Community of Practice on Traumatic Brain Injury Seventh Meeting - - PowerPoint PPT Presentation

Community of Practice on Traumatic Brain Injury

Seventh Meeting March 5th, 2014

Today’s Agenda

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• Presentation: Community-based Concussion

Management

• Team Update: Nebraska & Return to Learn

Meeting Orientation Slide

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• If you are having any technical problems

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• Type any additional questions or comments

into the Chat box on the left.

Presenter

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• Dr. Karen McAvoy

Director Center for Concussion at the Rocky Mountain Youth Sports Medicine Institute

Concussion Management It Takes a Village

Karen McAvoy, PsyD Center for Concussion

http://www.visualizing.org/visualizations/concussion-laws-state

Second Impact Syndrome (SIS)

center4concussion.com

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http://www.nasponline.org/publications/cq/40/6/return-to-learning.aspx

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Recovery From Concussion

10 20 30 40 50 60 70 80 90 100 1 2 3 4 5 Weeks Post Concussion % Recovered Series1

Collins et al, 2006 Neurosurgery

Seamless System of Communication and Collaboration

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REMOVE/REDUCE

REMOVE from all physical activities!

• No organized sports
• No recreational play
• No PE, dance class
• No physical play at recess

REDUCE home stimulation!

• No texting
• No TV
• No computer screens
• No video games

REDUCE school demands!

• Mental Fatigue
• Slowed Processing Speed
• Difficulty converting memory

into New Learning

Legislation

C O N C U S S I O N

Medical

Fam/ Stud.

Coach ATC Nurse

T I M E (usually between 7 to 21 days)

FAMILY TEAM REDUCE Limit texting. Limit TV, video games, computer time. Limit homework. Limit driving. Keep home from dances, games, the

• mall. Decrease

stimulation. REST! SCHOOL ACADEMIC TEAM Keep home if severely symptomatic. Return to school when symptoms are still present but tolerable. Eliminate work, REDUCE work, adjust work. PACE MENTAL DEMANDS

Symptom Wheel

PHYSICAL

• headache/nausea
• dizziness/balance

problems

• blurred vision/

photophobia

• noise sensitivity
• neck pain

COGNITIVE

Trouble with:

• concentration
• memory issues
• mentally foggy
• slowed processing

Sleep/Energy

• mentally fatigued
• drowsy
• sleeping too much/too

little

• can’t initiate/

maintain sleep

EMOTIONAL

Feeling more:

• emotional
• nervous
• sad
• angry
• irritable

National Association of School Psychologists (NASP) Communiqué by Dr. Karen McAvoy CDE Concussion Management Guidelines (page 13)

Mental Fatigue

 Shortened day if needed – but only for a limited time  Student should be at school to maximize instruction Instruction (input) can’t be replicated. Work (output) can be adjusted!

• “strategic rest breaks”
• 5 to 10 minutes of “eyes closed/head down” per period

 Cutting back homework and in-class work

Reducing # of problems “Auditing” lecture material Oral vs written output

 Sunglasses or earphones to reduce stimuli  Emotional reactions are often signs of mental fatigue

Slowed Processing Speed

Cut back on the amount of work. Go for quality not quantity No tests in the beginning. Eventually, extra time on projects and tests

Tests can tax the brain – effect recovery Tests will not be accurate – not best measure right now

Use of technology for organization and ease (buddy notes, tape recorder, smart pens) Adjust due dates – but do not carry over too much work, it is not possible, it is not reasonable!

Difficulty Learning New Material

Be thoughtful about your teaching. What is most important for the student to know at this time? Focus on comprehension, not memorization Remove, do not postpone work:

REMOVE – consider 25% NEGOTIABLE – alternative project OR

delay – but consider delaying no more than 25%

REQUIRED – consider no more than 25%

Piling up work causes the biggest source of stress and it hampers recovery!

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Recovery From Concussion

10 20 30 40 50 60 70 80 90 100 1 2 3 4 5 Weeks Post Concussion % Recovered Series1

Front Load your interventions … and then taper back

C O N C U S S I O N

Health Care Provider

Coach ATC

T I M E (usually between 7 to 21 days)

100% back to pre- concussion level at home now! 100% back to pre- concussion level at school now!

• 1. Garbage in, garbage out.
• 2. Neurocognitive testing is simply a tool to

measure recovery, it is NOT the treatment.

• 3. Get corroborating data – Teacher Feedback

Form, it prevents “Sandbagging”.

Emergency Department REAP

50 100 150 200 250 300 2010-2011 2011-2012 2012-2013 193 126 163 167 98 Number of Schools Educated Year

Schools Reached with REAP by Year

New Schools Educated with REAP Schools Previous Educated with REAP

To Date: 1693 families Get REAP in ED

• Follow-up call to

parent

• Encourage

follow-up with healthcare provider of their choice

• Follow-up call to

school

• REAP sent to

school is needed

Karen McAvoy, PsyD Center for Concussion 720-979-0840 Karen.McAvoy@HealthONEcares.com

QUESTIONS?

Team Update

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Nebraska: Introduction of Return to Learn Legislation

“To require schools to establish a return to learn protocol for students who have sustained a

• concussion. The return to learn protocol shall

recognize that students who have sustained a concussion and returned to school may need informal or formal accommodations, modifications of curriculum, and monitoring by medical or academic staff until the student is fully recovered"

Thank you for your participation

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