Return-to-Learn for Students Who Experience Concussions

The prevalence of vision deficits in the pediatric/young adult concussion population in the private optometric practice setting remains unknown. Thus, a retrospective chart review in this area was conducted in the practice of the first author. Twenty-five consecutive patients with a medical diagnosis of concussion received a comprehensive vision and ocular health examination, which also included an objectively-based Visagraph reading assessment and clinical vergence/accommodative facility testing. Three primary categories of oculomotor-based deficits were found: convergence insufficiency (56%), accommodative insufficiency (76%), and oculomotor-based reading dysfunctions (68-82%). The most common symptom was headaches (84%), with 25% of the symptoms related to reading. 68% (15/22) were categorized as reading at least 2 grade levels below their current school grade level for reading eye movements based on the Visagraph findings. These overall findings are consistent with the general oculomotor-based/reading findings in the concussion/mTBI literature. The present results have important practical ramifications regarding the importance of preconcussion baseline oculomotor and Visagraph testing, as well as post-concussion follow-up testing, to help assess a student’s ability to return-to-learn (RTL).

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Application of Components of the Massachusetts’ Sports Concussion Regulations to All Students With Concussion: A Survey of School Nurses

The Journal of School Nursing ◽

10.1177/1059840518818709 ◽

2018 ◽

Vol 36 (4) ◽

pp. 265-271 ◽

Cited By ~ 1

Author(s):

Holly Hackman ◽

Jonathan Howland ◽

Alyssa Taylor ◽

Linda Brown ◽

Mary Ann Gapinski ◽

...

Keyword(s):

High School ◽

Confidence Interval ◽

Focus Groups ◽

Odds Ratio ◽

School Nurses ◽

Sports Concussion ◽

Medical Clearance ◽

Return To Learn ◽

Two Measures ◽

Academic Implications

Appropriate management by schools of all students with a concussion, regardless of the cause, has not received the same attention as sports-related concussions. Focus groups conducted with Massachusetts School Nurses in 2015 found that some had applied protocols required in the state’s sports concussion regulations to all students with concussion, not just student athletes. We surveyed high school nurses in Massachusetts to examine (1) the extent of this practice and (2) the extent to which protocols for all students with concussion are included in school policies. Of 168 (74%) responding, 94% applied the return-to-learn and play, and medical clearance requirements to all students with concussion, regardless of how or where the concussion occurred and 77% reported their school’s policy required these protocols for all students with concussion. A significant association (odds ratio: 13.3, 95% confidence interval [2.4, 72.8], p <.01) existed between the two measures. These findings have important clinical and academic implications.

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Return to Learn After Sport-Related Concussion: A Survey of Secondary School and Collegiate Athletic Trainers

Journal of Athletic Training ◽

10.4085/1062-6050-234-17 ◽

2018 ◽

Vol 53 (10) ◽

pp. 990-1003 ◽

Cited By ~ 4

Author(s):

Chelsea L. Williamson ◽

Grant E. Norte ◽

Donna K. Broshek ◽

Joseph M. Hart ◽

Jacob E. Resch

Keyword(s):

Secondary School ◽

Online Survey ◽

Current Knowledge ◽

Athletic Trainers ◽

Management Policy ◽

Annual Number ◽

Clinical Practices ◽

Cross Sectional ◽

Return To Learn ◽

National Athletic Trainers Association

Context Recent recommendations have emphasized return-to-learn (RTL) protocols to aid athletes in recovery from sport-related concussion (SRC) but have been based primarily on anecdotal evidence. Objective To investigate the RTL practices of certified athletic trainers (ATs) after an SRC. Design Cross-sectional study. Setting Online survey. Patients or Other Participants A total of 1083 individuals (27%) from a random sample of 4000 ATs in the National Athletic Trainers' Association membership database completed an electronic survey. Participants consisted of 729 self-identified secondary school ATs (SSATs; 67.3%; experience = 14.0 ± 9.7 years) and 354 self-identified collegiate ATs (CATs; 32.7%; experience = 13.4 ± 9.7 years). Main Outcome Measure(s) We used χ2 analyses to assess respondent differences related to current knowledge, current practices, and available resources. Independent t tests were used to compare SSATs and CATs on years of certification and annual number of SRCs evaluated. Results Of our total respondents, 41.2% (n = 446) correctly indicated the absence of evidence-based RTL guidelines. Whereas most (73.9%, n = 800) respondents had an established RTL policy, only 38.1% (n = 413) used such guidelines in their clinical practice. Most (97.1%, n = 708) SSATs and 82.2% (n = 291) of CATs had access to (a) mental health professional(s); however, minorities of SSATs (21.4%, n = 156) and CATs (37.0%, n = 131) never accessed these resources to care for concussed student-athletes. Conclusions Our results suggested that, despite the absence of empirical evidence, most surveyed ATs incorporated some form of RTL protocol in their SRC management policy. The varying AT knowledge, clinical practices, and resources highlighted by our results should be considered when creating or refining an RTL protocol.

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Pilot survey regarding “the green folder” – an educator-designed secondary school return to learn protocol after a sport-related concussion

British Journal of Sports Medicine ◽

10.1136/bjsports-2016-097270.221 ◽

2017 ◽

Vol 51 (11) ◽

pp. A85.3-A86

Author(s):

James D Carson ◽

Aliya Safwan ◽

Sari A Kraft ◽

Nariko Kuwahara ◽

Stefanie E Moser ◽

...

Keyword(s):

Secondary School ◽

Pilot Survey ◽

Return To Learn

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Schoolteachers' and Administrators' Perceptions of Concussion Management and Implementation of Return-to-Learn Guideline

Journal of School Health ◽

10.1111/josh.12687 ◽

2018 ◽

Vol 88 (11) ◽

pp. 813-820 ◽

Cited By ~ 2

Author(s):

Kaitlin E. Romm ◽

Jatin P. Ambegaonkar ◽

Amanda M. Caswell ◽

Candace Parham ◽

Nelson E. Cortes ◽

...

Keyword(s):

Concussion Management ◽

Return To Learn

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A-13 Return-to-Learn: Academic Accommodations for Concussion Recovery

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa036.13 ◽

2020 ◽

Vol 35 (5) ◽

pp. 609-609

Author(s):

B Davis ◽

K Creed ◽

C Keshvnani ◽

D Blueitt ◽

C Garrison

Keyword(s):

Primary Care ◽

Sports Medicine ◽

Care Center ◽

Care Physician ◽

Cognitive Symptoms ◽

Academic Accommodations ◽

School Work ◽

Medicine Physician ◽

Return To Learn ◽

Concussion Recovery

Abstract Objective To evaluate academic accommodations offered to student athletes following a concussive injury. Method Participants were identified during regularly scheduled visits to the participating fellowship-trained, board-certified primary care sports medicine physician (D.B.). A total of 127 participants (mean ± SD age, 14.8 ± 1.5 years [range, 12–18 years]) diagnosed with a concussion from December 2018 to October 2019 were surveyed. The participants were provided a questionnaire in which the following information was collected: age at injury, date of injury, locations of treatment, cognitive symptoms experienced, academic accommodations received, implementation of accommodation by educators, and school related problems. Results Cognitive symptoms were reported by 117 (92.1%) participants with trouble concentrating (81.2%), and feeling “slow” (78.7%) being the most common. Participants treated at the participating, sports-medicine concussion center had the highest rate of receiving academic accommodations (95.3%), while those also treated at an emergency or acute care center, primary care physician, or pediatrician’s office had significantly lower rates (<5%). Participants reported their accommodations as helpful (94.5%), with extra time (88.2%), and ability to take breaks (80.3%) having the highest frequency of recommendation. While symptomatic, 110 (86.6%) participants reported having difficulty completing school work and tests, 58 (45.7%) reported experiencing anxiety about completing their school work, and 55 (43.3%) reported a decline in their grades. Conclusions These data display the high frequency of cognitive symptoms and hindered academic performance associated with concussion recovery. The implementation of academic accommodations was demonstrated to be beneficial; however, not all medical centers are providing accommodations.

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Return to Learn: Academic Effects of Concussion in High School and College Student-Athletes

Frontiers in Pediatrics ◽

10.3389/fped.2020.00057 ◽

2020 ◽

Vol 8 ◽

Cited By ~ 2

Author(s):

Acacia Holmes ◽

Zhongxue Chen ◽

Lilian Yahng ◽

David Fletcher ◽

Keisuke Kawata

Keyword(s):

High School ◽

College Student ◽

Student Athletes ◽

Academic Effects ◽

Return To Learn ◽

College Student Athletes

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A-22 Gender Effects and Self-Reported Symptomatology at Baseline

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa036.22 ◽

2020 ◽

Vol 35 (5) ◽

pp. 618-618

Author(s):

K Horne ◽

M Gilmore ◽

R Bennett ◽

L Lashley

Keyword(s):

Sports Medicine ◽

Statistical Significance ◽

Somatic Symptoms ◽

South Florida ◽

T Test ◽

Gender Effects ◽

Post Injury ◽

Return To Learn ◽

Concussion History ◽

The Relationship

ABSTRACT Objective To examine potential effects of gender on self-reported symptomatology in athletes who did not report a prior concussion history at baseline using ImPACT. Method Participants were selected from an archival de-identified sports medicine ImPACT database. The sample (N = 28,616) consisted of primarily male (58.2%) student athletes in South Florida with a mean age of 15.36 years (SD = 1.332). An exploratory factor analysis performed by Kontos and colleagues (2012) was utilized to categorize ImPACT self-reported symptomatology into four symptom groups: Affective, Sleep, Cognitive, and Vestibular Somatic. An independent samples t-test was conducted to determine the relationship between gender and self-reported symptoms at baseline. Statistical significance was set at p < 0.01. Results The independent samples t-test determined significant differences (p < .001) between gender and self-reported symptomatology regarding cognitive (d = 0.14), affective (d = 0.30), sleep (d = 0.13), and vestibular somatic symptoms (d = 0.17). Descriptive statistics revealed females on average reported more symptoms than males at baseline. Conclusions Findings indicate females are more likely to endorse sleep, emotion, and somatic symptoms in comparison to males at baseline. The results suggest that gender may be a mediating factor in regards to self-reported symptomatology, and should be accounted for when comparing baseline assessments to post-injury. Additionally, these results suggest self-reported symptomatology may be an accurate representation of athlete’s baseline functioning and are not solely related to post injury complications. Going forward, one’s self-reported symptomatology at baseline should be highly considered when clearing athletes for both return to learn and play.

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