IN CASE OF INJURY

HOME ACCOMMODATIONS

Have a look at the information on the brain that is part of Module #2 of the Concussion Management Certification Course to see just how vulnerable your brain can become after an initial concussion. Click here to read>>>>
  
This means that there is to be no television at all at home the day of the injury. The visual stress of watching a television program may strain the injured areas of the brain. This is not a time to come home, sit on the couch and watch television.
  
There is to be no "radio" or "music from MP3 players" for at least the first night or until the symptoms disappear. If once you begin listening to music again it brings back symptoms, then this activity must cease or be cut back.
  
You should not use the computer to play video games or for any other purpose. Forget about doing homework or assignments immediately after an injury. Teachers will understand.
 
There is to be no use of cell phones or sending or receiving text messages. Give your phone to your parent/guardian so there is no temptation. Nor are there to be any phone calls.
 
You should refrain from doing any reading, whether they are books or magazines.
 
Finally, keep conversations to a minimum. You should go to bed in a dark, quiet room and just rest. This is a time to completely shut down the brain and let the body heal itself.

Even though you may not be feeling any symptoms from the injury, and this may even be the case by the time you return home from the game, this doesn't mean the concussion has healed. The headaches, dizziness, vision concerns and feeling that something is wrong, will disappear if the stress causing the problems disappears. However, that does not mean that the healing is completed. It just means that as long as you reduce the stress on the brain, the symptoms will be reduced or will stop. Unfortunately, too many young people think that as soon as symptoms disappear they are ready to get back to normal. Nothing could be further from the truth. This is an injury that takes time and both physical and cognitive rest to heal.

In most cases the day after the injury should also be a day of rest. You may want to stay home from school that day if some of the symptoms still prevail.  If the symptoms have gone away, you can get up and walk around slowly for a while. You might spend a few minutes watching television. You may even listen to some music if the volume is low (not with an earphone). The strategy here is to keep everything at the absolute minimum and to be carefully monitoring which activities cause symptoms to return. As soon as a symptom returns you must make sure to cease whatever activity was causing the problem.

You may gradually increase the amount of time doing normal activities, including a bit of light walking, but no weight lifting, jogging or anything else that will cause movement in the brain. As long as the increased activity does not bring on symptoms, you can continue to build up your activity sessions.

ONCE SYMPTOMS HAVE DISAPPEARED FOR GOOD...

Once the signs and symptoms have disappeared for good and you are confident that it seems as if the injury has pretty well healed, you should sit down with your parent/guardian and talk about signing your Student-Athlete Clearance to Resume Physical Training form. 

Your parent/guardian must also sign the Parent-Guardian Clearance to Resume Physical Training. You and your parents/guardians can discuss your progress and together you can decide if you are ready to resume physical training.

SCHOOL ACCOMMODATIONS

  
RETURNING TO CLASS

You and your parent/guardian will decide when the symptoms have subsided enough to allow you to return to school following the injury. In most cases, you will be able to return to some limited classroom activity within one or two days of the injury.

Teachers have been advised that until you are ready to return to school, it is not recommended that any work or notes be sent home for you to keep up since we do not want you to be doing any reading or other activity that will add to the cognitive stress levels. So make sure that you refrain from asking your peers to bring you any work while you are resting for the first day or so.

The first day back should be a very light day. You and your Teachers should spend some one-on-one time with each other to assess the situation and discuss any of the accommodations that have been explained to your teacher as outlined below. We are providing you with the accommodation recommendations that have been suggested to the Teachers, so you should talk about which ones you feel you would like to consider.

ATTENDANCE

Depending on the symptoms, you may need to remain home at complete rest for several days following the injury. Even upon returning to school, you may find that you need to stay home every second or third day, either because the symptoms are returning or you feel exhausted. Keep in mind that it is common for a person to feel very tired following a brain injury. Therefore, you must be prepared for irregular attendance and you should not count on being present on any particular day or class. It is possible that you may plan on being present on a certain day and then symptoms flare up the night before or the morning of the class and be unable to attend.

It may also be necessary for you to prioritize your classes, attending core subject classes only, while resting during electives. Therefore, depending on the subject, a classroom teacher may not see the you for days on end, even though you are at school. You may feel the need to keep up with your  compulsory subjects, but may find it necessary to cut back on some of your electives because these will be easier to maintain once you recover fully.

You may also find it easier to attend school during mornings or afternoons, depending on when symptoms are worse. For example, if you are having trouble sleeping you may be too tired in the morning to attend classes and will therefore find the afternoons easier. On the other hand you may find that your symptoms, such as fatigue, worsen as the day goes on so you may prefer to attend school in the morning and go home in the afternoon.

The daily schedule is something that you should discuss with your guidance counselor and all of your classroom teachers. If all goes well, this disruption of scheduling should only last a couple of weeks at the most, as long as you follow your guidelines for rehabilitation.

REST PERIODS DURING THE DAY

Following a concussion you may find that you are absolutely drained of mental energy. Some have likened it to a battery that loses its charge much faster than before. Further adding to the confusion, and to the internal stress you are under is the fact that your mental energy level will vary from day to day and activity to activity. In fact, despite everything that you are doing, you may find that the symptoms are getting worse. This is normal and the classroom teachers will be sensitive to this phenomenon of concussions. In some cases the symptoms may not even appear for days or weeks following the initial injury, so don't let this worry you. It is quite normal.

You may find that if you are allowed to take periodic rest breaks of 20 or 30 minutes in a quiet place when symptoms flare up, you are able to remain at the school for longer periods of time. Therefore, you should work out a procedure with your teachers whereby you can excuse him/herself and perhaps go and lie down in the nurse's room or the staff lounge for a while. It may be that all that is required is for you to go to the library to do seatwork if the noise level gets too loud in the class. The rest breaks will gradually lessen as the recovery process continues.

Some sort of procedure will have to be established with school administration so that your teachers can keep track of your whereabouts. You cannot simply disappear with no one being aware of your location. This is not just to address liabilities with respect to supervision duties, but also in case you ever have a health issue that may require emergency attention. Someone must be aware of your whereabouts at all times.

It may be a good idea to bring along a "buddy" when you need one of these rest sessions so that the "buddy" can do work nearby while you are resting. Remember, this is not an opportunity for socializing. It is a time to rest.

ASSIGNMENTS

One of the common symptoms of concussion is the inability to plan and organize. This means that you may be having trouble processing information, so you should allow extra time to complete homework assignments. You may even lose track of homework assignments or have difficulty approaching the planning of a project. In fact, you may appear to be a completely different student than you were prior to the injury. It will be extremely frustrating for you and will also be a bit frightening as you wonder if things will ever get back to normal. Don't let yourself get stressed out. If you are doing everything to help your own cause, things will get back to normal in time.

You may find that you forget to bring the right text books, material or pens to class. Unfortunately, because of the demands on a classroom teacher it is possible that these problems could go undetected for some time. We recommend that you find a "peer partner" or "buddy" during the recovery period. This partner can help you get organized and even meet you at your locker to make sure that all of the materials are brought to the class. You can even share material and/or books when yours  are misplaced.

Your Teacher will also be asked to reduce the expectations or requirements so that you are not required to produce the same amount of work as normal. This partial work load will assist in the recovery process even though it may create some difficulties for the teacher when it comes to evaluation of progress. You should not take advantage of this and use your injury to get out of work. Once again, this is a very serious injury, so don't do anything to jeopardize the recovery process.

Once you are able to do homework it is always advisable that you ask your Teacher or a friend to give you written instructions that can be followed while at home. Don't try to remember what was said in class. Keep in mind that while in rehabilitation, you may not be able to recall instructions or you may find it stressful trying to remember exactly what the teacher said. By having the instructions down in writing it will be easy to follow at home.

TESTING

This is perhaps one of the most important areas of adjustment that you will have to make, especially if the injury happens during Grade 12 or while taking courses that will affect entrance to university or college. And yet, if you are forced to take a test while you are symptomatic it will place you at a great disadvantage for coming up with passing grades. In addition, the mental effort required to prepare for the test may even exacerbate your symptoms.

If possible, it would be best to find an alternative evaluation procedure that would be suitable and agreeable to you and your Teachers. This is something that should be considered if the exam is not a mandatory requirement, such as an entrance exam for post-secondary school. It is quite reasonable to calculate your marks based on your daily seatwork, class participation and assignments, or to just use the marks earned up until the time of injury.

Postponing testing until you are fully recovered is another alternative, but the anxiety of knowing that you will be facing a huge challenge to get caught up and do the test at a later date may also have serious consequences to the recovery process.

One thing is for certain - you should never expect to take part in a major mid-term or final exam during the recovery period. If there is no other choice, then try to schedule the exams so that you are only taking one per day or every second day with plenty of study time in between.

You may feel that you are well enough to take tests, but even so you should ask your teachers to give you extra time to complete the test. The reason for needing this extra time is because when the brain is dysfunctioning as a result of a concussion, it takes longer to process information, so while you may feel fine, and you may be able to successfully complete the test, but it will take longer for you to process things.

If you insist on taking a test, it might be advisable to take the test in  a smaller exam room where there may be fewer distractions and pressure.

One suggestion that may help is the utilization of multiple-choice or open-book tests which tend to minimize the need to retrieve information. You may be able to recognize the correct answer, but may be unable to mentally recall what the answer is. Those "connections" in the brain may be damaged. You should ask your teachers if this is a possibility.

SENSITIVITY TO LIGHT, NOISE, CROWDS

Student-athletes who are suffering from concussion symptoms often have difficulty during the recovery period from over sensitivity to light or noise. If the fluorescent lighting in the classroom is bothering you, then perhaps you and your teacher can come up with some accommodations that won't interfere with the rest of the class. For example, you might ask if you can wear a baseball cap or sunglasses that will cut down on the light. You may even be able to turn down the lights a bit in one part of the room.

As for noise, it may be advisable for you to eat lunch in a quiet area rather than in a noisy cafeteria. This is another opportunity for you to have a "buddy" who will accompany you for lunch. Anything that is going to reduce the chances of causing stress on the brain is encouraged.

Changing classes may be accomplished without incident by leaving class early so as to avoid the noise of the rest of the students moving in the hallway. Anyone who has been caught in the hallway of a large high school during class change is well aware of the noise as well as the physical contact that is often made as people are rushing too and fro. Therefore, by allowing yourself some time to move prior to the heavy traffic, you will be helping to prevent some further physical or mental stress on the original injury.

LIMITED PHYSICAL ACTIVITY

During the recovery process you must not take part in any gym class. Nor should you be around any activity where there is a risk of being accidentally struck on the head by an errant basketball or baseball. Any blow to the head or body could result in a repeat concussion which could have serious consequences. So watch where you are standing during outside breaks and activities.

You should also avoid carrying around heavy backpacks and loads of books from class to class. This physical exertion may be enough to bring on symptoms.

Even the climbing of stairs should be avoided, or at the very least, you should be allowed to move up and down stairs when there is no danger of being bumped by other students. If there is an elevator, get permission to use it during your recovery period.

It has been found that playing musical instruments may also be too much exertion for a recovering student-athlete, so if you are in a band, it may be wise to avoid playing until you are free of symptoms.

That being said, it is quite acceptable for you to attend gym class and simply "walk" around for short periods of time. This light aerobic exercise is good for the recovery process. Once again, where you do the walking is important. You should not be at risk of being struck on the head accidentally.

READING

If you find reading to be too strenuous during the recovery period, you can ask your teacher to arranged to have another student "read" to you, or create tapes that can be listened to later on. It is crucial that as little mental exertion be created as possible in the initial stages of recovery. This stimulation should be increased gradually under careful observation.

You will be able to build up to normal reading functionality in time, so if you can find the opportunity to do a bit of easy reading it will help the recovery. This will be considered "mental conditioning" and is just as important as physical conditioning. Just be prepared to tire quickly or lose focus on what is being read. As always, if any symptoms return while reading, then you must cease that activity.

TAKING NOTES

It has often been stated that writing is one of the most difficult skills for a person to master because of the different parts of the brain that must work to coordinate the activity. Therefore, during the recovery period it is advisable to have another student take notes and provide photo copies of lecture notes for you. This will allow you to concentrate on listening to the teacher instead of both listening and writing notes at the same time. This may not seem like a big deal, but when your brain is disabled, it can be huge.

Some teachers also allow you to video record essays, stories and assignments. Therefore, you can say what you would normally write.

CLASSROOM SEATING

Sitting at the front of the classroom or moving away from the windows and doors is something that is recommended while you are recovering from concussion. This eliminates unnecessary distractions. Many students ask to sit at the front of the room while recovering so that they can concentrate better on what the teacher is saying and avoid distractions from the rest of the class.

By sitting near the front it is much easier to listen to what the teacher is saying, so there won't be as much stress trying to hear over any other background noises.

TUTORING ASSISTANCE

Some teachers are able to arrange for the services of a peer tutor or classroom assistant who will work with you during the recovery process. This helps you keep up with the concepts taken in class, keep track of assignments, tests, etc. If you find that you are are forced to attend school every second day or on a part-time basis, a home tutor can work wonders.

EMOTIONAL STRATEGIES

A student-athlete who is suffering from a concussion is very confused and may have undergone damage to the brain that will result in behavioural or emotional symptoms. Therefore, you may experience emotional outbursts or behaviour that is completely out-of-character for you. This is normal during the rehabilitation period and teachers will be sensitive to the problems.

It is advised that you avoid placing yourself in situations which might produce significant stress on the brain. For example, talk to the Teacher and come to an agreement that if you do not raise your hand the Teacher will not call on you to answer a question or go to the front of the class to make a presentation of some sort. This may cause an unhealthy level of anxiety which could produce a "fight or flight" response and you will then have another problem to deal with.

You should also be aware of signs that you are becoming frustrated. This goes for times when you appear to be getting overly excitable or stimulated. When this happens it is best to leave the class with a friend to go someplace where you can rest for a few minutes to calm down.

The relations you have with your classmates may be strained while you are recovering. They may not fully understand what you are going through. They may take things personally when actually you are acting out of character and may not be fully aware of what you are doing. It helps if you have a close friend who is able to explain to your other friends and classmates why you are acting this way.

COUNSELLING

A brain injury can often affect a student-athlete emotionally. Therefore, it is advisable to arrange for you to meet periodically with a guidance counsellor or to meet with a teacher after school or during the day. Sometimes you just need someone to confide in and just to talk with in order to help get a grip on you emotions and you mental outlook.

The must remember the importance of being honest about symptoms that occur as you are gradually increasing the day-to-day workload in class. This is not to be considered an excuse to stay out of work, nor should you be trying to hide symptoms. If a particular kind of assignment or activity brings on symptoms such as headaches, confusion, concentration difficulties, etc., then it is critical that you let the teacher know. 

Gradually, you will be able to take on more and more of the workload, increasing the amount of concentration as long as there are no recurring symptoms. Eventually you  will build up to a full workload without any symptoms as the original injury heals. 

By the time the Head School CMP Leader is prepared to issue a School Clearance to Resume Physical Training you should be able to handle a full workload without accommodations.  

LIFESTYLE ADJUSTMENTS

That being said, you are the person who is ultimately responsible for your own rehabilitation. You shouldn't need to be told what to do by your parents/guardians, your teachers or your coaches. 

Therefore, on top of everything that has been mentioned above, let's finish off this section with some final reminders about some of the personal lifestyle adjustments you may need to make following your injury:

1. If you feel any concussion-like symptoms, DO NOT KEEP IT TO YOURSELF! Let your parent/guardian know immediately. They are responsible for your well-being and they will know what to do, but they need to be told if you are experiencing symptoms. You know what the symptoms are and you know what kind of consequences you risk if you do not heed the signs.
    
2. Immediately stop what you are doing if any symptoms return. Keep track of what it was that caused the symptoms to return so that you can monitor what level of pressure or stress triggers those symptoms. As your brain heals you will be able to increase the level more and more before the symptoms come back. This is how you can judge your rate of recovery.
    
3. When you feel up to it, you can engage in light physical activities such as walking, gradually progressing to longer and faster paced walking. You may even be able to do the stationary bike as long as you do not place any resistance on the wheel. Once you feel symptoms, cut back to the duration and pace that did not produce symptoms. Remember that this is something you can do before you return to physical training. This is not training! Don't overdo it! And do not even attempt weights lifting.
    
4. Always talk to your guidance counselor and/or classroom teacher if you are feeling overwhelmed. They understand the CMP concussion management program. They know what you are going through and are prepared to drop whatever it is they are doing to address your needs. You are not alone in this. 
    
5. Don’t try to take on too much. Take it slowly, step-by-step. Do not try to push yourself. You've suffered an injury to the most important part of your body. 
    
6. Finally, one last time so that you know how important it is: DO NOT hide symptoms from your parents/guardians, your teacher, your coach or your guidance counsellor. Your entire future depends on how well you allow your brain to recover from this injury. If something is causing symptoms it means that the healing is still taking place. Let your body do its job. Give it time.