Concussion Protocol and Audio Books

Today’s post comes from a mom and brain injury advocate, Rose Cole, who is also an administrator in the University of Pennsylvania Hospital System. Her son is a student athlete, plays football and basketball, and has already suffered two concussions. As a result of her son’s experiences, Rose has learned a lot about concussions, their treatment and the laws surrounding proper care for student athletes who have suffered concussions. Here, she shares some of her experiences and the facts with us. [Download Rose's paper at the end of this post.]

**Update on 15 March 2018: Added link to a compelling article about concussions in school-age children from Western University in California. 


Watching your fourth grader be escorted off the football field after suffering a hard tackle is one of the most frightening aspects of being a parent of an athlete. Fortunately, our midget football program required an EMT be present at each game. The EMT suspected concussion and advised us to take our son to the Emergency Room. He was confirmed of suffering a mild concussion.

The emotions around that diagnosis were varied. I have worked in the health care field for the majority of my adult life so I had a bit of knowledge, but when it is your child, it puts a whole new perspective on things. I was immediately concerned for his neurological health as he got older and continued to play football as well as basketball and lacrosse.

The first and most difficult hurdle to overcome was the first few days following the concussion. For a child who is involved in so many activities, has so many friends and cannot sit still for very long; it was extremely challenging to adhere to the resting protocols. He was feeling ok, but he had to forego his beloved video games, television and playing with friends.

As it turns out, this would not be his last concussion. He suffered another a few years later while playing golf with his dad and a friend. He walked behind his friend while his friend was swinging and the club hit my son right in the eye. He suffered another concussion as well as a broken orbital bone and numerous stitches. My heart is always in my throat watching him play the sports he loves so much, praying he will not sustain one more concussion.

It is always important to follow your medical professional’s advice, and to do your own research. However, we hope this post will provide some background information that all parents of student athletes should know.

What is a Concussion?

The Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control defines a concussion as:

A type of traumatic brain injury - or TBI - caused by a bump, blow or jolt to the head that causes the head and brain to move quickly back and forth. This fast movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging the brain cells.

Along with the more common symptoms of a concussion, such as a headache or lack of alertness, a concussion can alter how your brain works in relation to memory, speech, coordination, and even sleep. Symptoms of a concussion can include a headache, nausea, difficulty concentrating, being forgetful, and extreme drowsiness. All of these symptoms would affect students’ learning patterns and behaviors.

Return to Play Legislation

According to the CDC, adolescents who do not properly recuperate have a greater risk of suffering another concussion, and if another concussion occurs while the brain is still healing, permanent brain injury or even death can be possible. Because young children’s brains are still developing, catastrophic brain injury as a result of concussion is more prevalent.

Each state has different regulations, but there are three mandates that are uniform throughout the United States. The regulations require that athletes, coaches, and parents be educated on concussions; a player must be removed from the game if they are suspected of suffering a concussion, and the player must not be allowed to return to play for a minimum of 24 hours after the injury and the return to play must be approved by a healthcare professional. 

Return to the Classroom

There is currently legislation in all 50 states to govern when an athlete is permitted to return to play. However, there is no legislation to address when a student is permitted to return to the classroom. With concussion symptoms potentially leading to cognitive deficits, the classroom setting can lead to delays in healing. Students with concussions are temporarily unable to retain material previously learned, or to process new material being taught.

How Audiobooks Can Help

Certain aspects of students’ school and home environments, such as bright lights, electronics screens, and elevated noise levels can impact the rate and quality of recuperation from a concussion. While most students recover from their concussions in fewer than eight days, up to 74% experience persistent postconcussive symptoms or PPCS for more than one month. Each student who suffers a concussion can benefit from an individualized recovery plan to work back up to his or her regular daily routine. Schools can help by providing special accommodations for recovering students. Accommodations can include extra time for taking tests, reduced work loads, avoidance of note taking or reading, avoidance of electronic screens (including smart boards), and increased provision for breaks throughout the day.

Studies have shown that students who felt their schools were positive and encouraging generally felt better about their overall condition and quality of life. Part of supporting students recovery includes maintaining a positive outlook. This can be difficult for students who are accustomed to leading full and active lives and are suddenly restricted in many ways. For example, the restrictions of being in noisy places and using electronics can be especially arduous because they limit students’ social interactions. Electronics also fill the role of providing entertainment, and without access, students can easily become bored. With the approval of a healthcare professional, students could use audiobooks to help keep up with school work. Halstead and his colleagues point out that attempting to learn can not only delay recovery, but can potentially worsen the symptoms of a concussion. Therefore, any listening should be cleared with individual students’ doctors. However, listening to the audio for books used in their classes can help students feel they are still connected to their coursework and reduce the stress associated with having to catch up. With reduced access to their primary forms of entertainment, listening to current, popular titles might help to ease students’ boredom and make the recovery time more manageable.

Much more research needs to be conducted to learn the true effects of concussions and the ability to learn. The use of audio books may be a truly useful resource for teachers, parents, and students to not only reduce the chances of worsening concussion symptoms, but also to reduce the amount of time needed for recovery.

**Please click here to download the full paper by Rose Cole, including all references.

For further reading about concussions, return to learn, and return to play protocols and school-age children, see this article from Western University. This article from District Administration discusses concussion protocol specifically in high schools

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