Concussion Signs

We love this graphic from the Brain Injury Association and wanted to pass this helpful information along to our readers:

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Mindfulness with Everyday Objects

Mindfulness isn’t just a buzzword; it is actually a powerful tool for both adults and children to reduce stress and help with emotional regulation.  Although the techniques can be very effective, they can be difficult to explain to children.  This article from Offspring shows us how to teach mindfulness to children using everyday objects, such as stuffed animals, an ice cube, an apple, and even a Hershey’s Kiss. The activities come from Susan Kaiser Greenland who wrote The Mindful Child. Visit Offspring.lifehacker.com to learn more about these techniques and see videos that demonstrate the activities.

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Do you know who your Concussion Contact is?

If you are not sure what a Concussion Contact is, much less who your Concussion Contact is, don’t be alarmed – you are not alone.  This term comes from the 2015 North Carolina Return to Learn After Concussion Policy, which took effect during the 2016-2017 school.  The North Carolina Department of Public Instruction created this Implementation Guide to help school districts meet the learning, emotional, and behavioral needs of all students, following a concussion.  They also produced this Parent Information Brochure (also available in Spanish) to provide information for families.

The Return to Learn (RtL) Policy was intended to broaden the existing 2011 Gfeller Waller Concussion Awareness Act (GWCA), which addressed concussion management for public school sports injuries.  The GWCA provided guidance for managing concussion symptoms of middle and high school students, including return-to-play guidelines.  However, the GWCA did not address student concussions that were not directly related to sports or that occurred outside of public school sports.  It also did not address injuries to younger students and the focus was clearly on returning to play, not to the classroom.

The RtL guidelines essentially broaden and expand the existing GWCA to include all of our students, regardless of where and how the concussion was sustained.  While it is absolutely critical to ensure student safety before they return to the playing field, we are thrilled to see that DPI recognizes that they are students first, and athletes second.  Return to Learn is focused on classroom success, not just athletic success.

The biggest part of RtL involves each school district developing a plan for how to respond to student concussions.  This includes immediately removing the child from any activity that could result in further injury, as well as written notification to all stakeholders (including coaches, administrators and teachers) if a student has been diagnosed with a concussion.  This is where the “Concussion Contact” comes in, as this person coordinates that student’s Return to Learn.  Each school will designate a Concussion Contact who becomes the point person in that building for any staff member who is notified that a student has experienced a concussion.

The injured student may require a Medical Care Plan, if there are lingering physical effects, or an Educational Care Plan, if there are academic, behavioral or emotional difficulties resulting from the concussion.  If the student is symptom-free after two weeks, the plan can be discontinued.  If symptoms persist, the student is referred to the Intervention Support Team (IST) for ongoing support and monitoring.  That Team should include a School Psychologist who is an Approved Provider of TBI evaluations – and we are fortunate to have 7 providers on staff in W-S/FCS.  DPI suggests that, if symptoms continue beyond six months, an evaluation for possible Exceptional Children’s services may be warranted.

In addition to establishing a process for returning students to the learning environment following a concussion, the Act requires that school districts provide annual training to all teachers and other school personnel on the potential behavioral and learning effects of concussion.  The Act also requires school districts to include a question related to any type of head injury/concussion on its annual student health history and emergency medical information forms.

W-S/FCS is currently rolling out the district’s plan for how to follow through with the requirements of the Return to Learn Act, but we wanted to give you a Heads Up (that’s an inside joke, for those of you not familiar with the CDC’s Heads Up program on sports-related concussions).  😊 The important thing to remember as we await more guidance is that this Act truly is about returning to LEARN, not just returning to PLAY.

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W-S/FCS TBI Focus Group

Last school year, School Psychologists Abby Flynn and Ginger Calhoun initiated a Focus Group for the members of our Psychological Services Department who are certified by the Department of Public Instruction as Approved Providers for Traumatic Brain Injury (TBI).  Although we were sad to see Ginger retire at the end of last year, we are still fortunate to have 7 psychologists who completed the additional training and supervision needed to conduct TBI evaluations.  Mandy McCoy stepped up to fill the role of co-leader after Ginger retired.

The goal of this year’s Brain Injury Awareness Campaign (recognized during the month of March) is “Change Your Mind About Brain Injuries” and that slogan aligns perfectly with the goals of our TBI  Focus Group. The Focus Group was developed to provide case consultation to our W-S/FCS colleagues, establish relationships with community agencies to improve student outcomes, gain new knowledge and skills in the field of TBI, and increase overall awareness and understanding about this low-incidence injury.

We were somewhat surprised to learn that we had only 12 students in W-S/FCS identified through the Exceptional Children’s program under the category of TBI when we started our Focus Group last year, although it’s likely that some of these students may be served under other eligibility categories.  We are excited to share that our district has now more than doubled the number of students accurately identified under the category of TBI to 25!

The Centers for Disease Control (CDC) reports that rates of TBI-related Emergency Department visits increased for all age groups from the period of 2001–2002 through 2009–2010. The highest rate of increase – by more than 50%, from 1,374.0 to 2,193.8 per 100,000 individuals – was for children four years of age and younger, and the Psychological Services Department is pleased to report that one of our Preschool Psychologists, Carolyn Roe, is certified to evaluate for possible TBI.

In our experience, TBI is not always a very “visible” injury.  Rarely do we have cases where the child had such a significant physical injury from a car/ATV accident, fall or other type of injury that it resulted in skull fractures, need for surgery or other medical intervention that results in visible physical scarring.  More often, these are “invisible” injuries, which can make a TBI difficult to understand.  For example, we’ve evaluated students with high levels of lead exposure, previous chemotherapy treatment, and near drowning.  It’s complicated because, while all of those events *could* have resulted in a TBI, not all students with those experiences necessarily experience a TBI.  Most – if not all – children will bump their heads at some point during their lives, but that doesn’t mean that they now have a TBI.

Effects of a traumatic brain injury can be very diverse, depending upon the type and location of injury.  For example, an impact to the back of the brain – not necessarily the back of the head, as the brain can essentially “rebound” inside the skull from an impact – might have some effect on visual processing.  Children who experience impact or injury to the frontal lobe of the brain could experience difficulties with executive functioning, including self-regulation of emotions, behavior and thinking.  Cognitive effects of brain injuries may include attention and concentration difficulties, memory issues and problems with decision-making.  Physical effects of brain injuries may include fatigue, dizziness, headaches, or heightened sensitivity to light, sound, smell, touch taste.  Behavioral/emotional effects of brain injuries may include depression, anxiety, anger or disrupted sleep pattern. 

Because the potential effects of brain injury are so diverse, TBI assessments rarely look the same and are guided by the location/type of injury and the areas of concern demonstrated by the student.  Complex injuries mean complex evaluations, often in partnership with our Speech-Language, Occupational Therapy, Physical Therapy and School Nurse colleagues.  As School Psychologist Mandy McCoy notes, “If you’ve evaluated one student with a TBI, you’ve evaluated one student with a TBI.”

We’v had the opportunity to talk about TBI with several groups, including school psychologists, EC case managers, school nurses, school social workers and speech-language therapists.  If you are interested in learning more about TBI, please reach out to  your School Psychologist – we’d love to help!

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MTSS as a Solution to Special Education Disproportionality

·       North Carolina is moving towards implementation of  a multi tiered system of support (MTSS) where students who have academic difficulty are required to go through targeted intervention before being referred to special education. MTSS as a framework is designed to provide students with high-quality instruction and intervention that match their needs. MTSS considers several factors that may impact a student’s ability to learn in order to ensure that we are not inappropriately referring students to special education. 

       Referring a child to special education services without proper investigation of environmental factors is not an effective solution. Special education is not mutually beneficial and misclassification could lead to expectations that are not consistent with the learner’s true ability (Flannagan, IASP 2015: Sheperd, 1975). In other words, telling a child and their family that they have a disability when they don’t, leads to them internalizing this message and impacts their motivation and confidence. For decades and presently there is a nationwide epidemic of special education disproportionality. Special education disproportionality is the over-representation of students from marginalized identities within special education. For example, the U.S. Office of Civil Rights reported that since 1968 African-American students have been over-represented in the intellectual disability and emotional disturbance category (NEA Report on Special Education Disproportionality, 2008). 

        Educational and psychological researchers are finding that children from marginalized identities are more likely to be placed in special education than their white peers. The reason for this is the pressure teachers feel to refer children to special education who are struggling academically. It is important to note that children from marginalized identities may face immense challenges due to systemic barriers which may be the underlying cause of academic failure and behavioral disruption. MTSS is an attempt at resolving this issue by allowing teachers and staff to make data informed and holistic decisions about a child’s ability, paying particular attention to environmental factors. 

        Disproportionate numbers of students with marginalized identities in special education contributes to systemic oppression. Minority children who are mis-identified lose out on access to a rigorous curriculum which perpetuates the achievement gap. 












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Advances in Diagnosing Concussions

Continuing with our theme of sharing information about head injuries during the month of March, which is Brain Injury Awareness Month, we wanted to share with you this exciting research from Penn State Medical Center. 

Although the research sample was small – a total of 52 patients between the ages of 7 and 21 – the findings were impressive.  The patients who had experienced a head trauma were asked to do a saliva test – simply spitting into a cup – that was analyzed for biomarkers of concussion.  The patients also completed the Standardized Concussion Assessment Tool 3, a questionnaire used to help make a diagnosis of mild Traumatic Brain Injury (mTBI).  The researchers discovered that the saliva biomarkers were more accurate than the questionnaire in identifying concussion.

School Psychologists are often asked to work with students returning to the learning environment following a concussion.  One of the toughest challenges in this work is the uncertainty surrounding the timeframe of concussion recovery.  Although further research is needed on the saliva biomarker test, this could someday help physicians determine when it might be safe for our students to return to sports or school following a mTBI.

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Controversy With Allergy Scene in “Peter Rabbit” Movie

Last year, we posted about the high rate of bullying in school age children with food allergies.  Studies have shown that in many of these cases the children were bullied with the allergic food, often by the bullies waving it in front of the children or forcing them to touch it.  You can read more about Food Allergy in the School Setting here. 

In the new “Peter Rabbit” movie, one scene hits painfully close to home for these families.  It highlights this type of bullying in a way that many parents and caretakers of children with life-threatening allergies feel is insensitive, irresponsible, and even dangerous. You can read more about their concerns Here and learn why they have decided to boycott the movie  What do you think about this controversy?  We would love you to weigh in on this topic.

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Congressional Hearings on TBI

As part of our continuing focus on Traumatic Brain Injuries during the month of March, we wanted to share additional information with you about this important topic.  On October 13. 2017, medical experts and NFL players testified to members of Congress on the latest research regarding CTE (Chronic Traumatic Encephalopathy) and their experiences and decline in their health from the constant jostling of the brain. The message to Congress was clear that more regulations and information need to be enforced especially with our youth involved in sports. The evidence provided included a 15 year old suffering from CTE, as he was involved in youth football from a young age.

The research and players stories are fascinating. This link will allow you to view the hearing, or CSPAN continues to air this important and vital information on TV.  Please take a look, as the impact to our youth is evident.

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Concussions Not the Cause of CTE

As you may already know, Winston-Salem/Forsyth County Schools’ Psychological Services Department has a group of 7 psychologists that are NC DPI Approved Traumatic Brain Injury (TBI) providers. We’re in the business of identifying and supporting brain injuries, as well as raising awareness. March is Brain Injury Awareness Month and we hope to provide continued information on this topic throughout the month.

Chronic Trauma Encephalopathy, also known as CTE, has become more widely studied and discussed in the sports world recently. In this article from CNN, a study by Dr. Lee Goldstein found that CTE is not actually the result of concussions, but is instead trauma resulting from exposure to multiple head impacts over time.  Not all hits to the head result in concussions and it seems that people only pay attention when a concussion has actually been sustained.  However, Dr. Goldstein’s study revealed that characteristics associated with CTE could be seen even without experiencing a concussion.  Changes to the brain that may be associated with CTE could be seen as soon as 24 hours after injury. This means that the “neurodegenerative disease (CTE) can start early and without any signs of concussion.”

Currently, CTE is diagnosed with an autopsy after death, but researchers are working to find indicators to help detect it in the living, which will hopefully lead to potential treatments. Dr. Goldstein has joined other researchers and former players to launch the Concussion Legacy Foundation’s Flag Football Under 14 Initiative to inform parents about the dangers of football’s repetitive hits.  This initiative reminds us that “you can play football differently” and that  “there are all sorts of ways to do it more safely.”

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