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REAP
TheBenefits
ofGood
Concussion
ManagementHow every school,
parent and doctor can
create a Community-
Based Concussion
Management
Program
The REAP Project
ReduceEducateAccommodatePace
A Partnership
between:
Rocky Mountain
Hospital For Children
Sky Ridge Medical
Center
Swedish Medical
Center
and
Cherry Creek Schools
Denver Public Schools
Aurora Public Schools
Littleton Public Schools
Authored by:Karen McAvoy, Psy.D.
Endorsed by the:
Colorado Department
o Education
Made possible by a
grant from the:
Colorado TBI Trust
Fund
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he REAP Projects BI st F Ecto gt btw Rocky Mo-t Hosptl o Chl/Hlth O Emgcy Dptmts o schoolstcts. T REAP Pojct s th clmto o sty o th Ct o Dss
Cotol (CDC) om 2004 to 2007. Oglly, th sty ws sg to ocs o thccy o w bsl/post-cocsso ocogtv scg tool. Mo th othos stts t Gvw Hgh School, th Chy Ck School Dstct, wgv bsl scg ov th ys. Nty-two stts wt o to s t lst ococsso (om spots o-spots lt ctv ts). T schs comp th 92cocss stts wth typcl ps, mtch o th sm spot, g g. T
slts o th sty w lghtg th schs o tht th two most sstlctos to goo cocsso mgmt : Ecto Collboto sstlly, goocommcto btw School m, Fmly m Mc l m. As slt,th REAP Pojct hs compl l l o th lssos l to ths ml to pomot Commty-Bs Appoch to Cocsso Mgmt.
Good concussion management requires
school/family/medical collaboration.
Mo th 80% o cocssos solv vy sccsslly mg wll wth th st thwks post-jy.1 T st th wks t th jy s o wow o oppotty. Ev-
yo mst st chl/stt cot wt to cov om th cocsso lt. T y o th jy s cos Dy 1 o th cocsso. Rcovy also stts o Dy
1. T Rc/Ect/Accommot/Pc (REAP) Pojct wll hlp th School m,Fmly m Mcl m mxmz covy g th st th wks post-jy. Rsch shows tht th vg covy tm o olsct s log th o lt.2
I yo chl/stt ss cocsso, th REAP pojct wll pov EctolLso to mt wth ct school tms, mly tms mcl tms (t ochg) ot to mxmz th 3 wk wow o oppotty. T REAP Poj-ct c b ccss by cllg 720-554-4252. Rocky Mot Hosptl o Chl/HlthO Emgcy Dptmts c lso ccss th REAP pojct by xg HIjy Follow-Up Fom to AN: REAP @ 720-554-4272.
FT
Family
Team
Student, Parents; may include Friends,
Grandparents, Primary Caretakers, and
others
ST/P
The School
Physical
Team
Coaches, Certied Athletic Trainers (ATC),
Physical Education Teachers, Playground
Supervisors, School Nurses, and others
ST/C
The School
Cognitive
Team
Teachers, Counselors, School Nurses, School
Psychologists, School Social Workers,
Administrators, and others
MTMedical
Team
Emergency Department, Primary Care
Physician, Family MD, Physicians Assistant,
Nurse, Concussion Specialist, and others
Community-Based ConcussionManagement Team
Loss o consciousness (LOC) is necessary or a concussion to be diagnosed.
False! Accog to th Amc Assocto o Nology (AAN), cocsso s y t-mtclly c ltto mtl stts tht my o my ot volv loss o coscosss.CDC pots tht stmt 1.6 to 3.8 mllo spots cto lt cocssos occ th Ut Stts ch y.3 90% o cocssos o ot volv loss o coscosss. Whlmy stts cv cocsso om spots-lt ctvts, mos oth cocssos
occ om lls, moto vhcl, bcycl plygo ccts.
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Medical note rom Sue Kirelik, MD.
Director o Pediatric Emergency
Medicine, Sky Ridge Medical Center,REAP Medical Advisor.
Newer recommendations are that children and teens should be treated much more conservatively than adults
when it comes to a head injury. The developing brain is very dierent rom the adult brain and much more likely
to maniest symptoms later and have longer term problems when injured, especially i the child is not allowed to
rest and recover. Because each concussion and each child is dierent, grading scales are no longer recommend-
ed. Care or each child and each concussion must be individualized.
How to use this ManualBcs t s mpott o ch mmb o th Cocsso Mgmt m to kow st th p t th pt ooths mmbs, ths ml ws wtt o th t tm. Howv, s omto s spclly ptt to ct gop,t s ot by colo.
Pay close attention to the sections in YELLOW.
FT
Parents, Students, Guardians,
Grandparents, Friends
Fo mo spcc omto o pts, owlo pt ct shts omth Hs Up oolkt: Fo Cochs Fo Physcs om th CDE wbst:www.cc.gov/cocssoIYothSpots/glsh/toolkt_pts_ctsht.htm
Pay close attention to the sections in BLUE.
ST/P
Coaches, Certied Athletic Trainers(ATC), Physical Education Teachers,Playground Supervisors, School
Nurses.
Fo mo spcc omto o Cochs, owlo th Hs Up ool-kt o Cochs om th CDCwbst: www.cc.gov/cpc/tb/Cochs_ool_Kt.htm
Pay close attention to the sections in PURPLE.
ST/C
Teachers, Counselors, School Nurs-
es, School Psychologists, School
Social Workers, Administrators
Ts REAP ml plcs mo mphss o tps o ctos s th lttlkow socs vlbl tlg spcc cocsso gls o c-tos. Gl omto c b o o th CDC wbst: www.cc.gov/cpc/p/spotlt/SYothSSchools.htm
Pay close attention to the sections in GREEN.
MTPediatricians, Family MDs, Primary
Care Physicians (PCP), Physician As-
sistants (PA), Nurses, School Nurses
Fo mo spcc omto o pts, owlo pt ct shts omth Hs Up oolkt: Fo Cochs Fo Physcs om th CDE wbst:www.cc.gov/cpc/tb/physcs_tool_kt.htm
REDUCE EDUCATE ACCOMMODATE PACESPECIAL
CONSIDERATIONS RESOURCES APPENDIX
A concussion is benign; it is just a
bump on the head.
False! Actl ly, cocsso s ml t-mtc b jy (mBI). T symptomsollowg cocsso c g om ml
to sv slly volv: coso,sotto, ms, slow ctos xtm motol ctos. T svtyo th symptoms cot b pct t thtm o th jy. T tms cocsso mBI wll b s tchgbly thogh-ot th st o ths ml.
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After your child/student has been evaluated and diagnosed for their concussion,
There is One Immediate and Essential Focus.
1Reduceth pottl o th jy to th b! Sco Impct Syom (SIS) s th phomo whch pso ssts sco blow to th h bo th st cocsso hs hl. SIS s kowto cs pmt mg /o v th. It tks mml mpct to cs th sco cocsso.4
To, t s mptv tht tl cocsso s 100% solv, stt mst b mov om y ctvtytht c pottlly cs th jy.
In the Fall o 2004, Jake Snakenberg was a reshman
ootball player at Grandview High School. He likely
sustained a concussion in a game the week prior,
but his symptoms were mild and he did not ully
understand that he had experienced a concussion.
One week later, Jake took a typical hit in a game,
he collapsed on the eld and never regained
consciousness. Jake passed away rom Second
Impact Syndrome on September 19, 2004
2Reducephyscl cogtv ms! ypclly wh thlt s j, physcl ms o thtj mmtly cs ( REAP, ths s REDUCE) th slowly t g h-bltto ( REAP, ths s PACE). I thlt s g mtho sps kl, th mmt
cto s movl om th c. Wth pop mgmt covy om th jy, th thlt my b l lowto g lt c. Athlts kow, l to mmtly c th physcl ms ollowg jy chv sos log-tm cts.
I th mtho o l, cocsso s lk th sp kl t s jy to th b. Sc th b s thog sposbl o mgg ll physcl cogtv ctos o th boy, both physcl cogtv -ms o th b mst b c g covy om cocsso. Fl to c both physcl cogtvms wll hmp covy. School s th plc wh cogtv ms th hghst. Spcc sttgs tschool ( REAP, ths s ACCOMMODAE) mpott o hcg covy om cocsso.
REDUCE
Message to Educators
Message to Educators REAP cannot
stress enough, management o con-
cussion requires that there is an equal
partnership between the members
o the school team who manage the
physical reduction and members o the
school team who manage cognitive
reduction. See ACCOMMODATIONS orhow to reduce cognitive load.
Message to Parents
I you want to maximize your childs
recovery rom concussion, double up
on your Rs. REDUCE and REST! Force
your child to rest, especially or the rst
ew days post-concussion and through-
out the three week recovery period.
Dont let your child convince youhe/she will rest later (ater the prom,
ater nals). Rest must happen imme-
diately! The school team will help your
child reduce cognitive load (see AC-
COMMODATIONS). However, it is your
job at home to help to reduce sensory
load i.e., it is advised that teens avoid
loud group unctions (games, dances),
avoid video games and text messag-
ing. Because reaction time is almostuniversally slowed down ollowing a
concussion, driving should be limited/
restricted pending medical clearance.
Plenty o sleep and quiet, restul
activities post-concussion maximizes
your childs chances or a great recov-
ery!
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EDUCATE
STEP 2: Managing Your Concussion
Management TeamT CDC/Gvw Hgh School sty mostt tht symptom qcy tsty typclly hghst Dys
1 thogh 4, cot thoghot Wk 1 bg to w thoghot Wks 2 3. Yo wll otc tht REAP hsvlop sggst tml by whch symptoms chck moto REAP hs ssg sposbltsto ct tm mmbs/ct tms to mg spcc symptoms. As vy mBI s t q, yo tmwll to b f fxbl.
Wth th gls st oth th REAP tml, t s comm tht th Cocsso Mgmt m -c (cs by cs):
Who wll b th School m Physcl (S-P) pot pso,
Who wll b th School m Cogtv (S-C) pot pso,
Who om th school wll commct wth th mly tm (F)
Who wll commct wth th mcl tm (M).
Dg th CDC/Gvw sty, th AC ot ct s th S-P; oth tms th School Ns ct s th S-P.T School Psychologst o Coslo slly ct s th S-C. Fqtly, tch ws th pot pso o cogtvsymptoms. T REAP mol sggsts tht o pso tk sposblty o mtg wth th stt (ly o t spctvls) to objctvly t symptoms. Tt o pot pso s ssg th ty o hlpg th stt complt, wt-g, th symptom tg scl. As o symptom coc/mpovmt th sh wth oth pot popl mggvos symptoms so tht ccommotos/csos c b m. REAP sggsts tht socs l low o oly o potpso t th school, tht pso mst b qlly cpbl o mgg cogtv/motol symptoms s wll s physclsymptoms. T mjoty o th commcto th CDC/Gvw sty hpp v pho, ml o o-o-o.Mtgs w mml.
A concussion is usually diagnosed
by neuroimaging tests (ie. CT scan
or MRI).
False! Cocssos cot b tct by -omgg tsts; cocsso s ctol, otstctl jy. Cocssos typclly g-os by cl xmto o th sgs/symp-toms o cocsso t th tm o jy thsbsqt solto o symptoms. Whl Csc o MRI s ot s to l ot mosos blg th b, t s ot gos-
tc tst o cocsso. A gtv sc os otm tht cocsso ot occ.
Ciera was 15 years old when she suered a concussion while playing basketball. H symptoms o pssg ot,costt hchs tg plg h o th m o h shm y. O o th most hlpl ccom-motos o C hs b:
It really helped me when my teachers had class notes already printed out. Tat way I could just highlight what the teacher wasemphasizing and ocus on the concept rather than trying to take notes. Since having a brain injury, I dont really see words on theboard, I just see letters. Tereore, having the notes beorehand takes some o the rustration o o me and I am able to concentrateand retain what is being taught in class. Being able to rest in the middle o the day is also very important or me. I become very
atigued ater a morning o my rigorous classes, so my counselors have helped me adjust my schedule which allows me some down
time so I can keep going through my day. Lastly, taking tests in a dierent place such as the conerence room or teachers ofce hashelped a great deal. Ciera Lund
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REAP suggests the ollowing timerame:TEAM WEEK 1 WEEK 2 WEEK 3
FT
Family TeamHlp chl sth/sh mst b hostpt th tg o
symptoms
Impose REST Assess symptoms daily especial ly monitor
mtc symptoms motol symp-toms.
Continue to assess symptoms (at least3X wk o mo s ), moto symptoms mpovg.
Increase demands and assess symptoms.
Continue with all assessments (at least2X wk o mo s )
Increase or decrease demands basedpo otcom (s PACE).
ST/P
School Team Physical
Coach/ATC/SchoolNurse
(1 pot pso to ovs/mg physcl symp-toms)
REAP suggests immediate removal from play/physcl ctvts!
Assess physical symptoms daily, use objectivetg scl.
ATC/Coach: assess postural-stability(s NAA c RESOURCES).
School Nurse: monitor visits to school clinicI symptoms t school sgct, cotctpts s hom om school.
Continue to assess that symptoms arempovg (t lst 3X wk o mo s).
Step-wise increase in physical demands(s PACE).
ATC/Coach: postural-stability assess-mt.
Continue with all assessments (at least2X wk o mo s ).
Increase or decrease demands basedpo otcom (s PACE.)
ATC/Coach: do postural-stability as-sssmt.
ST/C
School Team CognitiveEducators, School Psy-
chologist, Counselor,Social Worker
(1 pot pso to ovs/mg cogtv/mo-tol symptoms)
*Gt Rls o Iom-to sg mmtly totlk to MD
Reduce all cognitive demands immediately!(Rc, o ot lmt cogtv ms)
Meet with student individual ly to createcmc ccommoto pl o cogtv/motol cto o lt th Dy 2/3 &th ssss g.
Educate all teachers on the symptoms of con-csso (s Cocsso s Mo T Bmpto th H Appx).
Make immediate academic accommodations(s ACCOMMODAIONS).
Continue to assess that symptoms arempovg (t lst 3X wk o mo s).
Slow increase in cognitive demands (seePACE).
Continue academic accommodations as.
Continue with all assessments (at least2X wk o mo s ).
Increase or decrease demands basedpo otcom (s PACE).
Continue academic accommodations as.
Assess if longer term academic accom-motos my to b m (504Pl, IEP, tc.).
MT
Medical Team Assess and diagnose concussion. Monitor that symptoms are improving
thoghot Wk 1 - ot wosg th st48 to 72 hos.
Continue to consult with school and hometms.
Follow-up medical check including:comphsv hstoy, ologc xm,tl ssssmt o mtl stts, cog-tv cto, gt blc.
Continue to consult with school andhom tms.
*It is best practice that a medical proessional be involved in
each and every Return-to-Play decision
Dot b lm tht th symptoms, th gog to b symptoms - symptoms th hllmk o cocsso.T gol s to b wtchg o slow sty mpovmt ALL symptoms ov tm.I symptoms psst to Wk 4, s SPECIAL CONSIDERAIONS.
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ACCOMMODATE
Most Common Cognitive Problems Post-Concussionand suggested accommodations
Areas of concern Suggested Accommodations
Fatigue, specically MentalFatigue
Strategic rest strategic rest is scheduled. Do not wait until the student is so over-tiredthat they meltdown. Adjust the schedule to incorporate a 15-20 rest period mid-morn-
ing and a rest period mid-aternoon.
Missing recess or reading quietly does not constitute a rest period.
Difculty concentratingFeels like being in a fog
Reduce the cognitive load. Smaller amounts o learning will take place during the recov-ery. Since learning during recovery is compromised, you must decide: What is the most
important concept or the student to learn? Do not tax them cognitively.
Slowed processing speed
Feels like being converted from high speed internet todial up internet
Extra time on tests and projects. Assess whether the student has large tests or projects
due during the 3 week recovery period. Remove or adjust due dates.
Difculty with working memoryThe ability to temporarily store and manage informa-
tion during complex cognitive processes such as
learning and reasoning
Initially exempt rom routine work/tests. During recovery, they have limited workingmemory: What is the most important concept(s) you want them to know? Work toward
comprehension o material versus rote memorization.
Difculty converting new learning
into memory
Allow student to audit the material during this time. Remove busy work that is not
essential or comprehension. Making the student accountable or all o the work missedduring the recovery period (3 weeks) places undue emotional hardship on them and may
hamper recovery. Ease student back into ull load.
Emotional symptoms Be mindul o emotional symptoms throughout! Students are oten scared, overloaded,rustrated, irritable, angry and depressed as a result o mTBI. They respond well to educationand support during recovery.
Mo -pth omto commtos c b o th BSARS Ml (s RESOURCES)
School Team Educators
When an athlete is injured, the
coaches keep the athlete engaged
with the team (by attendingpractices, traveling with the team)even when the athlete cannot play.
This concept o keeping the student
involved and engaged in academics,in spite o the concussion, is very
important. Even though it is achallenge, the school team must
devise a plan to keep the student
academically conditioned andengaged in learning throughout
the entire three week recoveryperiod.
Interesting research note:The CDC/Grandview Study
demonstrated that concussedstudents were minimally absent
rom school during their recovery
and yet recovered well. This fndingis reinorced by a 2008 study
showing that concussed studentswho maintained moderate levels
o activity (not 100% bed rest and
not 100% on-the-go) had the mostpositive recovery!6
Me
dicalBox The newest research shows that neuropsychological testing has signicant clinical
value in concussion management, especially with children and especially whenbaseline scores are available. The addition o neuropsychological tests is emerging
best practice. However, limited resources and training are a reality or school dis-
tricts. An extensive list o paper and pencil neurocognitive tests known to be sensi-tive to mTBI can be ound at COkidswithbraininjury.com. I a school district chooses
to include neurocognitive testing o any type, REAP is still the oundation o the
Concussion Management program. Data gathered rom serial post-concussiontesting (by Day 2/3, by Day 7, by Day 14 and by Day 21, i still symptomatic) can
only serve to provide additional inormation. No single test score should ever be
used in isolation. All ethical quidelines o test administration and interpretationmust be adhered to.
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PACE
STAGE ACTIVITY FUNCTIONAL EXERCISE CHILD/STUDENT EQUIVALENT OBJECTIVE OF STAGE
1
No physical activity as long as there are
symptoms (This step could take days or even weeks)Complete physical rest Quiet time with maximum rest Recovery
When 100% symptom free for 24 hours proceed to Stage 2. (Younger children may need a longer symptom-free period.)
2Once 100% symptom-free:Light aerobic activity
Walking, swimming, stationery cycling,10-15 minutes o exercise
Solitary play, quiet parallel play Increase heart rate (light to moderate workout not requiringcognitive attention or high degree of coordination)
If symptoms reemerge with this level of exertion then return to the previous stage. If the athlete remains symptom free for 24 hours after this level of exertion then proceed to the next stage.
3Sport-specic exercise
Skating/running drills, 20-30 minutes in
gym, no head contactSupervised play, low risk activities
Add movement (increased attention and coordination
required)
If symptoms reemerge with this level of exertion then return to the previous stage. If the athlete remains symptom free for 24 hours after this level of exertion then proceed to the next stage.
4Non-contact training drills
Progression to more complex training
drills, high impact aerobicsMay run/jump as tolerated
Exercise, coordination (mimics athletes sport without
risk of head injury)
If symptoms reemerge with this level of exertion then return to the previous stage. If the athlete remains symptom free for 24 hours after this level of exertion then proceed to the next stage.
5Full-contact practice
Following medical clearance, participate
in normal training activities; ull exertion
Normal participation in non-contact
activities
Restore condence and assess unctional skills
by coaching sta(or family)
If symptoms reemerge with this level of exertion then return to the previous stage. If the athlete remains symptom free for 24 hours after this level of exertion then proceed to the next stage.
6 Return to Play Normal game play Normal playtime No Restrictions
Physical:Once symptom-free, increase
physical demands via step-wiseprogression
Physical:Do symptoms return or worsen
with added physical demand?
Physical:Continue to progress through
steps until Return-to-Play (RTP)GraduatedPacing
ConcussionD
ay1
REST
If NO
If YES
Cognitive:Once symptoms abate, increase
cognitive demands slowly
Cognitive:Do symptoms return or worsen
with increased cognitive oremotional demands?
Cognitive:Continue to slowly increase
cognitive demands until Return-to-Full-Learning
Return to previous step where child/student was without symptoms. Rest 24hours before attempting the next higher step again.
Graduated Return-to-
Learning/Cognitive ReturnRsmpto o oml cogtv ctv-ty ollows th sm pcpls s th -smpto o gt physcl ctvty
wth mtl st tl symptom th gl cs o cogtv -ms. (s ACCOMMODAIONS)Ulss chl/stt s ctly llom th cocsso, h/sh my tto school wthot sgct ly slog s cmc ccommotos plc. Cogtv ctvty s gllycs s log s th stt mssymptom . I symptoms mg
wth mtl xto, th th cog-
tv ctvty s g c tl thstt s bl to complt tht lvl ocogtv lo wthot symptoms.
The 2008 Zurich Consensus Statement on Concussion in Sport Recommends
A Graduated Return-to-Play (RTP)
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PACE
A mcl octo, whth th Emgcy Dptmt o t yo ollow-p clc, cot pct th lgth th cos o covy om cocsso. T bestssssmt o whth stt s y to t 100% to ply o to
lg s:
are symptoms resolving?
do symptoms worsen or return upon exertion?
Tt omto s oly vlbl o ly bss to th stt, th pt th school tm. Ev th most -volv mcl octo wl l lkly ot b bl to s th stt o ly bss, tho, th ssssmt motogo symptoms mst b collct by th school tm, th mly tm mst b sh wth th mcl octo. T kyto sccss s communication and collaboration!
In the spirit of teamworkthe decision for the child/student to return to full 100% activities (or play) cannot or shouldnot be made by any one single member of the team.. For example, an ATC should not return a child/student to contact playwithout educator/parent/medical professional input and support. Likewise, an outside medical professional should not make
a RTP decision without the school and home team input. In other words, the RTP/R-to-Learning decision must be madeby consensus of the Concussion Management Team, in consultation withmedical professionals.
When Symptoms do not Resolve as ExpectedAppoxmtly 10% to 20% o cocssos o ot solv 3 wks. Wh
symptoms (physcl, cogtv, motol o mtc) o ot solv s xpct,t s sggst tht th ch l/stt wok wth th mcl possol to ps
mo spclz otptt vlto (mcl o psychtc).As stt thoghot th ml, complct cocsso wll glly -
solv wth th wks. It s xtmly cot-ct o chl/st-ts to b bst om school (oth th th st y o two wh th cocsso smost ct). Howv, th log-tm sql o th cocsso css o qs xt bsc om school /o slts th o spc lz ssssmt/o pogmmg (IDEA o 504 Pl), t wol b ws to clssy th stt shvg b jy st thogh B Ijy svcs. It s byo th ocso ths ml to ct th scop o ssssmt pogmmg o b jy,howv, my school stcts hv B Ijy ms o cosltto sppot.Gls to hlp ctos cos b jy schools c b o o th
COkswthbjy.com wbst. My oth b jy socs lst th RESOURCES scto.
A parent should
awaken their child
each time they allasleep ollowing a
head injury.
False! Ct m-cl vc s tht t sot gos to llow chl to slp t h jy, octhy hv b m-clly vlt. T bst
ttmt o cocs-so s slp st.
Management o Concussion is Difcult Because it is a Moving Target
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SPECIALCONSIDERATIONS
Long-Term MonitoringSts hv ot b bl to stmt th mbs
o chl/stts who, tlly, cov wll om mBI/cocsso bt s lt om lg, mo-tol, bhvol sss. A thos poblms lt toth l mBI/cocsso? No o c sy o sbt ctos sspct th my b som cocto, s-pclly th cs o mltpl cocssos. T REAPPojct povs tmplt by whch schools, pts mcl possols c mg th shot-tm, thwk covy post-jy. Howv, th sco phs oth REAP Pojct s to h o th log tm moto-g o cocss chl/stts to th B Ijyms th 4 ptcptg school stcts ChyCk, Dv, Ao Lttlto Pblc Schools. TREAP Pojct th Coloo Dptmt o Ec-to thk ths 4 school stcts o th wllgss toollow ths chl/stts ov tm - to btt ssssth log-tm pct o mBI/cocsso. It s ot c-ssy to hv B Ijy m school stct toollow chl/stt log-tm post-REAP. Ay cgcto o kowlgbl pt c wtch ov chl/
stt thogh th ls o mBI s cog tos lm cocs mg lt th school c.
CDC/Grandview StudyT most mpott lsso l om th
CDC/Gvw sty s tht goo cocssomgmt gos byo ocogtv scg
th RP cso. Goo cocsso mg-mt goo mBI mgmt volvs xcp-tol commcto collboto btw School tm, Fmly tm th Mcl tm.Althogh gg poplty t ths tm, o osgl ssssmt (comptz, pp/pcl oothws) shol v b s solto to mk RP/RLg cso. Wh mkg s-os cso bot th hlth wll-bg o chl/stt, t s bst pctc to tlz mltpl
t pots, collct om mltpl socs. Tt sth chss o th Commty-Bs CocssoMgmt REAP Pojct.
Medical Box
Students who have Attention Decits,
Learning Disabilities, a history o migraine
headaches, sleep disorders, depression or
other psychiatric disorders may have more
difculty recovering rom a concussion.
Students who have had multiple concus-
sions, a recent prior concussion or who aregetting symptomatic ater less impact may
be at risk or long term complications.
Special Considerations...
REFERENCES
1. Colls, MW, Lovll, MR, Ivso, GL, I, , Moo, J.Exmg cocsso ts t to ply hgh school
ootbll plys wg w hlmt tchology: A th-ypospctv cohot sty.Neurosurgery2006;58:275-286
2. Fl M, Colls MW, Lovll MR, Moo J. Dos g ply ol covy om spots-lt cocsso? A compso ohgh school collgt thlts. J Pediatrics. 2003;142(5);546-53.6.
3. Lglos JA, Rtl-Bow W, Wl MM. T pmology mpct o tmtc b jy: b ovvw.J Headrauma Rehabil. 2006;21:375-78.2.
4. Ct RC. Sco mpct syom. Clin Sports Med.1998;17:3744.
5. McCoy, P., Mwss, W., Johsto, K., Dvok, J., Aby,M., Molloy, M., Ct, R. Cosss Sttmt o Cocs-so Spot: T 3 Ittol Coc o Cocs-so Spot Hl Zch, Novmb 2008. J Athl rain.2009;44(4):434-448.
6. Mjsk, CW, Mhlk, J P, R, D, Colls, MW, Ry, CC,Lovll, MR, Wg, AK. Cocsso spots:Postcocssvctvty lvls, symptoms, ocogtv pomc,J Athlrain. 2008;43(3): 265-274.
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RESOURCES
RESOURCES
Center or Disease Control (CDC): www.CDC.gov 1-800-CDC-INFO
Colorado TBI Trust Fund: www.tbicolorado.org 303-866-4779
CO Child/Adolescent Brain Injury website www.COkidswithbraininjury.com
Brain injury Association o Colorado (BIAC) www.biacolorado.org 303-355-9969
Brain Injury Association o America (BIAA) www.biausa.org
BrainSTARS www.lapublishing.com
National Association o Athletic Trainers (NATA) www.nata.org/ www.journaloathletictraining.org
Colorado Department o Education www.cde.state.co.us 303-866-6779
Acknowledgements Special thanks to: REAP thanks:
T REAP Pojctckowlgs th CDC/Grandview Study: pcplvstgtos - JDs-Lws, Ph.D., TChls Hosptl, Ao,Coloo Hl Lws,
Ph.D., JFK Pts,Uvsty Hosptl, Dv,Coloo. T sty wscoct t GvwHgh School, Chy CkSchool Dstct om 2004to 2007 th clclcto o K McAvoy,Psy.D.
L Fox, og GHSPcpl, Hy Bll, GHSPcpl thoghot CDCsty, th GHS Amsttvm
o McKch, GHS AC,Ncy Mkl, GHS SchoolNs, Alc Py, GHS
chcl Sppot
All o th GHS tchs,cochs stts
My Chsly, CCSDSptt thChy Ck School DstctLvl Amsttv m
CCSD Mcl AvsoyBo
T REAP Avsoy m: D. S Klk,D. Chyl Mlck, D. Sz Rosbg,D. Wy McB, Do Gb, Psy.D.,Nopsychologst, Cg Hosptl
T Chy Ck BI m, KstMcCllom wth Dv Pblc Schools,Shyl M wth Ao Pblc Schools Bb Rtch/Nt Tompso wth
Lttlto Pblc Schools, C mm, REAPEctol Lso
T N (BI Ntwokg ms) StgCommtt
Kll Jtz, Sho Jtz, th Jtz/Skbg mls
N L, C L th Lmly
T Coloo BI st F
Ly Bll, CCSD Dstct Athltc Dcto ll CCSD Ct Athltc s
Te REAP Project is dedicatedin memory of:
JacobSnakenberg
April 19, 1990 September 19, 200
To prevent future loss of life
to concussion
All questions or comments can bedirected to:
Karen McAvoy, Psy.D.
Coordinator o Mental Health ServicesCoordinator o the Brain Injury Team
Cherry Creek School District
720-554-4252 or
720-554-4272 fax
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APPENDIX
Concussion In ChildrenIts more than just a bump on the head!Cocssos chl c cs tmpoy chgs how thy ct, thk, l. I yo chl hs h cocsso, h o sh mght ct tly pobbly wll b
mo t o whl. Its goo to lt yo chl hv w ys o om school, tk mo st hv w xpcttos to mt o th xt wk o two. Ov th xtsvl wks, wtch o ths possbl chgs:
Changes in Behavior and Energy Changes in Thinking Changes at School Changes in Feelings
Has lots o headaches Is very tired; sleeps too much or too little
Tantrums; impulsive or aggressive at times; short use
Quiet, shy, or talking less than usual
Doesnt seem motivated; not concerned aboutperormance
Doesnt listen when corrected; doesnt seem to care whenin trouble
Not interested in usual activities
Has trouble getting started on work or activities
Not organized; doesntcomplete tasks
Forgets or cant rememberthings
Is upset by noises, lights,crowds, or busy places
Forgets assignments or doesnot hand in work
Does well one day andpoorly the next; grades areworse
Messy, incomplete, ordisorganized work
Doesnt pay attention inclass
Big emotional reactions Gets upset easily; more
worried or moody
Quiet or sad
Seems easilyoverwhelmed
Kp m tht w poblms ctg, thkg, o lg c b to yo chl s cocsso. Rmmb tht yo c gt hlp o ths poblms.ll yo chls octo, yo school s, school psychologst, tchbot th cocsso. Ask yo school psol to c th ms o yochl o th xt w wks. T Coloo Dptmt o Ecto (CDE),B Ijy Assocto o Coloo (BIAC) COkswthbjy.comhv hlpl omto o mBI mgmt o th wbsts.
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APPENDIX
POST-CONCUSSION SYMPTOM SCALE
SYMPTOMS SEVERITY RATING
Headache0 1 2 3 4 5 6
Nausea 0 1 2 3 4 5 6
Vomiting 0 1 2 3 4 5 6
Balance Problems 0 1 2 3 4 5 6
Dizziness 0 1 2 3 4 5 6
Fatigue 0 1 2 3 4 5 6
Trouble Falling Asleep 0 1 2 3 4 5 6
Sleeping More than Usual 0 1 2 3 4 5 6
Sleeping Less than Usual 0 1 2 3 4 5 6
Drowsiness 0 1 2 3 4 5 6
Sensitivity to Light 0 1 2 3 4 5 6
Sensitivity to Noise 0 1 2 3 4 5 6
Irritability 0 1 2 3 4 5 6
Sadness 0 1 2 3 4 5 6
Nervous/Anxious 0 1 2 3 4 5 6
Feeling More Emotional 0 1 2 3 4 5 6Numbness or Tingling 0 1 2 3 4 5 6
Feeling Slowed Down 0 1 2 3 4 5 6
Feeling like In a Fog 0 1 2 3 4 5 6
Difculty Concentrating 0 1 2 3 4 5 6
Difculty Remembering 0 1 2 3 4 5 6
Visual Problems 0 1 2 3 4 5 6
Other 0 1 2 3 4 5 6
TOTAL
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APPENDIX
GRADED SYMPTOM CHECKLIST (GSC)SYMPTOM TIME OF INJURY 2-3 HOURS POST-INJURY 24 HOURS POST-INJURY 48 HOURS POST-INJURY 72 HOURS POST-INJURY
Blurred Vision
Dizziness
Drowsiness
Excess Sleep
Easily Distracted
Fatigue
Feel In a Fog
Feel Slowed Down
Headache
Inappropriate Emotions
Irritability
Loss o Consciousness
Loss o Orientation
Memory Problems
Nausea
Nervousness
Personality Change
Poor Balance/Coordination
Poor Concentration
Ringing in Ears
Sadness
Seeing Stars
Sensitivity to Light
Sensitivity to Noise
Sleep Disturbance
Vacant Stare/Glassy Eyes
Vomiting
NOE: T GSC shol b s ot oly o th tl vlto bt o ch sbsqt ollow-p ssssmt tl ll sgs symptoms
hv cl t st g physcl xto. I l o smply chckg ch symptom pst, th AC c sk th thlt to g o scoth svty o th symptoms o scl o 06, wh 0 = ot pst, 1 = ml, 3 = mot, 6 = most sv.
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TheREAPProject is a Partnership between:
Rocky Mountain Hospital or Children
Swedish Medical Center
Sky Ridge Medical Center
and
Aurora Public Schools
Cherry Creek SchoolsDenver Public Schools
Littleton Public Schools
Endorsed by the: Colorado Department o Education
Made possible by a grant from the: Colorado TBI Trust Fund
Authored by: Karen McAvoy, Psy.D.