Community of Practice on Traumatic Brain Injury Seventh Meeting March 5 th , 2014
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Community of Practice on Traumatic Brain Injury
Seventh Meeting March 5th, 2014
Presenter
Presentation Notes
Welcome, fourth webinar
Today’s Agenda
www.ChildrensSafetyNetwork.org 2
• Presentation: Community-based Concussion Management
• Team Update: Nebraska & Return to Learn
Meeting Orientation Slide
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If you are having any technical problems joining the webinar please contact the Adobe Connect hotline at 1-800-416-7640 or email [email protected] Type any additional questions or comments
into the Chat box on the left.
Presenter
Presentation Notes
Thanks Bekah, your phone lines are currently muted to eliminate background noise during the presentation. If you have a question or are experiencing technical difficulties, please type them into the Chat window on your left and we will attempt to assist you. If you are having any problems joining the webinar please contact the Adobe Connect hotline at 1-800-416-7640. The phone number is also above the powerpoint slides. We have several resources available for you to download below the slide deck. To save these resources, click on the title of the resource and then hit the “download files” button. The resource will be saved to your computer. We’ll also email them out along with the archive of the webinar after the session. This meeting is being recorded. An archive and the PowerPoints from this session will be emailed to you after the webinar. At the end of the meeting we will open the phone lines for the group discussion. PLEASE REMEMBER TO MUTE YOUR COMPUTER SPEAKERS AND CALL IN IF YOU’D LIKE TO SPEAK. If you are in a location with lots of background noise, please self-mute your phone when you are not speaking. Even though your mic is muted, if you would like to speak, please use the handraise function which appears. . . .
Presenter
www.ChildrensSafetyNetwork.org 4
Dr. Karen McAvoy Director
Center for Concussion at the Rocky Mountain Youth Sports Medicine Institute
Presenter
Presentation Notes
Karen McAvoy is dually credentialed as a Licensed Clinical Psychologist and a School Psychologist in Colorado. She was the School Psychologist at the high school attended by Jake Snakenberg when he passed away from “Second Impact Syndrome” in 2004. As a result, Karen developed the multi-disciplinary team approach to community-based concussion management known as REAP (Remove/Reduce*Educate*Adjust/Accommodate and Pace). Seven years later, in 2011, the Colorado Concussion Bill is named the “Jake Snakenberg Youth Concussion Act”. After 22 years in education, Dr McAvoy was asked to open and direct the Center for Concussion with the Rocky Mountain Hospital for Children. Her experience in both educational and medical settings give her a unique perspective to develop policy and effect change in the area of concussion/brain injury.
Concussion Management It Takes a Village
Karen McAvoy, PsyD
Center for Concussion
http://www.visualizing.org/visualizations/concussion-laws-state
Second Impact Syndrome (SIS)
center4concussion.com
10
http://www.nasponline.org/publications/cq/40/6/return-to-learning.aspx
12
Recovery From Concussion
0102030405060708090
100
1 2 3 4 5
Weeks Post Concussion
% R
ecov
ered
Series1
Collins et al, 2006 Neurosurgery
Seamless System of Communication and Collaboration
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REMOVE/REDUCE REMOVE from all physical activities!
• No organized sports • No recreational play • No PE, dance class
• No physical play at recess
REDUCE home stimulation! • No texting • No TV • No computer screens • No video games
REDUCE school demands! •Mental Fatigue •Slowed Processing Speed •Difficulty converting memory into New Learning
Legislation
C O N C U S S I O N
Medical
Fam/ Stud.
Coach ATC Nurse
T I M E (usually between 7 to 21 days)
FAMILY TEAM
REDUCE Limit texting.
Limit TV, video games, computer
time. Limit homework.
Limit driving. Keep home from
dances, games, the mall. Decrease
stimulation. REST!
SCHOOL ACADEMIC TEAM
Keep home if severely symptomatic.
Return to school when symptoms are still
present but tolerable. Eliminate work,
REDUCE work, adjust work.
PACE MENTAL DEMANDS
Symptom Wheel
PHYSICAL -headache/nausea -dizziness/balance problems -blurred vision/ photophobia -noise sensitivity -neck pain
COGNITIVE Trouble with: -concentration -memory issues -mentally foggy -slowed processing
Sleep/Energy -mentally fatigued -drowsy -sleeping too much/too little -can’t initiate/ maintain sleep
EMOTIONAL Feeling more: -emotional -nervous -sad -angry -irritable
National Association of School Psychologists (NASP) Communiqué by Dr. Karen McAvoy CDE Concussion Management Guidelines (page 13)
Presenter
Presentation Notes
Direct to Communique article w/adjustments …. Student should be able to concentrate for at least 30 minutes when they return to school
Mental Fatigue
Shortened day if needed – but only for a limited time
Student should be at school to maximize instruction
Instruction (input) can’t be replicated. Work (output) can be adjusted!
“strategic rest breaks”
5 to 10 minutes of “eyes closed/head down” per period
Cutting back homework and in-class work Reducing # of problems “Auditing” lecture material Oral vs written output
Sunglasses or earphones to reduce stimuli
Emotional reactions are often signs of mental fatigue
Slowed Processing Speed
Cut back on the amount of work. Go for quality not quantity
No tests in the beginning. Eventually, extra time on projects and tests Tests can tax the brain – effect recovery Tests will not be accurate – not best measure right now
Use of technology for organization and ease
(buddy notes, tape recorder, smart pens)
Adjust due dates – but do not carry over too much work, it is not possible, it is not reasonable!
Difficulty Learning New Material
Be thoughtful about your teaching. What is most important for the student to know at this time?
Focus on comprehension, not memorization
Remove, do not postpone work: REMOVE – consider 25% NEGOTIABLE – alternative project OR
delay – but consider delaying no more than 25% REQUIRED – consider no more than 25% Piling up work causes the biggest source of stress and
it hampers recovery!
24
Recovery From Concussion
0102030405060708090
100
1 2 3 4 5
Weeks Post Concussion
% R
ecov
ered
Series1
Front Load your interventions … and then taper back
C O N C U S S I O N
Health Care Provider
Coach ATC
T I M E (usually between 7 to 21 days)
100% back to pre-
concussion level at
home now!
100% back to pre-
concussion level at school now!
1. Garbage in, garbage out. 2. Neurocognitive testing is simply a tool to
measure recovery, it is NOT the treatment. 3. Get corroborating data – Teacher Feedback
Form, it prevents “Sandbagging”.
Emergency Department REAP
0
50
100
150
200
250
300
2010-2011 2011-2012 2012-2013
193
126 163
167 98
Num
ber
of S
choo
ls E
duca
ted
Year
Schools Reached with REAP by Year
New Schools Educatedwith REAP
Schools PreviousEducated with REAP
To Date: 1693 families Get REAP in ED • Follow-up call to
parent • Encourage
follow-up with healthcare provider of their choice
• Follow-up call to school
• REAP sent to school is needed
Team Update
www.ChildrensSafetyNetwork.org 36
Nebraska: Introduction of Return to Learn Legislation
“To require schools to establish a return to learn protocol for students who have sustained a concussion. The return to learn protocol shall recognize that students who have sustained a concussion and returned to school may need informal or formal accommodations, modifications of curriculum, and monitoring by medical or academic staff until the student is fully recovered"
Thank you for your participation
Please take a moment to complete our short evaluation:
https://www.surveymonkey.com/s/CGGVW6T
Questions or Comments? Contact: [email protected] 617-618-2178
www.ChildrensSafetyNetwork.org 37
Presenter
Presentation Notes
Our next meeting is Wednesday, April second. We will be focusing on classroom accommodations and return to learn policies! I look forward to talking to you then. In the mean time, don’t forget to check out the TBI CoP page, please fill out the brief evaluation on the screen in front of you, and remember to fill out the mid-term evaluation and work with your team leader to complete the team specific mid-term evaluation. Until Next time, bye!
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