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Shepherd HA, Yeates KO, Reed N, Caron JG, Schneider KJ, Emery CA, Black AM. Academic Accommodations for Middle and High School Students Following a Concussion: Perspectives of Teachers and School Administrators. THE JOURNAL OF SCHOOL HEALTH 2023; 93:1099-1110. [PMID: 37386759 DOI: 10.1111/josh.13360] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND An estimated 1 in 5 adolescents have sustained a concussion in North America. Teachers and school administrators are responsible for implementing academic accommodations and other supports for optimal return to learn following a concussion. The primary objective of this study was to describe the prevalence and feasibility of providing academic accommodations to students following concussion from the perspectives of middle and high school teachers and school administrators. METHODS A cross-sectional survey was administered to teachers and school administrators (grades 7-12) across Canada online via REDCap. Participants were recruited via word-of-mouth and social media sampling. Survey responses were analyzed descriptively using proportions. RESULTS The survey was completed by 180 educators (138 teachers and 41 school administrators), of whom 86% had previously provided academic accommodations to students following concussion, and 96% agreed that students should have access to accommodations following concussion. Some accommodations (eg, breaks, extra time) were provided more often and were more feasible to provide than others (eg, no new learning, reduced bright light). Educators reported limited preparation time and limited school personnel support to assist students following concussion. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY The most feasible accommodations should be prioritized, ensuring students are supported within the school environment. CONCLUSIONS Teachers and school administrators confirmed the importance of providing accommodations to students following concussion.
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Affiliation(s)
- Heather A Shepherd
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Keith O Yeates
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Jeffrey G Caron
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montreal, Canada
- Center for Interdisciplinary Research in Rehabilitation, Montreal, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Evidence Sport and Spine, Calgary, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Amanda M Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
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Hess CW, Howland J, Hackman H, Campbell JK, Vannoy S, Hayden L. Implementation of Concussion Management Policies in High Schools: The Critical Role of School Nurses. J Sch Nurs 2023:10598405231160249. [PMID: 36916285 DOI: 10.1177/10598405231160249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Evidence-based practices in concussion management (CM) have been codified into legislation. However, legislation is varied, and implementation is narrowly evaluated. School nurses hold a unique position to assess the implementation of health policies. The implementation of concussion management policies across Massachusetts high schools was evaluated by the school nurse. A cross-sectional survey was sent to school nurses (N = 304), and responses (n = 201; 68.1% response rate) were tallied whereby higher scores indicated more practices being implemented. One open-text question was included to encourage nurses to provide context regarding implementation in their school. Descriptive statistics and thematic analysis were used to assess current implementation and nursing perspectives. Findings indicate that the degree of implementation varies, and some nurses reported difficulty with mobilizing clinical uptake of concussion management practices in their schools. Further implementation research is needed, and school nurses are an important stakeholder to include when assessing the clinical uptake of concussion management policies in schools.
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Affiliation(s)
- Courtney W Hess
- Counseling & School Psychology, 14708University of Massachusetts Boston, Boston, MA, USA
| | - Jonathan Howland
- Emergency Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.,1836Boston Medical Center, Boston, MA, USA
| | - Holly Hackman
- Emergency Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.,1836Boston Medical Center, Boston, MA, USA
| | - Julia K Campbell
- Health Behavior, 2331University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Steven Vannoy
- Counseling & School Psychology, 14708University of Massachusetts Boston, Boston, MA, USA
| | - Laura Hayden
- Counseling & School Psychology, 14708University of Massachusetts Boston, Boston, MA, USA
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Quick BL, Glowacki EM, Kriss LA, Hartman DE. Raising Concussion Awareness among Amateur Athletes: An Examination of the Centers for Disease Control and Prevention's (CDC) Heads Up Campaign. HEALTH COMMUNICATION 2023; 38:298-309. [PMID: 34289773 DOI: 10.1080/10410236.2021.1950295] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Attention to concussion prevention and management has grown in recent years due to the potentially long-term, debilitating effects a head injury can have on an individual. Although multiple campaigns have been designed to target this issue, there remains a need to evaluate the persuasive principles used to advocate for safety measures and protocols, specifically within youth sports. With this in mind, we applied the health belief model (HBM) in our content analysis of the Centers for Disease Control and Prevention's (CDC) Heads Up concussion awareness campaign. Campaign videos (N = 35) were coded for threat severity, threat susceptibility, benefits, barriers, self-efficacy, and cues to action. The majority of videos communicated the seriousness of concussions and attempts to communicate concussion susceptibility were driven by personal stories, rather than facts and statistics demonstrating concussion prevalence. Less than half of the videos communicated the benefits of following concussion protocols and only a third of the messages described barriers to following recommended protocols. The majority of videos aimed to elevate self-efficacy among athletes and parents, but not coaches, by focusing on identifying symptoms and concussion avoidance. The implications for concussion prevention and management among athletes, parents, and coaches are discussed.
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Affiliation(s)
- Brian L Quick
- Department of Communication, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign
| | - Elizabeth M Glowacki
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University
| | - Lauren A Kriss
- School of Journalism and Mass Communication at the University of Wisconsin-Madison
| | - Daniel E Hartman
- Department of Communication, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign
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Bevilacqua ZW, Cothran D, Rettke D, Koceja D, Nelson-Laird T, Kawata K. Return to Learn: Preferences of College Educators When Receiving Concussion Medical Notes. Neurotrauma Rep 2022; 3:185-189. [PMID: 35558728 PMCID: PMC9080999 DOI: 10.1089/neur.2022.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of this work is to uncover the preferences and perspectives of college educators as they interpret medical documentation outlining medically requested return-to-learn (RTL) instructions. Participants were recruited from five colleges across campus at a large Midwest public university. They each engaged in a private, one-on-one, audio-recorded interview. All recordings were transcribed and inductively analyzed using a grounded theory approach and two-coder system. All codes and themes were finalized once agreement was reached by both coders. Resultant themes from axial coding had to represent the voices of at least 80% of participants. Three characteristics emerged as being desired by college educators: brevity, clarity, and direction. Educators also expressed considerably less utility with medical documentation designed for pediatric students with concussion. College educators desire medical notes that are brief, clear, and provide straightforward direction, in addition to documentation that is tailored for the college setting.
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Affiliation(s)
- Zachary W. Bevilacqua
- Department of Exercise Science, Wegmans School of Health and Nutrition, Rochester Institute of Technology, Rochester, New York, USA
- Department of Kinesiology, School of Public Health, School of Education, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Donetta Cothran
- Department of Kinesiology, School of Public Health, School of Education, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Devin Rettke
- Department of Kinesiology, School of Public Health, School of Education, Indiana University Bloomington, Bloomington, Indiana, USA
| | - David Koceja
- Department of Kinesiology, School of Public Health, School of Education, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Thomas Nelson-Laird
- Department of Postsecondary Research, School of Education, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health, School of Education, Indiana University Bloomington, Bloomington, Indiana, USA
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Waltzman D, Daugherty J, Sarmiento K, Haarbauer-Krupa J, Campbell H, Ferrell D. Prevalence of Suspected Concussions Among K-12 Students in Utah: Findings From Utah's Student Injury Reporting System. THE JOURNAL OF SCHOOL HEALTH 2022; 92:241-251. [PMID: 34927246 PMCID: PMC8831567 DOI: 10.1111/josh.13126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/02/2021] [Accepted: 06/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND To inform prevention strategies, this study provides incidence, factors, and actions taken when a suspected concussion occurred in K-12 schools in Utah. METHODS Data were collected using Utah's Student Injury Reporting System (SIRS) from the academic years 2011-2012 to 2018-2019. SIRS is a unique online system that tracks injuries that occur in the school setting among K-12 students in Utah. Descriptive statistics were computed to characterize students with a suspected concussion. Chi-square (χ2 ) analysis looking at characteristics by school level was also conducted. RESULTS Over 63,000 K-12 students in Utah sustained an injury at school during the study period. Suspected concussions comprised 10% of all injuries. The prevalence of concussions was highest among males (60.6%) and elementary school students (42.6%) and most often occurred outdoors (57.6%) or on a playground/playfield (33.9%), and in sports- and recreation-related activities (75.1%) (specifically contact sports, 24.0%). Most students with a suspected concussion were absent 1 day or less from school (71.4%) but about 68% were seen by a medical professional. Further, there were differences by school level. Females and students playing contact sports had a higher percentage of suspected concussions as school level increased, whereas males and concussions sustained during school hours had a lower percentage of suspected concussions as school level increased. CONCLUSIONS SIRS enables schools in Utah to identify groups at risk for concussion, as well as activities most commonly associated with these injuries, within the school environment. Using this information, schools may implement targeted prevention strategies to protect students.
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Affiliation(s)
- Dana Waltzman
- Division of Injury Prevention, National Center for Injury Prevention & Control, Centers for Disease Control & Prevention, 4770 Buford Highway, Mail Stop: F62, Atlanta, GA, 30341
| | - Jill Daugherty
- Division of Injury Prevention, National Center for Injury Prevention & Control, Centers for Disease Control & Prevention, 4770 Buford Highway, Chamblee Campus, Bldg. 106/9110.17, Atlanta, GA, 30341
| | - Kelly Sarmiento
- Division of Injury Prevention, National Center for Injury Prevention & Control, Centers for Disease Control & Prevention, 4770 Buford Highway, Mail Stop: F62, Atlanta, GA, 30341
| | - Juliet Haarbauer-Krupa
- Traumatic Brain Injury Team, Applied Sciences Branch Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE | MS S106-9, Atlanta, GA, 30341
| | - Hillary Campbell
- Violence and Injury Prevention Program, Utah Department of Health, Salt Lake City, UT
| | - Deanna Ferrell
- Violence and Injury Prevention Program (VIPP), Utah Department of Health, 288 North 1460 West, PO Box 142106, Salt Lake City, UT, 84114-2106
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Pike Lacy AM, Eason CM, Stearns RL, Casa DJ. Secondary School Administrators' Knowledge and Perceptions of the Athletic Training Profession, Part II: Specific Considerations for Principals. J Athl Train 2021; 56:1029-1036. [PMID: 33150372 DOI: 10.4085/55-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Secondary school administrators fulfill many leadership roles, including creating and implementing policies to help ensure the safety of athletic programs. However, few researchers have examined principals' awareness and perceptions of the athletic trainer's (AT's) role. OBJECTIVE To explore secondary school principals' knowledge of the roles and responsibilities of ATs and perceptions of athletic training. DESIGN Concurrent mixed-methods study. SETTING Cross-sectional online questionnaire. PATIENTS OR OTHER PARTICIPANTS Principals (n = 686; age = 48.1 ± 7.8 years, time in position = 7.1 ± 5.8 years) represented public secondary schools across the United States. MAIN OUTCOME MEASURE(S) The web-based questionnaire was composed of demographics, various quantitative items assessing knowledge and perceived value of ATs, and open-ended questions. Descriptive statistics summarized demographic data. Select quantitative measures are reported as count responses and overall percentages. Responses to open-ended questions were analyzed inductively. RESULTS We obtained a 5% response rate (686 of 13 517). Approximately 93% (n = 637) of responding principals considered an AT to be a trusted source of medical information. The most frequently selected skills they believed ATs were qualified to perform were injury prevention (99.1%), first aid/wound care (96.5%), and therapeutic intervention (91.4%). Sixty-three percent (n = 430) of participants considered an AT to be extremely valuable to student-athlete health and safety. Our results indicated that secondary school principals had a vague understanding of AT "training" and appreciated the immediacy of care ATs could provide. They also appeared to use decentralized hiring practices. CONCLUSIONS Secondary school principals identified ATs as a trusted source of medical information and recognized the role ATs played in the immediate care of athletic-related injuries. However, principals had a limited understanding of the qualifications and educational requirements of ATs. Future professional advocacy efforts targeting this stakeholder group should highlight all medical services an AT provides and emphasize the AT's value in schools that sponsor athletics programs.
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Affiliation(s)
- Alicia M Pike Lacy
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, AZ
| | - Christianne M Eason
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Rebecca L Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
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Critical Elements of Return to Learn for Students With Concussion: A Scoping Review. J Head Trauma Rehabil 2021; 37:E113-E128. [PMID: 34145156 DOI: 10.1097/htr.0000000000000695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify critical elements of return to learn (RTL) for students with concussion and examine the state of the peer-reviewed published literature through a scoping review. METHODS Three electronic databases were systematically searched, and reference lists screened for articles addressing components of RTL protocols and accommodations for students with concussion. In total, 100 articles met inclusion criteria, including 56 empirical studies and 44 expert articles. RESULTS Four key components to RTL protocols were identified: RTL teams, management approaches, outcome measurement, and accommodations. Both bodies of literature agree on the importance of RTL teams, but evidence for specific monitoring tools and management approaches is less robust. Accommodations have been better addressed by experts than empirical evaluation. Empirical studies are largely cross-sectional, and many are survey based. Just 24 include student perspectives. Publication of expert literature has declined in frequency, as empirical studies have become more common. CONCLUSION This scoping review describes the current landscape of RTL and provides guidance toward expanding the empirical literature to systematically determine best practices to serve students with concussion.
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Pietz K, Graves J, Weybright E, Pinkleton B, Klein T. Original Research: Concussions at School: The Experiences and Knowledge of School Nurses. Am J Nurs 2021; 121:28-38. [PMID: 33470615 DOI: 10.1097/01.naj.0000733428.67589.5e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND School nurses' knowledge about and confidence in managing concussions are important to ensure continuity of care between a student's school and home environments. This mixed-methods study explored concussion-related knowledge, confidence, and management experiences among urban and rural school nurses in Washington State. METHODS Public school nurses, identified via state educational service district websites and recruited by e-mail, completed an online survey assessing their concussion knowledge and confidence levels. Following the survey, a subset of respondents participated in semistructured interviews aimed at exploring their confidence in managing concussions. RESULTS Of the 945 school nurses to whom the survey was sent, 315 responded (33% response rate). Most survey respondents held an RN license (89.6%) and were from urban areas (90.8%). Overall, the respondents exhibited accurate concussion knowledge; only one significant difference was noted based on rural-urban status. Correct responses were given for most questions (67.4% to 98.7% correct responses). In interviews with a subset of six school nurses, emergent themes pertained to communication, assessment, and monitoring, and the nurse's role in postconcussion management. Barriers can include a lack of relevant school policies, low concussion awareness among teachers and parents, and limited resources. CONCLUSIONS The study findings suggest that school nurses possess high levels of concussion knowledge and confidence in managing concussions. Continuing education remains important to ensure that current research and evidence inform practice regarding ongoing concussion management among school-age children.
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Affiliation(s)
- Katy Pietz
- Katy Pietz is an instructor and the clinical coordinator of the Athletic Training Program at the College of Education, Washington State University (WSU), Pullman Campus. Janessa Graves is an associate professor at the College of Nursing, WSU, Spokane Campus. Elizabeth Weybright is an associate professor in the Department of Human Development, College of Agricultural, Human, and Natural Resource Sciences at WSU, Pullman Campus. Bruce Pinkleton is a professor and dean of the Edward R. Murrow College of Communication at WSU, Pullman Campus. Tracy Klein is an associate professor in the College of Nursing, WSU, Vancouver Campus. Graves, Weybright, Pinkleton, and Klein are on the faculty of WSU's interdisciplinary Prevention Science program. Contact author: Katy Pietz, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing Consensus for Essential Elements in Returning to Learn Following a Concussion. THE JOURNAL OF SCHOOL HEALTH 2020; 90:849-858. [PMID: 32939780 DOI: 10.1111/josh.12949] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Returning to learn following a concussion is the process of managing a student's recovery during the school day by implementation of academic supports with varying intensity. Due to a lack of consensus or even guidance on Return to Learn, this paper set out to establish cross discipline consensus on some essential elements of Return to Learn using a Delphi method. METHODS Sixteen national organizations participated in a Delphi process to reach consensus on overarching themes of Return to Learn focused on: returning a student to school, composition of the school-based concussion management team, progress-monitoring, educational safeguards, neuropsychological testing, and legislation. Two rounds of questionnaires were disseminated via email using a Delphi process. Consensus was established during round 2. RESULTS Twelve national organizations were able to reach consensus and endorse 13 essential elements of Return to Learn following a concussion. CONCLUSIONS There continues to be limited research on concussion Return to Learn leading to confusion in the field. In this paper, we demonstrate consensus on a number of essential elements, from a wide variety of professional disciplines who participate in the care of students following a concussion, as a starting place for some guidance on Return to Learn.
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Affiliation(s)
- Karen McAvoy
- Center for Concussion Rocky Mountain Hospital for Children, 10107 RidgeGate Pkwy, Suite #310, Lone Tree, CO, 80124
| | - Brenda Eagan-Johnson
- BrainSTEPS Brain Injury School Consulting Program, 1891 Old State Road, New Castle, PA, 16101
| | | | - Stephen Hooper
- Department of Allied Health Sciences, University of North Carolina, 333 S. Columbia Street, Suite 304, Chapel Hill, NC, 27514
| | - Melissa McCart
- Center on Brain Injury Research and Training, Rainier Building, 1244 Walnut Street, Suite 220, Eugene, OR, 97403
| | - Janet Tyler
- Health and Wellness, Colorado Department of Education, 201 East Colfax Avenue, Denver, CO, 80203
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Weber Rawlins ML, Snedden TR, Kay MC, Valovich Mcleod T, Welch Bacon CE. School nurses' perceptions of concussion management for secondary school student-athletes. Brain Inj 2020; 34:665-672. [PMID: 32183537 DOI: 10.1080/02699052.2020.1739334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: School nurses play a vital role in concussion management at the secondary school level, often being the only on-site healthcare provider during school hours. However, little is known regarding how they perceive their role in the concussion management process. The purpose of this study was to explore school nurses' perceptions and satisfaction with concussion management in the secondary school setting using a qualitative approach.Methods: Twenty-two school nurses employed within a United States secondary school setting completed individual, semi-structured phone interviews. Data were analyzed using a consensual qualitative research approach.Results: Four overall themes emerged. This manuscript focuses on one specific theme: school nurse perceptions and satisfaction regarding concussion management. Subthemes included: school nurses' overall perception and satisfaction with current concussion management procedures, interactions with other involved personnel, concussion assessment tools, school nurses' perceived role, current concussion management policies, concussion education, and school nurse continuing education specific to concussion.Conclusions: School nurses were generally positive regarding concussion management within their setting and were satisfied with their roles overall. However, participants identified a number of areas that require further attention to ensure an evidence-based, consistent team approach to concussion management to support best student outcomes and continuity of care.
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Affiliation(s)
| | - Traci R Snedden
- School of Nursing, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Melissa C Kay
- School of Health Professions, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Tamara Valovich Mcleod
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, Arizona, USA.,School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - Cailee E Welch Bacon
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, Arizona, USA.,School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
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Return-to-Learn Accommodations and Concussion Perceptions Among Indiana High School Principals. J Head Trauma Rehabil 2020; 34:E10-E17. [PMID: 29863615 DOI: 10.1097/htr.0000000000000396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Care after concussion is important for all patients, although especially critical in children and adolescents because of continued rapid brain growth and maturation. Postconcussion symptoms often lead to impaired school performance. Conflicting data regarding best return-to-learn practices make it difficult for school administrators to develop policies to best accommodate concussed students. We sought to assess high school principals' knowledge of concussion, the personnel responsible for implementing accommodations, and the overall willingness to enact recommended academic accommodations. METHODS In our cross-sectional study, we surveyed 410 Indiana high school principals (157 responded). Assistant principals were excluded. RESULTS One-third of the respondents received academic accommodations training for concussed students and more than 80% were somewhat or very comfortable with academic management. Greater than 90% were willing to provide accommodations as long as necessary. However, nearly 40% of responding principals were unlikely or unwilling to implement accommodations for standardized testing. National and state data suggest the median Indiana high school should expect 30 and more concussions per year; more than 90% of principals estimated that fewer than 30 concussions occurred each year at their school. CONCLUSIONS The underestimation of concussion frequency highlights an opportunity for further education of high school principals to ensure all concussed students receive appropriate return-to-learn accommodations.
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Guo D, Verweel L, Reed N. Exploring Gaps in Concussion Knowledge and Knowledge Translation Among Coaches of Youth Female Hockey. Clin J Sport Med 2019; 29:486-493. [PMID: 31688180 DOI: 10.1097/jsm.0000000000000542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To better understand the level of concussion knowledge of youth female hockey coaches and to identify preferred methods of knowledge translation for this population. DESIGN Cross-sectional survey. SETTING Participants independently completed written surveys before in-person concussion information sessions or online surveys through link provided in emails. PARTICIPANTS Convenience sampling yielded 130 coaches of youth female hockey from Canada. MAIN OUTCOME MEASURES Knowledge level on concussion, resources from which coaches obtained information on concussion, opinions on the current level of concussion knowledge, and knowledge translation. RESULTS Coaches demonstrated adequate knowledge on concussion, achieving 84% correct on true-false questions and 92% correct on symptom identification accuracy. However, coaches showed limited awareness of concussion specific to mechanisms for injury (identification) and postconcussion symptoms. Internet resources were rated as the most used resources for concussion yet were not rated very helpful. Nonetheless, coaches indicated online courses and web sites as the most preferred method for concussion knowledge translation. CONCLUSIONS Youth female hockey coaches have overall adequate knowledge of concussion; however, gaps in knowledge do exist. Future efforts to raise the concussion knowledge among coaches of female youth hockey should include information specific to the mechanism of injury, along with sign and symptom identification, with particular attention paid to emotional symptoms. Given the reported preferences and the widespread availability of the Internet, further exploration and research validation of online courses and web sites tailored to the youth female hockey community is encouraged.
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Affiliation(s)
- David Guo
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Lee Verweel
- Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
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Sarmiento K, Donnell Z, Bell E, Hoffman R. From the CDC: A qualitative study of middle and high school professionals' experiences and views on concussion: Identifying opportunities to support the return to school process. JOURNAL OF SAFETY RESEARCH 2019; 68:223-229. [PMID: 30876515 PMCID: PMC6460470 DOI: 10.1016/j.jsr.2018.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/23/2018] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Current research recommends that students returning to school after a concussion should receive a return to school plan that is tailored to their individual symptoms. School professionals play important roles in designing and implementing the supports outlined in return to school plans. METHODS This qualitative study explored middle and high school professionals' experiences with concussion, particularly their knowledge and perceptions of the injury and their experience with supporting students with concussion. Six focus groups were conducted with two to four school professionals per group, including two groups of teachers, two groups of school psychologists and counselors, and two groups of school nurses. Findings were coded into four categories: (a) challenges with identifying a concussion; (b) strategies for communicating with students about concussion; (c) barriers to implementing return to learn plans; and (d) establishing a collaborative school support team. RESULTS School professionals who participated in the focus groups were knowledgeable about concussion and the importance of helping their student recover. Participants also understood the importance of recognizing the signs and symptoms of concussion and communicating with students and parents about this injury. However, the study participants reported various challenges related to concussion identification and management, including the perceived validity of concussion symptom reporting by students. A team-based approach was mentioned across all groups as the preferred method for school-based concussion management for students. CONCLUSION School professionals in this study were eager to address concussion in their schools, but desire guidance on how to overcome social norms around concussion identification and reporting. In addition, there is a need for consistent use of written instructions from healthcare providers to help guide return to learn (RTL) accommodations. Practical applications: The findings from this study can help inform the integration of concussion, and other health, management plans in schools.
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Affiliation(s)
- Kelly Sarmiento
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027, United States.
| | - Zoe Donnell
- ICF, 530 Gaither Road, Rockville, MD 20850, United States
| | - Elizabeth Bell
- ICF, 530 Gaither Road, Rockville, MD 20850, United States
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14
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The Association Between Length of Recovery Following Sport-Related Concussion and Generic and Specific Health-Related Quality of Life in Adolescent Athletes: A Prospective, Longitudinal Study. J Head Trauma Rehabil 2019; 34:E1-E9. [DOI: 10.1097/htr.0000000000000394] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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15
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McLeod TCV, Cardenas JF. Emergency Preparedness of Secondary School Athletic Programs in Arizona. J Athl Train 2018; 54:133-141. [PMID: 30517023 DOI: 10.4085/1062-6050-35-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Schools that sponsor athletic programs have an obligation to provide a safe environment with appropriate policies for addressing emergencies. OBJECTIVE To describe the emergency preparedness of secondary schools in Arizona specific to emergency action plans (EAPs), cardiac arrest, concussion, and heat illness. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS Athletic directors from 143 Arizona secondary schools (response rate = 54%). INTERVENTION(S) A 6-section survey that included questions related to athletic trainer (AT) access, EAPs, automated external defibrillators (AEDs), concussion, heat illness, and other policies. MAIN OUTCOME MEASURE(S) Descriptive statistics were reported. Comparisons of responses between schools with and without AT access were conducted with Mann-Whitney U tests. RESULTS Most respondents (81%, n = 116) indicated their school had access to an AT, and 95% (n = 125) of respondents reported their school had a written EAP. The AEDs were available at most (93%, n = 121) schools. All respondents were familiar with the interscholastic concussion policy, and 98% (n = 123) indicated they had a school-specific policy. Almost all respondents (99%, n = 121) reported being familiar with the state heat-illness policy. Environmental measures were taken before practices at 48% (n = 60) of schools. Schools with access to an AT were more likely to have an EAP, venue-specific EAPs, physician approval of EAPs, AEDs, heat-illness policies, and cold-water immersion tubs and to take environmental measures. CONCLUSIONS Whereas the majority of schools reported AT access, not all schools had adequate EAPs in place. Schools would benefit from educational opportunities regarding best practices and policy development to improve emergency preparedness.
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Donnell Z, Hoffman R, Myers G, Sarmiento K. Seeking to improve care for young patients: Development of tools to support the implementation of the CDC Pediatric mTBI Guideline. JOURNAL OF SAFETY RESEARCH 2018; 67:203-209. [PMID: 30553425 PMCID: PMC6445253 DOI: 10.1016/j.jsr.2018.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The Centers for Disease Control and Prevention (CDC) Pediatric Mild Traumatic Brain Injury (mTBI) Guideline was created to help standardize diagnosis, prognosis, and management and treatment of pediatric mTBI. This paper describes the process CDC used to develop educational tools, and a dissemination and implementation strategy, in support of the CDC Pediatric mTBI Guideline. METHODS Two qualitative data collection projects with healthcare providers who care for pediatric patients were conducted. In-depth interviews were used in both projects. Project One examined healthcare providers' guideline use and dissemination preferences. Project Two assessed perceptions of the CDC Pediatric mTBI Guideline educational tools. RESULTS Project One brought to light four key areas related to Guideline usage and dissemination preferences, specifically a need for: (1) partnership with professional medical societies; (2) integration into electronic health records, mobile apps, and websites; (3) development of continuing medical education (CME) opportunities; and (4) dissemination through healthcare system leadership. In Project Two, healthcare providers reported that the CDC Pediatric mTBI Guideline educational tools were well-organized, clear and easy to navigate, and informative. Healthcare providers also requested more information on the Guideline methodology. DISCUSSION Assessment of pediatric healthcare providers' current use of clinical guidelines and preferences for educational tools yielded important insights that helped inform CDC's dissemination and implementation strategy for the Pediatric mTBI Guideline. PRACTICAL APPLICATIONS The findings from these data collection projects can also inform other guideline implementation and dissemination efforts among healthcare providers.
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Affiliation(s)
- Zoe Donnell
- ICF, 530 Gaither Road, Rockville, MD 20850, United States.
| | | | - Gaya Myers
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027, United States
| | - Kelly Sarmiento
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027, United States
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Romm KE, Ambegaonkar JP, Caswell AM, Parham C, Cortes NE, Kerr Z, Broshek DK, Caswell SV. Schoolteachers' and Administrators' Perceptions of Concussion Management and Implementation of Return-to-Learn Guideline. THE JOURNAL OF SCHOOL HEALTH 2018; 88:813-820. [PMID: 30300931 DOI: 10.1111/josh.12687] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 12/05/2017] [Accepted: 12/12/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Concussions are a public health concern and concussion management in school requires a team approach. We examined schoolteachers' and administrators' perceptions of concussions, management, and implementation of return-to-learn (RTL) guidelines. METHODS We audio-recorded and transcribed semistructured interviews with teachers (N = 16) and administrators (N = 6) from a public school system. We analyzed data using an analytic induction and constant comparison approach. RESULTS Two themes emerged: different understanding, and school context. Participants with no sport coaching experience were less familiar with concussions than those who coached a sport. Participants with personal experience with concussions were more sympathetic toward concussed students' needs. Teachers expressed feeling ill-equipped to implement RTL guidelines without specific instructions in the complex school environment. However, school administrators had minimal understanding of teacher-described challenges. CONCLUSIONS Teachers and administrators recognize that concussions are a health concern, but differ in their perceptions of concussions, management, and implementation of RTL guidelines. Personal experiences mediate individual perceptions about concussions. The daily realities of a school environment complicate teachers' capacity to implement RTL guidelines. Conversely, school administrators did not express awareness of any challenges with concussion management. To best facilitate students' recovery schools should include all stakeholders when devising concussion management policies.
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Affiliation(s)
- Kaitlin E Romm
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory. George Mason University, 10900 University Boulevard, Bull Run Hall 220, MSN 4E5, Manassas, VA 20110
| | - Jatin P Ambegaonkar
- Athletic Training Education Program, George Mason University, 10900 University Boulevard, Bull Run Hall 220, MSN 4E5, Manassas, VA 20110
| | - Amanda M Caswell
- Athletic Training Education Program, George Mason University, 10900 University Boulevard, Bull Run Hall 220, MSN 4E5, Manassas, VA 20110
| | - Candace Parham
- Athletic Training Education Program, George Mason University, 10900 University Boulevard, Bull Run Hall 220, MSN 4E5, Manassas, VA 20110
| | - Nelson E Cortes
- Kinesiogy, George Mason University, 10900 University Boulevard, Bull Run Hall 220, MSN 4E5, Manassas, VA 20110
| | - Zachary Kerr
- Department of Exercise and Sport Science, 313 Woollen Gym, CB# 8605, University of North Carolina, Chapel Hill, NC 27599-8700
| | - Donna K Broshek
- Neurocognitive Assessment Lab, Psychiatry & Neurobehavioral Sciences, University of Virginia Health System P.O. Box 800623, Charlottesville, VA 22908-0623
| | - Shane V Caswell
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory. George Mason University, 10900 University Boulevard MS 4E5, Manassas, VA 20110
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Abstract
Purpose of this study was to identify whether children aged 12-14 years benefit from academic reentry plans when returning to school following a mild traumatic brain injury. An integrative review was carried out with data sourced from CINAHL, Medline, Education Full Text, Health Source: Nursing/Academic Edition, and hand searching of references. Abstracts were reviewed for inclusion/exclusion criteria, resulting with six articles appraised and analyzed for this article. The review shows the need for gradual return to physical and cognitive activity postconcussion to facilitate a quicker recovery with fewer postconcussive symptoms. Although each traumatic brain injury case is individualized with symptoms and severity, a guideline of recommendations and accommodations for return to cognitive activity would be beneficial for the student, educator, family, and medical personnel involved in the children's care. Further research is recommended to develop a better understanding of long-term effects mild traumatic brain injury has on children and recommendations of how to minimalize or accommodate these changes.
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Weber ML, Welch Bacon CE, McLeod TV. School Nurses' Management and Collaborative Practices for Student-Athletes Following Sport-Related Concussion. J Sch Nurs 2018; 35:378-387. [PMID: 29772943 DOI: 10.1177/1059840518774391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to examine school nurses' management and collaboration with health-care providers (HCPs) for student-athletes following a concussion. Secondary school nurses accessed an online survey titled the Beliefs, Attitudes, and Knowledge of Pediatric Athletes with Concussions (access rate = 15.6%; n = 1,246/8,000). Approximately 40% of schools where nurses were employed administered baseline and postinjury concussion assessments. No significant differences were found between employment model (single vs. multiple sites) in regard to conducting baseline (p = .908) administration at their site; however, those employed at a single school more frequently offered postinjury assessments at their site than those at multiple sites (p = .019). School nurses most frequently reported relationships with an athletic trainer (38.8%, n = 483/1,246) compared to other HCPs. A concussion management team, including school nurses, and other recommended members should develop comprehensive concussion management plans. Plans should comprise of multiple concussion assessments to aid in the return-to-learn/play processes.
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Abstract
PURPOSE OF REVIEW This article summarizes the impact and complications of mild traumatic brain injury and concussion in children and outlines the recent evidence for its assessment and early management. Useful evidence-based management strategies are provided for children who have a typical recovery following concussion as well as for those who have persistent postconcussion syndrome. Cases are used to demonstrate the commonly encountered pathologies of headache, cognitive issues, and mood disturbances following injury. RECENT FINDINGS A clinical risk score using risk factors for poor recovery (eg, female sex, adolescence, previous migraine, and a high degree of acute symptoms) can be used to help the clinician plan follow-up in the community. Prolonged periods of physical and cognitive rest should be avoided. Multidisciplinary treatment plans are often required in the management of persistent postconcussion syndrome. SUMMARY A paucity of research exists for the treatment of postconcussion syndrome. Current treatments target individual symptoms.
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Welch Bacon CE, Kay MC, Weber ML, Tierney DK, Valovich McLeod TC. School Nurses' Perceived Challenges With Concussion Management Procedures in the Secondary School Setting. SAGE Open Nurs 2018; 4:2377960818798437. [PMID: 33415205 PMCID: PMC7774346 DOI: 10.1177/2377960818798437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/03/2018] [Indexed: 11/17/2022] Open
Abstract
School nurses have an integral role in managing student health concerns throughout the school day, yet little is known about their specific role in concussion management. Therefore, the purpose of this study was to explore the challenges encountered by school nurses regarding concussion management in the secondary school setting. Twenty-two school nurses employed in the secondary school setting were interviewed via phone. We analyzed the data via the consensual qualitative research paradigm. Overall, we found school nurses face consistent challenges with their role on the concussion management team, specifically related to education of school personnel, parents, and community health-care providers. Challenging topics included the inconsistency of community health-care provider recommendations and others' perceptions of school nurses' preparation and training to be important members of the concussion management team. Efforts to increase concussion education and improve communication across all stakeholders of the concussion management team should be implemented.
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Dachtyl SA, Morales P. A Collaborative Model for Return to Academics After Concussion: Athletic Training and Speech-Language Pathology. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:716-728. [PMID: 28793153 DOI: 10.1044/2017_ajslp-16-0138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 03/17/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE In this article, we describe an academic concussion management protocol designed for grades Pre-K to 12, called Cognitive Return to Exertion (CoRTEx). Collaboration between the speech-language pathologist (SLP) and athletic trainer (AT) is highlighted. METHOD A description of CoRTEx is provided, and the need for collaboration is emphasized. A case study illustrates an example of how CoRTEx can be implemented at the individual student level. RESULTS A total of 165 students went through CoRTEx from the pilot in April 2014 through December 2016. Referrals to CoRTEx were highest for football, blows to the head, and soccer. Anecdotal evidence suggests that CoRTEx provided necessary support for students and their families, although research is needed to provide objective data. CONCLUSIONS CoRTEx and other similar protocols can be used as models for SLPs to create their own academic concussion management protocols. For cases in which the injured student is an athlete, the SLP-AT collaboration is critical to carefully coordinate return to academics and return to play so that students are successful in school, as well as ready to safely return to sport. Suggestions are made for designing research studies that can provide empirical evidence for the efficacy of such academic concussion management protocols.
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Affiliation(s)
- Sarah A Dachtyl
- Sahuarita Unified School District, Arizona
- Northern Arizona University, Flagstaff
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24
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Abstract
The authors conducted a cross-sectional survey of Massachusetts school nurses examining return-to-learn practices for children recovering from concussion in prekindergarten through high school. Regardless of school setting, all students received academic accommodations to support learning during recovery. School nurses perceived less benefit to prolonged cognitive rest (>4 days) for high school students relative to students in elementary school, but provided academic accommodations to them for comparatively longer periods of time (10-14 days vs 6-10 days). In all settings, respondents indicated a need for improved communication among treating physicians, parents, and school personnel, as well as improved education and standardized management tools for younger children and those who sustain non-sport-related injuries. Despite serving children at different developmental stages, school return-to-learn practices are essentially the same in primary and secondary schools, highlighting the need for standardized, developmentally appropriate return-to-learn plans and additional education for the providers and school personnel who implement them.
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Affiliation(s)
- Laura S Blackwell
- 1 Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA
| | - Anna F Robinson
- 1 Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA
| | - Mark R Proctor
- 2 Department of Neurosurgery, Boston Children's Hospital, Boston, MA, USA
| | - Alex M Taylor
- 1 Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA.,3 Department of Neurology, Boston Children's Hospital, Boston, MA, USA
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Gänsslen A, Neubauer T, Hartl C, Moser N, Rickels E, Lüngen H, Nerlich M, Krutsch W. [School re-integration after child brain dislocation : The trauma surgeon's role]. Unfallchirurg 2017; 120:442-448. [PMID: 28130573 DOI: 10.1007/s00113-017-0317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Concussion injury of the brain is still a frequently underestimated injury, which can be associated with long-lasting consequences. Compared to adults, the recovery phase is often prolonged in childhood. Primary treatment consists of symptom-dependent physical and mental activities. Re-integration into daily life is crucial. In childhood, the primary focus is therefore on returning to school. New symptoms, or an increased presence of symptoms must be detected, to avoid prolonged recovery courses. School restrictions have to be minimized. Corresponding concepts are already implemented in North America. Comparable concepts are not established in Germany. In addition to well-known standard return-to-play protocols for sport re-integration, it is urgently recommended to integrate gradual return-to-learn protocols.Thus, academic adaptations and support must be established as well as symptom-oriented organizational and teaching modules.
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Affiliation(s)
- A Gänsslen
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Wolfsburg, Sauerbruchstr. 7, 38440, Wolfsburg, Deutschland.
| | - T Neubauer
- Unfallchirurgie, Landesklinikum Horn, Spitalgasse 10, 3580, Horn, Österreich
| | - C Hartl
- Unfallchirurgie, Landeskrankenhaus Steyr, Sierninger Str. 170, 4400, Steyr, Österreich
| | - N Moser
- Verwaltungs-Berufsgenossenschaft, Bezirksverwaltung München, Postfach 20 20 42, 80020, München, Deutschland
| | - E Rickels
- Klink für Unfallchirurgie, Orthopädie und Neurotraumatologie, Allgemeines Krankenhaus Celle, Siemensplatz 4, 29223, Celle, Deutschland
| | - H Lüngen
- ZNS - Hannelore Kohl Stiftung, Rochusstr. 24, 53123, Bonn, Deutschland
| | - M Nerlich
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - W Krutsch
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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26
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Schneider KH. Psychometric Evaluation of a New Instrument to Evaluate School Nurses' Perceptions on Concussion Care Management. J Sch Nurs 2017; 33:364-373. [PMID: 28073309 DOI: 10.1177/1059840516686842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The rate of concussions in adolescents has risen over the last decade, resulting in cognitive and emotional problems. Neurologists recommend cognitive and physical rest during the recovery period, followed by a transitional return-to-classroom protocol. The purpose of the study was to develop and test an instrument that explores the beliefs and roles of school nurses in concussion care management. The instrument was a cross-sectional descriptive survey based on the theory of planned behavior, using Qualtrics®. The psychometric properties of the instrument were assessed through exploratory factor analysis with orthogonal rotation. The reliability of the instrument was assessed for internal consistency reliability using Cronbach's α. Kaiser-Meyer-Olkin for sample adequacy was .8; Cronbach's α strong (.851).
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Thompson LL, Lyons VH, McCart M, Herring SA, Rivara FP, Vavilala MS. Variations in State Laws Governing School Reintegration Following Concussion. Pediatrics 2016; 138:peds.2016-2151. [PMID: 27940709 DOI: 10.1542/peds.2016-2151] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We sought to examine the prevalence, scope, and specificity of provisions governing school reintegration in current state concussion laws. METHODS State concussion laws as of May 2016 were independently assessed and classified by 2 trained coders. Statutes were classified as "Return-to-Learn" (RTL) laws if they contained language mandating institutional action at the state, district, or school level related to academic reintegration of youth who have sustained a concussion. All statutes classified as RTL laws were further analyzed to determine scope, required actions, and delineation of responsibility. RESULTS RTL laws were uncommon, present in only 8 states. Most (75%) of these laws held schools responsible for RTL management but mandated RTL education for school personnel was less frequent, present in only one-quarter of the laws. None of the RTL laws provided guidance on support of students with persistent postconcussive symptoms, and only 1 recommended an evidence-based standard for RTL guidelines. CONCLUSIONS Our review of state concussion laws indicates scant and vague legal guidance regarding RTL. These findings suggest an opportunity for legislative action on the issue of RTL, and reveal the need for better integration of laws and research, so that laws reflect existing best-practice recommendations and remain current as the evidence base develops.
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Affiliation(s)
| | - Vivian H Lyons
- Harborview Injury Prevention and Research Center, Seattle, Washington.,Departments of Epidemiology
| | - Melissa McCart
- The Center on Brain Injury Research and Training, Eugene, Oregon
| | - Stanley A Herring
- Rehabilitation Medicine.,University of Washington Medicine Sports Health and Safety Institute, and.,University of Washington Medicine Sports Concussion Program, University of Washington, Seattle, Washington; and
| | - Frederick P Rivara
- Seattle Children's Research Institute, Seattle, Washington.,Harborview Injury Prevention and Research Center, Seattle, Washington.,Departments of Epidemiology.,Pediatrics, and
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, Seattle, Washington; .,Pediatrics, and.,Anesthesiology
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Graff DM, Caperell KS. Concussion Management in the Classroom. J Child Neurol 2016; 31:1569-1574. [PMID: 27591004 DOI: 10.1177/0883073816666205] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/12/2016] [Accepted: 07/24/2016] [Indexed: 11/17/2022]
Abstract
There is a new emphasis on the team approach to pediatric concussion management, particularly in the classroom. However, it is expected that educators are unfamiliar with the "Returning to Learning" recommendations. The authors' primary objective was to assess and improve high school educators' knowledge regarding concussions and management interventions using an online education tool. A total of 247 high school educators completed a 12 question pretest to assess core knowledge of concussions and classroom management followed by a 20-minute online literature-based education module. Participants then completed an identical posttest. The improvement in core knowledge was statistically significant (P < .001). Initial areas of weakness were the description and identification of concussions. Questions regarding concussion classroom management also showed a statistically significant increase in scores (P < .001). This study identifies the deficits in the knowledge of educators regarding concussions and classroom management as well as the significant improvement after an online educational module.
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Affiliation(s)
- Danielle M Graff
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kerry S Caperell
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
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Building Statewide Infrastructure for the Academic Support of Students With Mild Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:397-406. [DOI: 10.1097/htr.0000000000000205] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dreer LE, Crowley MT, Cash A, O’Neill JA, Cox MK. Examination of Teacher Knowledge, Dissemination Preferences, and Classroom Management of Student Concussions: Implications for Return-to-Learn Protocols. Health Promot Pract 2016; 18:428-436. [DOI: 10.1177/1524839916650865] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Laura E. Dreer
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria T. Crowley
- Alabama Department of Rehabilitation Services, Birmingham, AL, USA
| | - Augusta Cash
- Alabama Department of Rehabilitation Services, Birmingham, AL, USA
| | | | - Molly K. Cox
- University of Alabama at Birmingham, Birmingham, AL, USA
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Kasamatsu T, Cleary M, Bennett J, Howard K, McLeod TV. Examining Academic Support After Concussion for the Adolescent Student-Athlete: Perspectives of the Athletic Trainer. J Athl Train 2016; 51:153-61. [PMID: 26942658 DOI: 10.4085/1062-6050-51.4.02] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Student-athletes may require cognitive rest and academic support after concussion. Athletic trainers (ATs) in secondary schools are uniquely positioned to provide medical care and to collaborate with school professionals while managing concussions. However, little is known regarding return-to-learn policies and their implementation in secondary schools. OBJECTIVE To examine ATs' perspectives on return to learn, cognitive rest, and communication with school professionals after concussion. DESIGN Cross-sectional study. SETTING Web-based survey. PATIENTS OR OTHER PARTICIPANTS A total of 1124 secondary school ATs completed the survey (28.5% response rate). The majority of participants were employed full time (752/1114 [67.5%]) in public schools (911/1117 [81.6%]). MAIN OUTCOME MEASURE(S) School and AT employment characteristics, demographics, number of concussions evaluated annually, and perceptions of school professionals' familiarity with ATs' responsibilities were independent variables. RESULTS Of the ATs, 44% reported having an existing return-to-learn policy. The strongest predictor of a return-to-learn policy was frequent communication with teachers after concussion (odds ratio = 1.5; 95% confidence interval = 1.2, 1.7). Most ATs recommended complete cognitive rest (eg, no reading, television; 492/1087 [45.3%]) or limited cognitive activity based upon symptoms (391/1087 [36.0%]). Common academic accommodations were postponed due dates (789/954 [82.7%]), rest breaks (765/954 [80.2%]), and partial attendance (740/954 [77.6%]). Athletic trainers self-reported as primary monitors of health (764/1037 [73.7%]) and academic progression (359/1011 [35.5%]). The strongest predictor of ATs' communication with school professionals was their perception of school professionals' understanding of ATs' roles. CONCLUSIONS Overall, ATs followed best practices for cognitive rest and return to learn after concussion. Although ATs are central to the management of student-athletes' physical health after concussion, school professionals may be better suited to monitor academic progress. Increased communication between the AT and school professionals is recommended to monitor recovery and facilitate academic support for symptomatic student-athletes.
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Baugh CM, Kroshus E. Concussion management in US college football: progress and pitfalls. Concussion 2016; 1:CNC6. [PMID: 27064258 PMCID: PMC4825689 DOI: 10.2217/cnc.15.6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 06/18/2015] [Indexed: 12/14/2022] Open
Abstract
Reducing the frequency and severity of concussions from sport is an important issue in public health currently addressed by a multifaceted approach. Given the large number of participants and the comparatively high risk of injury, American football is an important sport to consider when examining concussion management practices. Focusing on American football at the collegiate level, this manuscript describes current research regarding concussion epidemiology, policy, implementation of clinical diagnosis, management and return-to-play standards and athlete concussion education. Although American collegiate sports leagues have put forth concussion-related policies in recent years, the implementation of these policies and related effects on athlete concussion education, clinical management of concussion and ultimately athlete health outcomes are not well understood. Additional research is needed.
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Affiliation(s)
- Christine M Baugh
- Interfaculty Initiative in Health Policy, Harvard University, 14 Story Street, Fourth Floor, Cambridge, MA 02138, USA
- Division of Sports Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Boston MA 02115, USA
| | - Emily Kroshus
- Harvard School of Public Health, Department of Social & Behavioral Sciences, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA 02116, USA
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Rose SC, McNally KA, Heyer GL. Returning the student to school after concussion: what do clinicians need to know? ACTA ACUST UNITED AC 2015; 1:CNC4. [PMID: 30202549 PMCID: PMC6114019 DOI: 10.2217/cnc.15.4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 04/10/2015] [Indexed: 11/21/2022]
Abstract
Participation in school is vital to a child's academic and social development. Following concussion, returning the student to school can pose several challenges for families, healthcare providers and school personnel. The complex constellation of postconcussion symptoms can impair learning and can make the school environment intolerable. Research evidence to guide the return to school process is lacking, but protocols have been proposed that outline a gradual reintroduction to school with academic accommodations tailored to the student's specific symptoms. Key medical and school personnel must understand their respective roles to optimize the process. This review of the current literature examines the available data and expert recommendations that can support a student's successful return to school following concussion.
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Affiliation(s)
- Sean C Rose
- Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA.,Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Kelly A McNally
- Division of Pediatric Psychology & Neuropsychology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA.,Division of Pediatric Psychology & Neuropsychology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Geoffrey L Heyer
- Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA.,Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA
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Rose SC, Weber KD, Collen JB, Heyer GL. The Diagnosis and Management of Concussion in Children and Adolescents. Pediatr Neurol 2015; 53:108-18. [PMID: 26088839 DOI: 10.1016/j.pediatrneurol.2015.04.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Concussion is a complex brain injury that results in more than 100,000 emergency department visits for school-aged children each year in the United States. All 50 US states have passed concussion legislation designed to promote safety in youth sports. Most of these laws require medical clearance by a licensed health care provider before returning to sport, which may have contributed to an increase in pediatric subspecialty referrals, particularly referrals to the child neurologist. METHODS We reviewed the literature on pediatric concussion. RESULTS This review summarizes the current knowledge and recommendations for concussion diagnosis and management in children and adolescents, athletes and nonathletes. It highlights concussion epidemiology, pathophysiology, advances in neuroimaging, and potential health risks including second impact syndrome and chronic traumatic encephalopathy. It also underscores clinical areas where evidence is lacking. CONCLUSIONS The diagnosis and management of concussion requires specific considerations in children. Further concussion research must be done to minimize injury risk and to optimize medical care for this common problem.
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Affiliation(s)
- Sean C Rose
- Departments of Pediatrics and Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Kevin D Weber
- Department of Neurology, The Ohio State University, Columbus, Ohio
| | - James B Collen
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Geoffrey L Heyer
- Departments of Pediatrics and Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio.
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Logan K. Overuse and underutilization in youth sports: time to seek equipoise. J Pediatr 2015; 166:517-9. [PMID: 25556015 DOI: 10.1016/j.jpeds.2014.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 11/10/2014] [Indexed: 11/20/2022]
Affiliation(s)
- Kelsey Logan
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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