Why do concussions matter?

A concussion is a mild traumatic brain injury. Recognizing when one happens, knowing how to respond, and appropriately supporting a student’s return to school can make a difference to their recovery and help prevent re-injury.

Recovery from a concussion spans the home and school setting. It starts immediately following the incident causing the concussion and ends when the student has gradually returned to normal activities including academics and physical activities. Most concussions resolve within a few days or weeks, however, some concussion symptoms can last for months and have the potential to cause long-term academic and social difficulties for the student.

A concussion can have a significant impact on a student’s physical, cognitive and emotional functioning and therefore can affect the way a student learns. Every student’s recovery is unique. An individualized process which monitors a student’s symptoms and addresses issues such as workload, breaks, assessment and emotional adjustment works best. The school’s involvement in the student’s return to learn following a concussion is key.

For more information on a student’s return to learn following a concussion take the Concussion Awareness Course for School Professionals.

What is a concussion?

A concussion is a brain injury that happens when the brain moves rapidly around inside the skull. This movement can temporarily disrupt brain function which can cause physical, cognitive and emotional symptoms. A concussion can cause a variety of symptoms and may affect the way your student learns.

What causes a concussion?

Any force that causes the brain to move around in the skull can potentially cause a concussion. This can happen by a direct hit to the head or indirectly through a hit to the body that causes the head to move back and forth or rotate.

The types of activities that can cause a concussion include falls, collisions with people or objects, and motor vehicle collisions. This could occur during sports or recreational activities, at recess or lunch, in the school building, or on the way to and from school.

To be safe, you should suspect a concussion if a student has either hit their head or received a hit that could cause their brain to move rapidly in their head—EVEN if they don’t show any immediate signs of having one.

There is still much not known about concussions and the knowledge is continually changing. However, this website is updated on a regular basis and provides current education, tools, and resources to help support a student’s return to school following a concussion.

For more information on concussions take the Concussion Awareness Course for School Professionals.

Does my student have a concussion?

Any force that causes the brain to move around inside the skull can potentially cause a concussion. This can happen by a direct hit to the head or indirectly through a hit to the body that causes the head to move back and forth or side-to-side.

You should consider the student to have a concussion if the student has had an impact that caused a sudden jerk to the neck or head—EVEN if they don’t show any immediate signs of having a concussion.

Signs and symptoms of a concussion can be delayed for several hours or even days following an incident. Following is a list of signs and symptoms consistent with a concussion.

Thinking / Remembering Physical Emotional / Mood Sleep
Not thinking clearly

Feeling slowed down

Unable to concentrate

Unable to remember new information

Headache

Fuzzy or blurry vision

Nausea and vomiting

Dizziness

Sensitivity to light or noise

Balance problems

Feeling tired or having no energy

Easily upset or angered

Sad

Nervous or anxious

More emotional

Sleeping more

Sleeping less

Having a hard time falling asleep

If the student is showing any of these signs and symptoms then the student should be seen by a healthcare professional immediately.

Concussion Response Tool

The Concussion Response Tool was developed to assist in the recognition and response to concussions. You can use the first two pages to guide and document your response to a concussion at the time of the incident. The third page provides important information for the parent or guardian.

The Concussion Response Tool can also serve as an important communication tool for sharing information from the scene of the incident. Note that it does not replace school incident reports that must be completed.

For more information on recognizing a concussion take the Concussion Awareness Course for School Professionals.

Red Flag Symptoms

If your student shows any of the following Red Flag Symptoms call 911 immediately.

  • Neck pain
  • Increased confusion or irritability
  • Repeated vomiting
  • Seizure or convulsion
  • Weakness in arms/legs
  • Tingling or burning in arms/legs
  • Deteriorating consciousness
  • Loss of consciousness
  • Severe or increasing headache
  • Change in behavior
  • Double vision
What do I do if I think my student has a concussion?

If you think a student might have sustained a concussion and the student shows any of the Red Flags, call 911 immediately and notify the student’s parent or guardian.

If the student does not have any Red Flags:

  • Notify the parent or guardian
  • Monitor for Red Flags and signs of a concussion until a responsible adult arrives to pick up the student
  • Do not leave the student alone
  • Do not let the student return to activities
  • Do not let the student drive or ride a bike

It is important to know that any advice or directions given to the student at this time might not be remembered.

Concussion Response Tool

The Concussion Response Tool was developed to assist in the recognition and response to concussions. You can use the first two pages to guide and document your response to a concussion at the time of the incident. The third page provides important information for the parent or guardian.

The Concussion Response Tool can also serve as an important communication tool for sharing information from the scene of the incident. Note that it does not replace school incident reports that must be completed.

For more information on responding to a concussion take the Concussion Awareness Course for School Professionals.

My student has a concussion. What is the recovery process?

A concussion is a medical event and the recovery starts at home and continues in the school setting. The recovery process includes resting the brain followed by a gradual and well-managed return to activities—learning and playing.

Children and adolescents tend to experience a longer recovery than adults. On average, an adult takes about 7 to 10 days to recover, whereas many students will take 2 to 4 weeks to heal, and most (about 85%) will fully recover within 3 months.

The recovery process involves balancing the student’s activity level so they don’t do too much or too little. It is a fluctuating process where the student can be doing well one day but not the next.

The recovery period may be influenced by many factors including:

  • Prior concussions
  • History of headaches or migraines
  • Learning disabilities
  • Mental health issues
  • Family or social supports
  • ADHD

A Return to Learn Plan which monitors a student’s symptoms and addresses issues such as workload, breaks and assessment works best.

What is the return to learn protocol?

Returning to activities such as completing school work, socializing, participating in physical activity and using technology should be done gradually. A Return to Learn Protocol can help manage the gradual re-introduction of cognitive activities while allowing the brain to heal. The Return to Learn Protocol is a stepwise protocol that can be used to guide a student back to school following a concussion.

For more information on using the Return to Learn Protocol, take the Concussion Awareness Course for School Professionals.

How does a concussion affect my student's learning?

A concussion can affect a student’s physical, cognitive and emotional functioning. These symptoms can have an effect on a student’s learning in the following ways:

Physical Cognitive Emotional
Tires easily

Sensitive to light

Sensitive to noise

Fatigues as day/week progresses

Restlessness

Unsteadiness when walking

Headaches

Visual disturbances

Neck pain

Dizziness/lightheadedness

Nausea/vomiting

Sleep disturbance

Tires easily

Decreased academic achievement

Attendance issues

Late/incomplete homework

Difficulty concentrating

Difficulty remembering

Easily distracted

Difficulty organizing

Slowed information processing

Difficulty multitasking

Difficulty understanding concepts

Difficulty expressing themselves

Difficulty reading

Difficulty learning new information

Irritable/angry

Sad/depressed

Behaviour changes

Problems with motivation

Social issues (with peers)

Frustration

Gets upset easily

Anxiety

Restlessness

Symptoms can be situational and triggered by elements in the environment. For example, a student may experience a headache in the classroom from the fluorescent lights but the headache subsides when they go outside.

A healing brain has to work harder to accomplish anything. For many students this limited energy is compounded by:

  • Changes in their sleep patterns
  • Overexerting themselves
  • Feeling pressure to keep up with school work
  • Dealing with the emotional impacts of concussion

What learning accommodations could help a student with a concussion?

Learning accommodations are very individual. What works for one student may not work for another and performance may fluctuate daily. So it’s important to monitor the effectiveness of the selected accommodations.

The following are some examples of how to support students with concussion:

Physical Cognitive Emotional
Frequent rest breaks

Restrict physical activity including PE, team sports, recess, and lunch break

Allow student to wear sunglasses/hat, noise reducing earplugs

Seat student away from windows or bright lighting

Preferential seating to reduce distractions

Allow for a modified timetable

Access to a quiet space for breaks

Restrict classes with noise and/or safety issues

Allow class transition before bell

Reduce:
– Amount of time at school
– Academic expectations
– Work loadLimit time focusing on school workPrioritize essential school work

Avoid stimulating or noisy environments

Provide a quiet space for schoolwork

Provide class notes

Frequent rest breaks

Allow extra time to complete tasks

Allow access to the learning support teacher

Consider tutoring support

Provide opportunities for socialization

Allow student to remove themselves from situations they aren’t tolerating well

Provide avenues for student to express themselves

Access to school counsellor/psychologist

Provide supportive feedback/reassurance

Ultimately, the goal of learning accommodations is to support concussed students to participate in school to the best of their ability and to avoid:

  • Exacerbating symptoms
  • Delaying their recovery
  • Have a negative impact on their grades or social relationships

For more information on the effects of concussion on learning and learning accommodations see the Resources section or take the Concussion Awareness Course for School Professionals.

How do I prepare for my student's return to learn after a concussion?

A student’s return to learn is best supported if the school, parent or guardian, and student are prepared by completing a Return to Learn Plan. You won’t always have an opportunity to prepare before a student returns to the classroom. However, planning before the student begins any school work is important to their recovery. Not all students with a concussion will have the same needs.

It’s important that the student’s Return to Learn Plan be individualized to the student’s own needs as every student with a concussion will have a different set of symptoms and a unique recovery. Ideally, the plan should be developed in collaboration with the student’s support system.

Return to Learn Planning Tool

A Return to Learn Planning Tool was developed to assist schools in developing a Return to Learn plan for student’s returning to school with a concussion. It includes the steps for a school to take to prepare for a student’s return to learn. These include:

  1. Identifying a school contact
  2. Identifying the student’s support system
  3. Creating a return to learn plan
  4. Disseminating the plan

For more information on preparing for a student’s return to learn take the Concussion Awareness Course for School Professionals.

Who should be involved in supporting my student's return to learn?

Collaboration with the student and their support system will help manage all aspects of the student’s return to learn – at home and at school.

The student’s support system could include:

  • Parent or guardian
  • Classroom teachers
  • Administrators – principal or vice principal
  • School counsellor

Other resources may include:

  • Learning support teacher
  • Hospital or homebound teacher
  • Education assistant
  • School psychologist
  • School coach
  • Peers

In some cases, the student may have health care professionals that may need to be included. This could be:

  • Doctor
  • School nurse or public health nurse
  • Physiotherapist
  • Occupational therapist
  • Social worker
  • Mental health professional

Students could also have other caregivers for example, after school care providers or extended family members.

The key individuals in the student’s support system can be documented on the Return to Learn Planning Tool.

Should my student participate in PE?

The student’s physical activity level should be obtained from the parent or guardian and documented in their Return to Learn Plan. The student should not participate in any activity that puts them at risk for sustaining another concussion. Once a student has a concussion, it is easier for them to sustain another one. Therefore, unless under the direction of a healthcare professional, students should not participate in PE or any activity that puts them at risk for falling, or receiving a direct hit to the head or a hit to the body. For example: use of climbing equipment, running activities, gymnastics, team sports, etc. should be restricted.

Most students should tolerate regular classroom activity like moving around in the room. However, any activity that involves more physical exertion, such as a field trip where the class is going hiking or skating, should be avoided until medical clearance is obtained for increasing the student’s physical activity.

The first priority for a student is to get back to school full-time before focusing on increasing physical activity. Once back at school full-time, the student should provide written medical clearance by a healthcare professional before focusing on increasing physical activity. The student’s gradual return to physical activities should be guided by the Return to Play protocol before returning to full participation in PE.

For information on the return to play protocol visit the Concussion Awareness Training Tool for Parents, Players and Coaches.

How do I increase my student's workload?

To start, introduce school work that has a low demand on the brain. Consider how much thinking and stimulation is involved. Help the student choose work that they enjoy and is one of their strengths. The work should be at the student’s current level and therefore less likely to overwork the brain. A student should not be pressured or expected to catch up on missed school work or maintain current school work.

Follow the student’s Return to Learn Plan in regards to testing, homework and other learning accommodations. The student’s workload can be increased or decreased by adjusting their learning accommodations. A student’s return to learn is a fluctuating process where the student can be doing well one day but not the next; it’s important to ensure that the plan is reviewed and revised with the student and their support system and that the plan remains flexible enough to allow for the individual needs of the student.

For some students, falling behind in school work is difficult and this might cause them to increase their workload on their own or they might continue to work despite experiencing an exacerbation of symptoms. If a student’s symptoms are exacerbated, allow for physical and cognitive rest. Once their symptoms have subsided, try a shorter period of time. These students may need closer monitoring and reassurance to prevent a more prolonged recovery.

It’s important to get input from both the student and the parent or guardian when making decisions on the student’s workload.

For more information on preparing a Return to Learn Plan, take the Concussion Awareness Course for School Professionals.

How do I know if my student is progressing?

A Return to Learn Plan is effective if the student is progressing. The goal is to have the student remain symptom-free or in cases where the student returns to school with symptoms, to not exacerbate the symptoms.

The student’s Return to Learn Plan will include how to monitor the plan’s effectiveness including:

  • Mode and frequency of communication between the school contact and the parent or guardian – this could be using school agendas, email, and phone calls
  • Mode and frequency of communication between the school contact and the teachers
  • Timing of regular meetings to discuss the student’s progress and make adjustments as needed
  • How the student’s academic progress will be monitored
  • How the student’s emotional adjustment is monitored, by whom and what actions to take should there be concerns
  • Any issues that develop and what strategies will be implemented to address those issues

Each student’s recovery is unique. Most students will make academic progress independently, but some students may benefit from temporary learning support or tutoring to guide their progress.

When should I be concerned?

If the student does not progress within a 4 to 6 week period or there are concerns about the student’s mental health, the parent or guardian should be advised to seek further medical advice. Other professional resources can be consulted such as the school counsellor, learning support teacher or school psychologist for further recommendations.

For more information on concussions, take the Concussion Awareness Course for School Professionals.

My student seems more anxious than usual. What should I do?

A concussion can cause a student to become anxious, or if a student has pre-existing anxiety it may be exaggerated by a concussion.

There are many concerns that could lead a student with a concussion to be anxious. For some students concerns with falling behind in school, not participating in sports, fear of re-injury or an unknown recovery period can lead to feelings of anxiety.

For some students, providing supportive feedback and reassurance can help them manage their anxiety. Others may need professional support to cope with their anxiety. Early intervention is key. If you are concerned your student is having a problem with anxiety, discuss this with their parent or guardian.

A student with anxiety might need additional resources such as a school counsellor, school psychologist or other community based mental health services.

More information on supporting a student’s emotional well-being is available in the Resources section.

My student seems depressed. What should I do?

A concussion commonly causes emotional symptoms such as feeling sad, down, irritated or frustrated – particularly in adolescents. If a student has pre-existing mental health concerns, these may be exaggerated by a concussion.

Mental health changes in some students can be the result of physical changes in their brain associated with the injury itself. For others, not being able to go to school, participate in team sports, or attend social functions may lead to feelings of sadness and isolation. These emotional symptoms can interfere with recovery. Early intervention is key.

Students with a concussion should be closely monitored throughout the recovery period for behavioural changes such as withdrawing from others, acting out, and/or self harm. If you are concerned, you should contact the student’s parent or guardian.

A student with a change in their mental health might need additional resources such as a school counsellor, school psychologist or other community based mental health services.

Strategies that teachers can use to help support a student’s emotional well-being include:

  • Providing opportunities for socialization
  • Allowing the student to remove him/herself from situations they aren’t tolerating
  • Providing avenues for the student to express him/herself
  • Helping the student to access other school resources e.g. school counsellor or psychologist

More information on supporting a student’s emotional well-being is available in the Resources section.

What policies and procedures can help prevent concussion and support my student's return to learn?

As with any health and safety issue, implementing policies and procedures related to concussion is an important step to create safe and supportive environments. This type of environment decreases the likelihood of a concussion happening at school and supports a student’s return to learn.

The Comprehensive School Health model, which uses a holistic approach to integrate health and education into school practices, can be beneficial for concussion policy development. This model encompasses the whole school environment with actions in four distinct but interrelated pillars.

The ‘Our School Policies’ pillar refers to provincial, district, school or classroom policies, rules, procedures, and codes of conduct at all levels that help create and maintain a safe and healthy school environment.

Key elements of policies that support concussion prevention and management include those that support:

  • Adequate supervision of students during physical activities, like recess and lunch time activities
  • Students wearing appropriate sporting equipment, like footwear that can protect the student from falling and sustaining a concussion, or helmets which do not prevent concussions but can decrease the risk of more serious injury.
  • The response to concussion incidents that happen at school such as a concussion response protocol or procedure. This would be similar to or become part of an existing policy on responding to a student who is ill or injured at school.
  • A student’s return to school following a concussion including return to learn planning, documentation and communication. For example, incorporating the return to learn planning and protocol outlined in the Concussion Awareness Course for School Professionals.
  • Education of school personnel, including teachers, administrators and support staff, including professional days and information sessions. This could include using this website.
  • Concussion awareness and prevention strategies such as parent handouts, school newsletters and websites
  • Safe school environments such as the BC Safe, Caring and Orderly Schools guide

To help in the development of strategies including policies and procedures, examples of programs in other school jurisdictions are available in the Resources section.

For more information on developing policies related to concussion take the Concussion Awareness Course for School Professionals.

School professionals play a key role in supporting a student’s return to learn