Boulder Valley School District has established a protocol for students who have experienced traumatic brain injuries, including concussions. The overall aim is supporting students as their brain recovers and focuses on returning them back to school as soon as possible.
“People don’t realize that there are things you can do in school to help aide in the speed of recovery and give students better outcomes both physically and academically,” explained BVSD School Nurse Consultant Kate Fatica.
Fatica leads Boulder Valley’s Brain Injury Resource Team (BIRT), which includes health experts from both inside and outside the district and developed BVSD’s Guideline for Concussion Management in Students. The resource helps guide schools as they navigate the precious time after a traumatic brain injury (TBI). It provides schools with information on several relevant strategies, from what to look for after a student bumps their head at school to the temporary adjustments that may be made in the classroom to support an injured student to guidance on when to allow students to return to sports and other activities.
“We return to learn first, then we have a return to activity protocol and then we have them return to play,” said Fatica.
BVSD encourages students to return to learning as soon as possible
Students who have suffered a TBI, whether at school, at home or elsewhere, are encouraged to notify the school after seeking appropriate medical attention.
“Everyone experiences the recovery through a concussion differently, but there are things that we know are beneficial in helping the brain to heal in a more timely fashion,” Fatica said. “If you can pace your brain and take things easy and pace yourself through your day, that is the ideal situation.”
By making a few adaptations to a student’s day and environment, they can return to school.
“Really these are just accommodations like what teachers would use with a lot of other students in their class – but since concussions are so limited in their time span, it doesn’t force us to create a formal plan. It is a little more fluid,” Fatica said. “If you understand the neuro/metabolic changes that are going on with the cells in the brain after a concussion – they’re expending a ton of energy just to get through the normal tasks that you would do every day. When your brain cells get fatigued, that is when you see symptoms. For you, it might be a headache, for me it might be dizziness, but regardless your brain cells are trying to do too much. When this happens, we pull it back in a little.”
In the past, students were often kept home longer, but the latest research and experience has shown that returning sooner is better for the recovering student, both physically and psychologically.
“If you do too much brain rest, like sitting in a dark room, that has also been shown to prolong recovery. It is like working your muscles. If you don’t do anything with your muscles, they are going to waste away. You don’t want to your brain to be completely shut off. You want to be reintegrating, but you want to do it in a balanced way,” Fatica said. “Additionally, we don’t want to completely isolate the student. If you think about it from a student perspective, especially an athlete – someone who is already separated from their sport and then all the sudden they are isolated from all these other activities that they normally do. It can really impact how they deal with that – especially on the social-emotional level.”
The district also provides additional support when students have longer-term or more complex injuries. The BrainSTEPS team, a multi-disciplinary team, which includes speech therapy, occupational therapy, physical therapy, a school psychologist, school nurses and special education/504 experts, works closely with the school.
“We assign one of our team members to the case. We try to pick the most appropriate team members so we know if it is something causing balance issues we might send PT to consult on the case,” Fatica said. “One of our team members reviews the case with the school, consults with them and gathers more information, and then we bring it back to our team and we look at it together and review and brainstorm some ideas of what maybe can help them.”
Protocol has been a game-changer
The protocols have brought consistency and increased support for both schools and families struggling to navigate these injuries.
“The reason we have written the policy the way we have is that we’re trying to put the power back into the hands of the schools to help these kids so they get back to school earlier. It is not normal for a kid to sit at home and not be active,” said Dr. Sherrie Ballantine, a member of BVSD’s BIRT and a physician for CU Sports Medicine.\
“What we are really trying to get the parents to understand is that it is OK for your students to be in school with a concussion. We really want to help them pace themselves through the day so they can get through the whole school day. They can stay on top of their work,” added BVSD Health Services Director Stephanie Faren. “If parents keep kids home too much, they can develop school avoidance. They really have a much more difficult time coming back to school and readjusting to routine and schedules. On the other hand, some of our high performing students don’t slow down at all or want less work because they feel it will affect their chances of getting into college. Either way, students can get farther behind and more overwhelmed because either they don’t take the time to heal or don’t stay engaged. Then depression and anxiety can set in. These issues can become more of a problem and last longer than the concussion itself. It can become a long term problem for some students.”
“It has been amazing. Most families say they just wished that they knew about it earlier,” Ballantine said. “We want to bring some awareness that this concussion policy exists and it is progressive. There are not a lot of places that have something like this,” said Dr. Ballantine. “It has been transformative for the families I work with and in the district. It has been fantastic for me professionally to see how my skill set can be used to enhance our kids in the Boulder Valley School District and their life quality."
LEARN MORE: Concussion 101 - February 25
Join us on February 25 at Monarch High School for Concussion 101, a FREE informational class provided to parents, athletes and coaches to educate them on signs, symptoms and treatment for concussions in young athletes.
The event, which will feature presenter Sherrie Ballantine-Talmadge, D.O., Assistant Professor Department of Orthopedics, University of Colorado School of Medicine, Primary Care Sports Medicine, is brought to you by the Brain Injury Resource Team (BIRT) of the Boulder Valley School District, CU Sports Medicine, Boulder Community Health and Good Samaritan Medical Center.