Special Considerations
We now know, 70% of concussions will resolve within 4 weeks, in Tier 1 general education supports.
However, there remains a subset of students, around 30%, who continue to experience physical, cognitive, emotional or sleep/energy symptoms beyond the 4 week mark. In those cases, parents are encouraged to explore existing educational programs within the school system. Various initiatives, such as Response to Intervention (RTI) and Multi-Tier System of Support (MTSS), offer increasing levels of support for students experiencing conditions that impact their learning. While concussion is typically a short-term condition, in some instances, it may require elevated levels of educational support if symptoms persist. The concept of ascending levels of support underscores the importance of more tailored teaching methods and reasonable academic accommodations in the general education classroom for all students facing academic challenges.
For weeks 1-4 of a concussion, we maximize the student’s recovery by focusing on robust academic “adjustments” in the general education classroom. Beyond 4+ weeks, we focus on academic "accommodations".
For the small percentage of students who struggle with persisting concussion symptoms beyond 4+ weeks, they may need a longer amount of "targeted intervention" called academic "accommodations" at Tier 2. Academic "accommodations" may be provided via a Health Plan, a Learning Plan, and/or a 504 Plan. It is still hoped that the accommodations are temporary and amenable to intervention but it is recognized that they may take months (instead of weeks) for progress to show. Lastly, in the rare event that a permanent "disability" is determined to be responsible for the educational struggle, the student may be assessed and staffed into Specially Designed Instruction, also known as special education services (IDEA) for a traumatic brain injury (TBI) and provided an IEP (Individualized Education Program) at Tier 3. This would be rare and constitute an extremely small number of students with a concussion. For Tiers 2 and 3, the interdisciplinary teams need to continue to work together. Parents and HCPs need to seek medical explanations and treatment for "persisting symptoms"; educators need to continue to provide the appropriate supports and the school physical team needs to continue to keep the student out of high risk physical play. Due to the cumulative effect of multiple concussions, schools are advised to keep track of the number and trajectory of concussions/TBI's throughout a child's entire academic career.
Concussion Management Guidelines Pyramid Diagram
A triangular pyramid diagram showing the Multi-Tier System of Support (MTSS)/Response to Intervention (RTI) framework for concussion management with three tiers:
Pyramid Structure
Tier 3 (Top - Yellow)
Intensive Intervention for FEW students
Includes Special Education/IDEA Modifications/SDI
Tier 2 (Middle - Green)
Targeted Intervention for SOME students
Includes Formalized Academic Accommodations Plan (504)
Tier 1 (Bottom - Pink)
Universal Core Instruction for ALL students
Includes Informal Classroom Adjustments
Blue arrows between tiers indicate movement between levels of support based on student needs. The diagram is labeled "Interdisciplinary Concussion Management Guidelines" at the top and "Multi-Tier System of Support (MTSS)/Response to Intervention (RTI)" at the bottom.
Words Matter: Use these terms intentionally: Adjustments/ Accommodations/Modifications
DAYS TO WEEKS: Academic Adjustments = informal, flexible day-to-day supports in the general education classroom for the first 4 weeks of a concussion. Can be applied and lifted easily, by a classroom teacher without need for permission/meetings, when no longer needed. Considered Tier 1 of MTSS/RTI.
WEEKS TO MONTHS: Academic Accommodations = slightly longer supports to the environment/ learning to account for a longer than 4+ week recovery. Helps with adjusted grading and helps justify school supports for a longer time. Considered Tier 2 of MTSS/RTI.
MONTHS TO YEARS: Academic Modifications = actual changes to the curriculum/placement/instruction. Considered Tier 3 of MTSS/RTI. Student must meet IDEA criteria for Specially Designed Instruction (SDI).
Medical Note
Any condition that was present prior to the injury, such as a history of headaches/migraines, learning/ attentional problems, emotional diagnoses, can get amplified during a concussion due to the energy crisis of a concussion. Additionally, new research is finding that we must be especially cognizant that a concussion may be contributing to or bringing on higher levels of depression, anxiety and behavioral/ emotional responses in children and adults.
Students who have experienced multiple concussions or who exhibit more symptoms with less force, may be at risk for long term complications. Studies indicate that individuals who suffer one concussion are at an increased risk of sustaining future concussions.
Retirement from sport: If the burden of one concussion or each successive concussion is significant, the family, school and medical teams should discuss retirement from sport.