David Hayward began thinking differently about his job the day the parents of a student-athlete at Highland High School in Gilbert, Ariz., expressed frustration to him about their son's lack of academic progress while recovering from a concussion.
(photo by Bob Hubner)David Hayward began thinking differently about his job the day the parents of a student-athlete at Highland High School in Gilbert, Ariz., expressed frustration to him about their son's lack of academic progress while recovering from a concussion.
"They had some justification, and it made me gather more information from medical professionals and activate a different process about how we handle concussions," says Hayward, Highland's full-time certified athletic trainer. "In the past, we were so focused on return to play that we really didn't think about whether a student-athlete with a concussion could take a test. There is a connection between academics and athletics, and we needed to create a community environment to foster that."
Hayward implemented a process that involves the school nurse, who meets with a concussed student-athlete the day he or she returns to school - and sometimes for additional days afterward - to check for symptoms. The nurse also is responsible for informing teachers of the injury and alerting them to the possibility that a given student might require temporary academic accommodations, which could include modified assignments, extra time for tests and permission to have a friend take notes in class.
"The process has improved communication between athletics and academics," Hayward says. "Now, teachers are aware of what student-athletes are dealing with, and they are more apt to provide accommodations because they understand what's going on."
That kind of cross-pollination is crucial in an era when concussions have become an every-game occurrence in some sports, says Tamara Valovich McLeod, professor of athletic training at A.T. Still University in Mesa, Ariz., and a certified athletic trainer.
"There is a lack of communication," she says. "There seems to be this dichotomy between the quote-unquote athletic side of the school - the AD, the coach, the athlete and the athletic trainer - and the academic side, which are the teachers and school administrators. A concussion can have a more far-reaching effect than whether or not an athlete is going to play in the Friday night football game, and we need to step back and take a look at that. We started hearing from athletic trainers in Arizona that they were seeing things anecdotally after a concussion, including kids hanging out with a different crowd and fighting with their parents. With some of these athletes who are having prolonged symptoms, there are definitely psychosocial, family and academic issues that need to be addressed. There really is not a lot of published research out there looking at how sport concussions affect school activities."
So McLeod decided to conduct some research of her own. Using grant money provided by the National Operating Committee on Standards for Athletic Equipment, she and her team evaluated 143 concussed high school student-athletes from Arizona and found that 29 of them were absent from school because of the injury. Additionally, 12 of them needed academic accommodations, and 11 both missed school time and required accommodations upon their return.
One of McLeod's students also surveyed 850 certified athletic trainers representing every state and discovered that 44 percent of all concussions they treated required some type of academic accommodation. "It may be the simplest thing - like allowing a soccer player with sensitivity to light to wear sunglasses in the classroom - but unfortunately, there has been resistance from some schools," she says. "I think now that the concussion issue is bigger and we're trying to look at its impact on school life, some of that resistance might start to fade."
McLeod also evaluated concussed student-athletes who self-reported altered social interactions, unusual school behaviors and disturbed sleep patterns. Patients who still experienced symptoms after 10 days were interviewed, as was at least one of their parents, and common themes that emerged included social isolation, desire to minimize and even mask symptoms, and sudden emotional and personality changes.
"The majority of concussions resolve within about two weeks, and many athletes don't necessarily have difficulty reintegrating back into school," McLeod says, although concussions tend to psychologically impact their victims more than other types of injuries. "Maybe they just miss a couple days or postpone a test. It's the athletes with prolonged symptoms that last beyond the second week who have these quality-of-life issues and need accommodations in the classroom. It's a larger subset of concussion victims than I would want to see, but it's not all of them."
Efforts like those undertaken by Hayward at Highland High to help teachers and other administrators better understand the mental and intellectual effects of concussions appear to still be few and far between. That said, "Brain 101: The Concussion Playbook," a free online tool developed by the Oregon Center for Applied Science (now known simply as ORCAS), is designed to educate school administrators and teachers about injury basics and the importance of allowing for academic accommodations. Similarly, the U.S. Centers for Disease Control created "Heads Up to Schools: Know Your ABCs," an online version of its popular and free "Heads Up" prevention, recognition and response program, designed specifically for principals, teachers and school nurses.
Last fall, the Minnesota Department of Health began tracking concussions at 42 high schools to help determine how they affect academic performance. "We have heard stories of students who lost scholarships because their grades went down," Lori Glover of Fairview Health Services' Institute for Athletic Medicine in Minneapolis told the Minneapolis Star Tribune in October. "Students and parents sometimes don't understand that could be because of their concussion, and instead of struggling through it, they need to reach out for help."
Fairview's institute provides certified athletic training services to area high schools, and those trainers input such information as when a concussed student-athlete returns to both the classroom and the playing field, as well as monitor whether academic problems occur.
Getting administrators on both the athletic and academic sides to cooperate isn't always easy. "We found a couple of cases in Arizona where the certified athletic trainer had never met the school nurse, and the school nurse didn't know what an athletic trainer was," McLeod says. "Finally, at one school, they met and had lunch. It was just a very bizarre situation, because you would think that everyone would know who everyone else is within a school building, but that's not the case."
"To be honest with you, when we first started, we had resistance from the nurses," Hayward adds. "They didn't want to see an athlete unless they had already been seen by a doctor, because they didn't want to be a part of any evaluation. Then, later on, I got an email from the district nurse, who thought what we are doing is unbelievably great. So there was a learning curve for the nurses, too."
Things move much more smoothly at Highland now. "A lot of times, athletes are hesitant to speak to their teachers and let them know they have a problem," Hayward says. "I think that may be because they're afraid the teachers won't believe them or think the athlete is whining or lying. With this approach, I just want athletes to know they have an open communication line to their teachers."
