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National attention on concussion management includes a

controversial debate involving the appropriate time for students to


return to the cognitive demands of school. Young adults attending
college who have sustained a concussion are returning to school
prematurely resulting in decreased academic performance and
inappropriate application of physician recommended academic
adjustments. The Occupational Performance Center, a clinic
focused on identifying individuals performance capabilities &
deficits, simulates the tasks associated with school or work,
develops supports to assist in individual performance and is a
liaison between school and medical professionals for this
population.

The program, which is still under development, will have five


graded phases, which are constructed on symptoms tolerance,
cognitive endurance and academic performance. Each phase
consists of graded activities to ensure the proper progression to
standard classroom demands. The program includes focused
assessments, clinical tools and outcome evaluations to
demonstrate effectiveness of school reintegration.

Concussion Program Phase Overview


Phase 1
Accident-1 week (Moser, Glatts, & Schatz, 2012)
Cognitive rest till symptoms are manageable in the absence of auditory and visual
stimuli.
Phase 2
7-10 days post injury- reported average recovery of symptoms and neurocognitive
function (Sady, Vaughan, & Gioia, 2011)
Graded levels of reading activities throughout the day (determined by symptom
tolerance and activity endurance)
Graded levels of listening activities throughout the day (determined by symptom
tolerance and activity endurance)
Quiz on the reading/listening task given to determine if student retained any
information presented
Reflections Questions
Identify and educate client about symptom management strategies
Provide Symptom Checklist to monitor, grade tasks and see progress
Phase 3
10 days till student returns to school

OT Role: Occupational therapists can play a role in program


formation by encompassing the person, environment, occupation
(school) and performance factors to ensure academic success
through a graduated re-entry process: using academic
adjustments, modifications, strategies, advocacy and a liaison
between the medical and school professionals. Occupational
therapists can analyze tasks and develop alternative ways to
perform such tasks.
Future Goal: The program is projected to educate students,
families and professionals involved with the plan of care about
concussion and its effect on school performance. The program is
expected to support academic needs for school reintegration.

Thank you to those who have provided professional opinion and


dedicated time to help build and support this program:
Occupational Performance Center at The Rehabilitation
Institute of St. Louis, Dr. David Brody, Dr. Maurizio Corbetta, Dr,
Raman Malhotra, Dr. Mark Halstead, and MAJ Erik Johnson,
MS, OTR/L. Photo Credit: Dr. Christine Berg, AYAPS
assessment collection

Combine reading or listening with written task to simulate the college classroom
environment
Incorporate a pre-recorded lecture, so the student can be evaluated on listening to a
lecture, reading the slides, and transcribing notes (Can use a computer to type notes or
use hand written notes)
In second half of day student will take a short quiz on material to determine recall
capabilities
Implement an at-home make-up work schedule to have student prepared to return to
class
Administer the PTI Oral Directions Test for quantitative comparison with performance
Use Symptoms Checklist to monitor, grade task and see progress
Begin incorporating Academic Adjustments from Physician
Determine concussion advocate at the college campus
Reflection Questions
Phase 4
Return to School for Half Days- determined by 30 minutes of mental activities w/o
symptoms (Waeckerle, 2013)
Incorporate multi-tasking activities, organizational strategies, and academic
adjustments into therapy session
Student creates a writing example answering a proposed question to assess abstract
writing skills while paying attention to the question
Use Symptom Log and Checklist to identify subject matter that increase concussion
symptoms
Identify academic difficulties through communication with student, family, teacher and
concussion advocate
Reflection Questions
Phase 5
Return to Full-Time School and Academic Demands
Maintenance and Long-term Modifications based therapy
Gather academic performance information from student, family, teacher and
concussion advocate to support further treatment sessions for the student
Educate student on effective study habits
Determine and collaborate with other professionals if the academic accommodations
are long-term. If so, create a plan to ensure the student is supported throughout the
college semesters

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