We are now beginning to understand that it is important for a young athlete (or any child, for that matter) who has suffered a concussion be cleared by a medical professional before returning to practice, to play or to school. For most people, the medical professional of choice will be the family physician. As the importance of proper care and management of the injury is becoming top of mind, parents must be able to talk to their family doctor and con”rm they are up to date on concussion management protocols. Although most primary care doctors are familiar with a broad range of medicine, they are not necessarily familiar with concussion treatment. It will take time for this issue to receive significant focus within our medical system. Thus, parents have an important role in “nding quali”ed medical professionals with concussion knowledge. Remember, you as the parent must be convinced that your child’s doctor is educated in the latest methods pertaining to treating young players who have sustained a concussion. Here are some questions you can ask to “test the waters”:
Do you grade concussions?
If the answer is yes, the physician is not current on the latest protocols. The latest recommendations are to no longer grade concussions as mild, moderate or severe.
Do you believe in baseline testing?
Children older than 10 years should have a true baseline that includes cognitive, balance and strength testing.
Are you familiar with the Zurich concussion guidelines?
Released in 2008, the Zurich concussion guidelines have been adopted by the American Academy of Pediatrics and the American College of Sports Medicine, among other groups.
Are you familiar with the Zurich graduated return to play protocol for athletes, and do you routinely follow these guidelines?
This six-step process was designed to ensure that symptoms do not recur as exertion approaches full activity after symptoms have resolved.
Are you familiar with the CDC’s online course for physicians, and have you taken the course?
This course was made available in the fall of 2011. Every physician who is clearing children for return to play should have completed this program.
What sort of criteria do you use to assess concussions?
There are four ways to assess a concussion: symptom score, balance, vestibular function and neurocognitive grade.
Do you recommend cognitive rest in addition to physical rest?
The answer should be yes. We are learning more about how the brain needs true rest to heal itself. This ultimately includes rest from cognitive activity. Once it is determined that the patient is ready for rehab, your doctor should help you “nd the appropriate therapist needed to continue recovery.
Are you comfortable writing academic accommodations for returning to school (if necessary) following a concussion?
Children who have suffered a concussion often need to ease back into the rigors of school in a graduated fashion, rather than being expected to make up all of the missed work and tests after injury.
Communicating with the Teacher
Cognitive rest is as important as physical rest, and the teacher is an integral part of ensuring the student receives the necessary management. Therefore, communication with a teacher is essential. When your child suffers a concussion, notify the teachers right away. This communication is important for two reasons: Teachers must work cooperatively with you, your child, the school nurse, and the team’s athletic trainer to reduce assignments and workload as necessary. Without this cooperation, conflicts between academic expectations are sure to arise if teachers do not understand what’s needed for your child. The following possible accommodations should be discussed with teachers during your child’s recovery:
- Attending school part time
- Having the option to go to the nurse’s office or Quiet
- Room to rest during the school day
- Eating lunch in a quiet area
- Having permission to wear sunglasses inside if bright lights are bothersome
- Reducing the amount of homework
- Giving prepared notes, rather than having the child take notes during class
- Giving assignments in a written format, rather than verbally
- Using step-by-step assignment sheets
- Encouraging the child to use a “study buddy” if needed
With the amount of interaction teachers will have with your child, these professionals can report any symptoms they observe to you, the school nurse and the team’s athletic trainer. A teacher may recognize different behaviors in a student than what the child exhibits on the playing field or at home. The following list of signs and symptoms specific to classroom learning can be passed along to your child’s teacher(s). If they notice any of these symptoms, they should immediately inform the proper parties:
- Poor attention and concentration
- Irritability and low tolerance for frustration
- Difficulties in following directions or answering questions
- Reduced short-term memory recall
- Delayed processing
- Easily distracted
- Inability to follow through with routine assignments
- Disproportional reaction to situations
- Repeating themselves
- Sensitivity to light and/or noise