Return to Learn-Neuropsychologist Perspective

hercegPublished:  August 1, 2014

A lot much has been made about RTP (return to play) after concussion.  Yet, RTP is one small aspect of healing from a concussion.  To high school student athletes who don’t depend on sports for their livelihood, returning to school (or learn) takes greater precedent as it will have lifelong consequence.  Thus, nowadays there is greater discussion regarding questions pertaining to “Return to School” or “Return to Learn.”

In examining this issue, a few important areas need to be addressed:

  • How does a concussion affect learning?
  • When is a student ready to return to school after a concussion?
  • Who should be included as part of the team supporting the student?
  • Identification of a student’s needs
  • Signs/symptoms
  • Cognitive rest versus exertion
  • Strategies for addressing concussion symptoms while in the classroom
  • What if symptoms persist?

Effects on Learning:  In majority of cases, there is minimal impact. However, it can adversely impact: class participation; ability to learn new information; follow through with assignments; concentrate and take notes at same time; reduced speed of reading and inability to do multi-step math problems.  Often, without an adjustment in schedule and assignments, a student can struggle to keep up.

When is a student ready to return to school? Returning to the classroom may or may not parallel returning to play. Health care professional, including physician, school nurse, guidance counselor, school psychologist and neuropsychologist, together can make determination about a student’s readiness.  In order to return, appropriate physical AND cognitive levels need to be achieved. Once deemed ready, it is vital that the “team” MUST monitor the student closely.

The school team should include the following:

  1. Student: It is vital that he/she are “in the loop” and understand each step in the process.
  2. Parents/Guardians: Need to understand what a concussion is, what health care professionals to seek out and when, and ensure that their child gets proper treatment.
  3. School Nurse: Periodic monitoring of symptoms- even after obvious physical symptoms have subsided.
  4. Teachers: Look out for changes in concentration, focus, forgetting assignments, “daydreaming” in class, fatigue, reduced interest, poor test results.
  5. School Principal/Administration: Should appoint the internal members of the team as well as designate a “manager” to ensure communication and collaboration within the team.
  6. School Psychologist/Counselor: Vigilance about changes in learning, or emotional/behavioral decline.   Help identify specialty services and resources and facilitate academic accommodations such as IEP’s & 504 plans.
  7. Physician: Responsible for diagnostic work up, basic changes in mental status, assessing all physical symptoms, ordering neuroimaging, and medications and determines return to play.
  8. Neuropsychologist: Assesses cognitive, emotional, behavioral and personality changes through objective measures. Measures that are more likely to pick up changes that computerized tests do not.  Comprehensive tests remain the cornerstone in neuro-cognitive treatment and management.  And the neuropsychologist is the  most trained individual to assess yet the least likely to have students referred to for various reasons.

Members of the team should meet on a regular basis in order to share observations and any new information from the family or health care professionals; work with the family and student to develop appropriate action plan to meet the student’s needs; and continually re-assess the student for symptoms, academic issues, and progress in healing.  This allows for any adjustments over time.

Leave a Reply