CONCUSSIONS: what to know—how to handle (a faculty overview)
In simplified medical terms, concussions are trauma injuries to the head which place the brain in a state of energy crisis: as the brain calls for an increased supply of glucose to promote healing, the nature of the injury has asked the brain to protect itself from further damage by reducing cerebral blood flow, thus compromising the delivery system. (And, concussions are not limited to athletes!)
Diagnosis and treatment, despite ongoing, extensive research is still–primarily—based on rigorous medical assessment and nuanced interpretation of the symptoms. Standardized testing has not, to date, yielded dependable diagnostic or prescriptive data. And, as you probably already know from working with concussed students, the recovery timeline defies prediction and insists on following its own individualized path, making a standardized approach to treatment impossible.
In the experience of our health professionals, eight out of ten cases (approximately), resolve themselves in a seven to ten day period (approximately), but recovery phases are unpredictable and vary widely from one student to the next. What is clear is that during recovery, a student’s ability to think clearly and to keep up with classroom traffic is seriously compromised. The cognitive rest mandated by the Health Center immediately following a concussion can be a significant source of anxiety for our students. Missed class time and their inability to meet academic deadlines create a challenging situation—for them and for you! This is made more complicated by students feeling that they should be able to do more than they can, and the unintended pressure a faculty member might generate because a student appears for class looking significantly better than he/she feels. As you might imagine, the pressure—most often self-imposed—to recommit and re-engage with classroom demands slows the recovery process and often leads to an exacerbation of their concussion symptoms.
Our health professionals are continuing to fine-tune their treatment protocols, but the underlying guidelines to their approach have remained constant:
- Requiring immediate medical assessment and ongoing—often daily—in-person visits to the Health Center.
- Designing a treatment plan which emphasizes a gradual return to academic activities without exacerbating existing symptoms.
- Insisting that students return to full academic function and be asymptomatic before returning to physical activity of any kind, including intercollegiate sports.
- Ameliorating the stress and anxiety that students experience around missed classes and assignments by recommending appropriate short-term academic adjustments and support from professors.
- Coordinating care and follow-up between the Health Center, counseling services, sports medicine (if appropriate), and the Dean’s Office.
Since a concussion is considered a temporary brain injury, treatment rarely involves legally mandated accommodations through our Office of Academic Resources. Instead, temporary academic adjustments are the appropriate response in supporting a student’s needs.
The examples that follow (not intended to be a comprehensive list) may be offered by a faculty member, without further consultation with our office, to a concussed student on an individualized and short-term basis.
- Permission to attend and observe class without active participation
- Extensions on assignments
- Permission to leave class briefly on occasion
- Preferential seating if necessary
- Option of rescheduling exams if multiple exams are scheduled on one day
- Option of rescheduling exams held at night
- Option of written instructions in place of oral instructions
- Extended time on quizzes and exams (up to double time)
- A distraction-reduced exam space
Medical assessment does not determine which academic activities students should try or in what order–only that they should start up gradually and back off their efforts briefly if symptoms worsen. Students’ return to being able to do full academic work most often takes days, but is highly unpredictable and may take weeks or longer. While most students with concussion will need some academic adjustments during recovery, the adjustments will need to be considered on an individual basis. The list provided in this document is by no means exhaustive and students and deans are encouraged to work with faculty as well as health care providers to find creative solutions that support recovery when necessary.
For students with symptoms lasting longer than 2 weeks, further medical management considerations and academic accommodations, rather than academic adjustments, may be needed. At this point, a Dean will be assigned to work with students and their professors to help manage long time considerations in conjunction with G. L. Wallace, Director of Accessible Education.
as of: February 11, 2015