A concussion is a brain injury caused by a blow to the head or body that causes the brain to move rapidly inside the skull, resulting in a physical and/or chemical change to the brain’s neurons, which affects the physical integrity, metabolic activity, or functional ability of nerve cells. A brain injury can affect the way we think, act, and feel. For our students, it can affect their cognitive and behavioral functioning and can be associated with physical symptoms (like headaches, fatigue, light sensitivity), reduce their ability to concentrate and keep track of schedules and assignments, as well as cause them to become easily overwhelmed, emotional, or irritable.
No two brain injuries are exactly the same, so each student presents with different symptoms and length of recovery time. The effects of a brain injury are complex and vary greatly from person to person, depending on factors such as cause, location of injury on the brain, force of injury, and severity of damage to the brain; these varying factors are often difficult to measure at the time of injury and are assessed by presenting symptoms. While concussive injuries may result in a loss of consciousness, many do not. Simple concussions do not show up on CT scans, so it is no longer standard practice to have a scan unless there is concern of a more serious brain injury. Sometimes symptoms of a concussion are obvious at the time of injury, and other times the symptoms become apparent hours or days after the injury when trying to return to normal activity. Most children with a concussion feel better within a couple of weeks; however, some will continue to experience symptoms for a month or longer.
At The Geneva School, we desire to customize our care of students who have sustained a concussion based on their individual needs in order to support them during their recovery, to optimize brain healing, and to encourage a full restoration to health.
The purpose of this protocol is to help our students, parents, teachers, school nurses, administration, and coaches understand and have the same expectations around managing concussions at school to provide continuity of care, both at the time of injury and during recovery.
Injury During the School Day
- Students experiencing an injury that may have caused a brain injury during the school day in class, in PE, or at recess should be escorted to the nurse’s clinic for evaluation by the school nurse. If the student is unable to move, the nurse will be called to the scene. If the student is unresponsive, 911 will be called.
- Our school nurses use their nursing judgement to assess and to care for students who are injured at school.
- If a student experiences a head injury at school and is showing any signs of possible concussion, the school nurse will use the CDC concussion checklist to assess and evaluate the student and keep the student for observation for at least 30 minutes.
- Common signs and symptoms of concussion that may be present at or shortly after the time of injury:
- Trouble concentrating
- Dizziness or decreased balance
- Feeling “in a fog”
- Sensitivity to light or loud noises
- Nausea and/or vomiting
- Ringing in the ears
- Visual disturbances
- Fatigue and/or sleepiness
- Slow to respond to questions/requests
- Vacant stare
- Poor coordination or slurred speech
- Personality change
- Loss of consciousness or impaired conscious state
- If, after 30 minutes of observation and rest, the school nurse is seeing one or more signs and symptoms of concussion based on the CDC concussion checklist or if the student has a headache unrelieved by ice, rest, and pain reliever, a parent/guardian will be contacted by phone about the injury and advised to pick the child up to take home for rest, and possibly referred to a physician if warranted by the symptoms.
- Educational material (CDC Heads Up: Caring for Your Child’s Concussion) will be provided to the parent/guardian to care for their child at home following a possible minor concussion. Care may include rest, sleep, and avoidance of screen time and competitive activity, along with guidance of symptoms to watch for that would warrant taking their child to a physician for further evaluation.
- If a student initially is returned to class because they are not complaining of a headache after observation and rest for 30 minutes in the clinic but then returns to the clinic complaining of a headache, a parent/guardian will be called and advised to pick the child up to take home to rest, provided with educational materials regarding healing from mild concussions, and may be advised to seek further evaluation by a physician if warranted.
- If a student comes to the clinic complaining of headache and reporting an injury that happened outside of school, the school nurse may, based on assessment, contact a parent/guardian to pick the child up to rest at home, provide educational materials regarding healing from mild concussions, and may advise further evaluation by a physician if warranted.
Injury During School-Relate Athletic Practice or Competition
- To help ensure the health and safety of student athletes, our school follows the Florida High School Athletic Association (FHSAA) concussion policy for both immediate care and evaluation for return to play. See the FHSAA website for the full policy.
- Student athletes injured in a school practice or school athletic competition will be evaluated by their coach for a concussion. If the student shows any signs of a concussion, they will be removed from play and must be evaluated by an appropriate health-care provider. They then must follow the FHSAA graduated return-to-play guidelines in the FHSAA policy listed in the link above once they have been cleared to play by their physician.
- All JV and varsity coaches take an online concussion course each year.
- Soccer, basketball, baseball, volleyball, and softball coaches (JV and varsity) use the King-Devick (KD) Test as a concussion assessment tool to get a baseline for their athletes at the beginning of the season.
- JV and varsity coaches (for the sports listed above) are equipped to perform a sideline KD Test at school practices and athletic competitions and compare the current KD Test score with the baseline KD Test score to help evaluate for concussion when a student athlete experiences an injury.
- Student athletes in grades 6-12 are expected to watch a video about concussions, as directed on the FHSAA EL-3 consent form.
Managing Students Returning to School Following a Concussion
- Students experiencing symptoms resulting from a concussion must allow time for their brain to heal. They are encouraged to stay home and rest their brain for a few days from both physical and cognitive activities to optimize brain healing. As they start to feel better, students are encouraged to gradually return to school and non-strenuous activities; but they may need extra support from the school. Depending on the severity of the injury, and the area of the brain that experienced the injury, students may need various accommodations upon return to school. No two concussive injuries are the same, and each student will have different needs for varying amounts of time, based on symptoms they are experiencing (headaches, fatigue, inability to concentrate, inability to organize, inability to remember short-term facts, light sensitivity, noise sensitivity, etc.). We desire to individualize our care of students based on their specific needs to help them fully heal and gradually return to their normal activity, as they are able.
- Helpful accommodations that students may require for a period of time to support their healing include (but are not limited to):
- Gradual return to school (coming for a few hours a day, arriving late and/or leaving early)
- Rest breaks in the nurse’s clinic during the school day due to fatigue or headaches
- Extra time for tests and assignments
- Reduced workload (reduced make-up work, reduced homework and/or assignments, dropping a class/adding a study hall)
- Hallway access (leaving class early, supervision through the hallways, use of elevator)
- Activity restrictions, as specified by physician
- Sunglasses inside for light sensitivity
- Listening in class while having a friend take notes for them, audiotaping classes
- Sitting out of chapel and assemblies for noise sensitivity
- The school nurse is to be notified by a parent/guardian of any student sustaining a concussion by the next school day, regardless of where the injury occurred. Coaches of Geneva sports should also alert the school nurse when an athlete on their team experiences a concussion at practice or in competition.
- Any absence that results from a concussion will be considered an excused absence, similar to other types of illnesses. The student’s parent/guardian must still contact the school receptionist when their child is away from school. If a student exceeds the normally allowed number of absences, the student’s case will be reviewed by the director of the upper school or director of the lower school to determine how best to support the student.
- The school nurse, parent/guardian, and director of the upper school/director of the lower school will work together to form an academic plan and accommodations. This will be communicated to teacher(s), to be followed for a minimum of one week, unless more restrictive guidelines or longer timeframes are ordered by the student’s physician.
- The school nurse will be a liaison to help students and their families communicate with the school staff regarding their needs.
- Parent/guardian will provide the school nurse with copies of the physician’s recommendations from each follow-up visit. These will be filed in the student’s medical records in their cumulative file. The school nurse will then update teacher(s) and administrators of the student’s progress.
Advice to Parents
- When the school nurse sends a child home due to a possible concussion at school or from an injury that occurred the previous day, the nurse will advise parents (based on the CDC Heads Up: Caring for Your Child’s Concussion) to have their child rest at home from physical and mental activity for a few days if they are having any headaches or other symptoms resulting from a concussion. Helpful tips for healing include:
- Encourage a good night’s sleep and frequent naps during the day.
- Encourage activities that are quiet and relaxing.
- Avoid screen time from TV, computers, or phones as visual stimulation slows brain healing. Listening activities, like soft music and audio books, are encouraged.
- Avoid loud music and loud activities.
- Avoid activities that put the child at risk for another injury to the head.
- Avoid activities that require thinking, concentrating, or remembering.
- Concussion symptoms may appear during the normal healing process and will generally improve over time. Most people with a concussion feel better within a few weeks. Some symptoms may appear right away, while other symptoms may not appear for hours or days after the injury. A child may not realize they have some symptoms until they try to do their usual activities. A parent may notice changes before their child does. Symptoms that give rise for concern, or symptoms that get worse, may need immediate care, and the child’s physician should be consulted.
- Eating healthy fats found in nuts and seeds, avocados, wild salmon, eggs, butter, and olive oil along with the antioxidants found in wild blueberries have been shown to help the brain to heal.
- Making adjustments to a child’s activities immediately after a head injury can help them heal and get back to their regular routine more quickly!