STEP THREE: ADJUST/ ACCOMMODATE for EDUCATORS.
School Team Educators
RTL refers to a teacher’s ability to help a student with a concussion learn to “pace” levels of energy in order to maximize learning while minimizing symptom flare-ups. A RTL plan is most robust when classroom teachers, are empowered to make educational decisions for their students hourly, daily and weekly, as they see fit. While outside medical input may be helpful in an RTL plan, teachers need not wait for medical input/”clearance”/approval to apply or remove academic adjustments. RTL recommendations provided by healthcare providers are “suggestions,” not mandates.
Schools may accept or reject outside RTL suggestions based upon its educational soundness, feasibility and alignment with school policy/protocol and the appropriateness in the educational setting.
Most Common “Thinking” Cognitive Problems Post-Concussion
And suggested adjustments/accommodations
Fatigue, specifically Mental Fatigue
- Schedule “strategic” rest periods. Do not wait until the student’s over tiredness results in an emotional “meltdown.” Proactively adjust the schedule to incorporate a 15-20 minute rest period 1X mid-morning and 1X mid-afternoon, as needed. Wean back breaks when no longer needed.
- Allow for “PACING” – 5 to 10 minute eye/brain/water breaks in the classroom after periods of mental exertion.
- Do not consider “quiet reading” as rest for all students.
- Consider letting the student have sunglasses, headphones, preferential seating, quiet work space, passing in quiet halls, etc., as needed.
Difficulty concentrating
- REDUCE the cognitive load—it is a fact that smaller amounts of learning will take place during recovery from concussion.
- Since learning during recovery is compromised, the academic team must decide: What is the most important concept for the student to learn during this recovery?
- Be careful not to tax the student cognitively by demanding that all learning continue at the rate prior to the concussion.
Slowed processing speed
- Provide extra time for tests and projects and/or shorten tasks.
- However, do not just give extensions or postponements of work - REMOVE non-essential work and REDUCE semi-essential work.
- Assess whether the student has large tests or projects due during the 4-week recovery period and reduce demands or adjust due dates.
- Provide a peer notetaker or copies of teacher’s notes during recovery.
- Grade work completed – do not penalize for work not completed; consider exemption of non-essential work without penalty whenever possible.
Difficulty with working memory
- Initially exempt the student from routine work/tests (but don't forget to add those back in as tolerated - teachers don't have to wait for medical approval to do so).
- Since memory during recovery is limited, the academic team must decide: What are the most important concepts for the student to know?
- And what are some creative ways to assess for that knowledge (and give a grade) when memorization for a test can be compromised during concussion recovery?
- Work toward comprehension of material versus rote memorization.
Difficulty converting new learning into memory
- Allow student to “audit” the material during this time (i.e. listen without demands to prove mastery).
- REMOVE “busy” work that is not essential for comprehension. Making the student accountable for all of the work missed during the recovery period (4 weeks) places undue cognitive and emotional strain on the student and may hamper recovery
- Ease student back into full academic/cognitive load.
Emotional symptoms
- Be mindful of emotional symptoms throughout! Students are often scared, overloaded, frustrated, irritable, angry and depressed as a result of concussion. They respond well to support and reassurance that what they are feeling is often the typical course of recovery.
- Watch for secondary symptoms of depression – usually from social isolation.
- Watch for secondary symptoms of anxiety – usually from concerns over make-up work or slipping grades.
- Research informs us that a concussion can have an impact on emotional well-being. Supportive psychological support, education, cognitive-behavioral strategies and stress reduction are all suggested for psychological rehabilitation. Involve school counselors/mental health professionals as needed.