Recognizing and Treating the Effects of Concussions

by: Cassie Pfeifer, The Sandner Group - Claims Management

Concussions are an often misunderstood injury that can result in detrimental health issues if not treated properly. Even a mild fall while walking down the hallway can be the cause of a concussion that can develop into a severe problem for the person injured. Concussions are also not always accompanied by a loss of consciousness; in fact, most instances where a concussion is sustained do not involve a loss of consciousness. The following information will help your district become more adept in ensuring the recovery process of a student or staff member suffering from a concussion is as smooth as possible.

An untreated concussion can lead to potentially fatal health problems; therefore, all district staff should be given instruction in how to identify signs of a concussion in order to help guarantee that no potential concussion goes untreated. The Centers for Disease Control and Prevention (CDC) defines a concussion as “a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works.”  Additionally, a concussion can be caused by a fall or blow to the body that causes the head and brain to move quickly back and forth. Whiplash from a car accident, for instance, can be the cause of a concussion. As a concussion is not an injury to the brain itself, it does not often show up on standard imaging devices. Due to the unreliability of modern medical equipment to detect a concussion, it is important to be fully aware of the signs and symptoms often associated with a concussion. A concussion presents several symptoms; however, not all symptoms may be present and one person’s concussion symptoms may differ from another person’s symptoms. The CDC recommends looking at four different categories when assessing someone who may have had a head injury: cognitive/memory, physical, emotional, and sleep. Cognitive symptoms include difficulty thinking clearly, feeling slowed down, difficulty concentrating, and difficulty remembering new information. Physical symptoms of a concussion are: headaches, blurred vision, nausea/vomiting, sensitivity to noise/light, balance problems, feeling tired, and lacking energy. Some emotional symptoms to watch for are: irritability, sadness, anxiety, and the person feeling or acting more emotional than usual. A victim of a concussion may also experience differences in his/her usual sleep patterns. In some instances, the blow to the head may have caused a severe or traumatic brain injury. A more severe concussion can result in the following symptoms: pupils dilating unevenly, seizures, slurred speech, or the inability to walk or stand upright. While medical assistance must be sought in all instances where a concussion is suspected, if the injured person is presenting any of the symptoms indicating a severe brain injury, 911 should be called immediately.

After witnessing an accident that may have caused a concussion, the suspected injured party should be taken aside and monitored closely. A detailed accident report should describe the accident as well as the state of the injured party. This report helps ensure that the injured party is adequately observed, and provides the appropriate medical personnel with an accurate account of the injury as well as the physical and mental state of the injured person following the incident. The CDC lists the following as items to keep in mind when reporting a concussion: cause of the injury, any loss of consciousness, any memory loss, any seizures, and the number of previous concussions (if any). In some cases, signs of a concussion do not appear until several hours after the incident. If no signs of a concussion are immediately present, a medically-qualified employee, such as a school nurse, should check in with the student or staff member periodically to ensure no symptoms develop. Family members should also be informed of the incident so they know to watch for unusual symptoms or behaviors that might indicate a concussion.

If the incident has resulted in a concussion, it is important to follow specific steps in getting the student/staff member treatment. The injured person should be taken to a healthcare professional or emergency room as soon as possible following the injury in order to be properly assessed. Remember, according to the CDC, a concussion can be very difficult to diagnose, so no one other than a healthcare professional should decide whether a concussion was sustained after an accident. After a concussion has been diagnosed, the most important part of the recovery process is both physical and mental rest. As a concussion involves damage to brain cells, immediately putting the brain cells to work without giving proper time for them to repair may exacerbate side effects, most significantly brain damage or even death. It is important not to take recovery lightly and to proceed with caution when reintegrating the student or staff member into their daily routine. The district should follow the primary physician’s recommendations exactly as stated in order to ensure recovery is successful, and all employees who work with the student or staff member should be informed of how to proceed with missed work and catching up when returning to school or work.

For injured students, the return to school must be a gradual process. It is important not to overwork the injured student; he or she may need  frequent breaks or may come back part-time to ensure that symptoms of the concussion, (such as headaches) do not return. The school nurse or other medically-qualified employee should check in with the student periodically throughout the day to ensure he or she is not working too hard. Inform the student that ‘toughing out’ signs of a concussion is the worst possible thing to do. The student should take those symptoms as a sign to rest so that the brain cells do not sustain further damage. The CDC notes that risking a second concussion before being fully recovered from the first can slow recovery and increase the likelihood of long-term problems. Therefore, the student should be kept out of physical education classes and sports indefinitely until the primary physician treating the student says they are symptom-free and ready for physical activities.

When the concussion is particularly severe, it may be necessary to set up an individualized educational plan for the returning student. The student may need assistance taking tests and doing homework, particularly if there is concentration or reading difficulties as a result of the injury, and a tutor may be needed for assistance in catching up with work missed while in recovery if an extended period of time was spent out of class. Districts may need to enlist the special education department in order to create an effective educational plan that includes efficient support for the recovering student. Be sure to follow physician instructions regarding the status of the student’s recovery as well as the recommendations outlining what the student is capable of doing. The district should communicate all limitations to teachers to ensure the student does not work outside what he or she is able to do, thus providing a smooth transition from recovery to normal life. The brain is perhaps our most vital organ and treating it with care after a concussion is absolutely essential.

Concussions can be a tricky injury and not giving the injured party enough time to recover can have dire consequences. At Sandner Group – Claims Management, we are dedicated to providing the resources necessary to assist districts in addressing all injuries. However, it is vitally important to contact qualified medical professionals when working with a student or staff member with a complicated injury like a concussion.

The content of this bulletin is meant for members of the WCSIT*ISDA Trusts. Participating school districts should feel free to distribute the bulletin to district personnel.