McKercher - REAP Project Manual4

8/9/2019 McKercher - REAP Project Manual4

1/16

REAP

TheBenefits

ofGood

Concussion

ManagementHow every school,

parent and doctor can

create a Community-

Based Concussion

Management

Program

The REAP Project

ReduceEducateAccommodatePace

A Partnership

between:

Rocky Mountain

Hospital For Children

Sky Ridge Medical

Center

Swedish Medical

Center

and

Cherry Creek Schools

Denver Public Schools

Aurora Public Schools

Littleton Public Schools

Authored by:Karen McAvoy, Psy.D.

Endorsed by the:

Colorado Department

o Education

Made possible by a

grant from the:

Colorado TBI Trust

Fund


2/16

he REAP Projects BI st F Ecto gt btw Rocky Mo-t Hosptl o Chl/Hlth O Emgcy Dptmts o schoolstcts. T REAP Pojct s th clmto o sty o th Ct o Dss

Cotol (CDC) om 2004 to 2007. Oglly, th sty ws sg to ocs o thccy o w bsl/post-cocsso ocogtv scg tool. Mo th othos stts t Gvw Hgh School, th Chy Ck School Dstct, wgv bsl scg ov th ys. Nty-two stts wt o to s t lst ococsso (om spots o-spots lt ctv ts). T schs comp th 92cocss stts wth typcl ps, mtch o th sm spot, g g. T

slts o th sty w lghtg th schs o tht th two most sstlctos to goo cocsso mgmt : Ecto Collboto sstlly, goocommcto btw School m, Fmly m Mc l m. As slt,th REAP Pojct hs compl l l o th lssos l to ths ml to pomot Commty-Bs Appoch to Cocsso Mgmt.

Good concussion management requires

school/family/medical collaboration.

Mo th 80% o cocssos solv vy sccsslly mg wll wth th st thwks post-jy.1 T st th wks t th jy s o wow o oppotty. Ev-

yo mst st chl/stt cot wt to cov om th cocsso lt. T y o th jy s cos Dy 1 o th cocsso. Rcovy also stts o Dy

1. T Rc/Ect/Accommot/Pc (REAP) Pojct wll hlp th School m,Fmly m Mcl m mxmz covy g th st th wks post-jy. Rsch shows tht th vg covy tm o olsct s log th o lt.2

I yo chl/stt ss cocsso, th REAP pojct wll pov EctolLso to mt wth ct school tms, mly tms mcl tms (t ochg) ot to mxmz th 3 wk wow o oppotty. T REAP Poj-ct c b ccss by cllg 720-554-4252. Rocky Mot Hosptl o Chl/HlthO Emgcy Dptmts c lso ccss th REAP pojct by xg HIjy Follow-Up Fom to AN: REAP @ 720-554-4272.

FT

Family

Team

Student, Parents; may include Friends,

Grandparents, Primary Caretakers, and

others

ST/P

The School

Physical

Team

Coaches, Certied Athletic Trainers (ATC),

Physical Education Teachers, Playground

Supervisors, School Nurses, and others

ST/C

The School

Cognitive

Team

Teachers, Counselors, School Nurses, School

Psychologists, School Social Workers,

Administrators, and others

MTMedical

Team

Emergency Department, Primary Care

Physician, Family MD, Physicians Assistant,

Nurse, Concussion Specialist, and others

Community-Based ConcussionManagement Team

Loss o consciousness (LOC) is necessary or a concussion to be diagnosed.

False! Accog to th Amc Assocto o Nology (AAN), cocsso s y t-mtclly c ltto mtl stts tht my o my ot volv loss o coscosss.CDC pots tht stmt 1.6 to 3.8 mllo spots cto lt cocssos occ th Ut Stts ch y.3 90% o cocssos o ot volv loss o coscosss. Whlmy stts cv cocsso om spots-lt ctvts, mos oth cocssos

occ om lls, moto vhcl, bcycl plygo ccts.


3/16

Medical note rom Sue Kirelik, MD.

Director o Pediatric Emergency

Medicine, Sky Ridge Medical Center,REAP Medical Advisor.

Newer recommendations are that children and teens should be treated much more conservatively than adults

when it comes to a head injury. The developing brain is very dierent rom the adult brain and much more likely

to maniest symptoms later and have longer term problems when injured, especially i the child is not allowed to

rest and recover. Because each concussion and each child is dierent, grading scales are no longer recommend-

ed. Care or each child and each concussion must be individualized.

How to use this ManualBcs t s mpott o ch mmb o th Cocsso Mgmt m to kow st th p t th pt ooths mmbs, ths ml ws wtt o th t tm. Howv, s omto s spclly ptt to ct gop,t s ot by colo.

Pay close attention to the sections in YELLOW.

FT

Parents, Students, Guardians,

Grandparents, Friends

Fo mo spcc omto o pts, owlo pt ct shts omth Hs Up oolkt: Fo Cochs Fo Physcs om th CDE wbst:www.cc.gov/cocssoIYothSpots/glsh/toolkt_pts_ctsht.htm

Pay close attention to the sections in BLUE.

ST/P

Coaches, Certied Athletic Trainers(ATC), Physical Education Teachers,Playground Supervisors, School

Nurses.

Fo mo spcc omto o Cochs, owlo th Hs Up ool-kt o Cochs om th CDCwbst: www.cc.gov/cpc/tb/Cochs_ool_Kt.htm

Pay close attention to the sections in PURPLE.

ST/C

Teachers, Counselors, School Nurs-

es, School Psychologists, School

Social Workers, Administrators

Ts REAP ml plcs mo mphss o tps o ctos s th lttlkow socs vlbl tlg spcc cocsso gls o c-tos. Gl omto c b o o th CDC wbst: www.cc.gov/cpc/p/spotlt/SYothSSchools.htm

Pay close attention to the sections in GREEN.

MTPediatricians, Family MDs, Primary

Care Physicians (PCP), Physician As-

sistants (PA), Nurses, School Nurses

Fo mo spcc omto o pts, owlo pt ct shts omth Hs Up oolkt: Fo Cochs Fo Physcs om th CDE wbst:www.cc.gov/cpc/tb/physcs_tool_kt.htm

REDUCE EDUCATE ACCOMMODATE PACESPECIAL

CONSIDERATIONS RESOURCES APPENDIX

A concussion is benign; it is just a

bump on the head.

False! Actl ly, cocsso s ml t-mtc b jy (mBI). T symptomsollowg cocsso c g om ml

to sv slly volv: coso,sotto, ms, slow ctos xtm motol ctos. T svtyo th symptoms cot b pct t thtm o th jy. T tms cocsso mBI wll b s tchgbly thogh-ot th st o ths ml.


4/16

After your child/student has been evaluated and diagnosed for their concussion,

There is One Immediate and Essential Focus.

1Reduceth pottl o th jy to th b! Sco Impct Syom (SIS) s th phomo whch pso ssts sco blow to th h bo th st cocsso hs hl. SIS s kowto cs pmt mg /o v th. It tks mml mpct to cs th sco cocsso.4

To, t s mptv tht tl cocsso s 100% solv, stt mst b mov om y ctvtytht c pottlly cs th jy.

In the Fall o 2004, Jake Snakenberg was a reshman

ootball player at Grandview High School. He likely

sustained a concussion in a game the week prior,

but his symptoms were mild and he did not ully

understand that he had experienced a concussion.

One week later, Jake took a typical hit in a game,

he collapsed on the eld and never regained

consciousness. Jake passed away rom Second

Impact Syndrome on September 19, 2004

2Reducephyscl cogtv ms! ypclly wh thlt s j, physcl ms o thtj mmtly cs ( REAP, ths s REDUCE) th slowly t g h-bltto ( REAP, ths s PACE). I thlt s g mtho sps kl, th mmt

cto s movl om th c. Wth pop mgmt covy om th jy, th thlt my b l lowto g lt c. Athlts kow, l to mmtly c th physcl ms ollowg jy chv sos log-tm cts.

I th mtho o l, cocsso s lk th sp kl t s jy to th b. Sc th b s thog sposbl o mgg ll physcl cogtv ctos o th boy, both physcl cogtv -ms o th b mst b c g covy om cocsso. Fl to c both physcl cogtvms wll hmp covy. School s th plc wh cogtv ms th hghst. Spcc sttgs tschool ( REAP, ths s ACCOMMODAE) mpott o hcg covy om cocsso.

REDUCE

Message to Educators

Message to Educators REAP cannot

stress enough, management o con-

cussion requires that there is an equal

partnership between the members

o the school team who manage the

physical reduction and members o the

school team who manage cognitive

reduction. See ACCOMMODATIONS orhow to reduce cognitive load.

Message to Parents

I you want to maximize your childs

recovery rom concussion, double up

on your Rs. REDUCE and REST! Force

your child to rest, especially or the rst

ew days post-concussion and through-

out the three week recovery period.

Dont let your child convince youhe/she will rest later (ater the prom,

ater nals). Rest must happen imme-

diately! The school team will help your

child reduce cognitive load (see AC-

COMMODATIONS). However, it is your

job at home to help to reduce sensory

load i.e., it is advised that teens avoid

loud group unctions (games, dances),

avoid video games and text messag-

ing. Because reaction time is almostuniversally slowed down ollowing a

concussion, driving should be limited/

restricted pending medical clearance.

Plenty o sleep and quiet, restul

activities post-concussion maximizes

your childs chances or a great recov-

ery!


5/16


6/16

EDUCATE

STEP 2: Managing Your Concussion

Management TeamT CDC/Gvw Hgh School sty mostt tht symptom qcy tsty typclly hghst Dys

1 thogh 4, cot thoghot Wk 1 bg to w thoghot Wks 2 3. Yo wll otc tht REAP hsvlop sggst tml by whch symptoms chck moto REAP hs ssg sposbltsto ct tm mmbs/ct tms to mg spcc symptoms. As vy mBI s t q, yo tmwll to b f fxbl.

Wth th gls st oth th REAP tml, t s comm tht th Cocsso Mgmt m -c (cs by cs):

Who wll b th School m Physcl (S-P) pot pso,

Who wll b th School m Cogtv (S-C) pot pso,

Who om th school wll commct wth th mly tm (F)

Who wll commct wth th mcl tm (M).

Dg th CDC/Gvw sty, th AC ot ct s th S-P; oth tms th School Ns ct s th S-P.T School Psychologst o Coslo slly ct s th S-C. Fqtly, tch ws th pot pso o cogtvsymptoms. T REAP mol sggsts tht o pso tk sposblty o mtg wth th stt (ly o t spctvls) to objctvly t symptoms. Tt o pot pso s ssg th ty o hlpg th stt complt, wt-g, th symptom tg scl. As o symptom coc/mpovmt th sh wth oth pot popl mggvos symptoms so tht ccommotos/csos c b m. REAP sggsts tht socs l low o oly o potpso t th school, tht pso mst b qlly cpbl o mgg cogtv/motol symptoms s wll s physclsymptoms. T mjoty o th commcto th CDC/Gvw sty hpp v pho, ml o o-o-o.Mtgs w mml.

A concussion is usually diagnosed

by neuroimaging tests (ie. CT scan

or MRI).

False! Cocssos cot b tct by -omgg tsts; cocsso s ctol, otstctl jy. Cocssos typclly g-os by cl xmto o th sgs/symp-toms o cocsso t th tm o jy thsbsqt solto o symptoms. Whl Csc o MRI s ot s to l ot mosos blg th b, t s ot gos-

tc tst o cocsso. A gtv sc os otm tht cocsso ot occ.

Ciera was 15 years old when she suered a concussion while playing basketball. H symptoms o pssg ot,costt hchs tg plg h o th m o h shm y. O o th most hlpl ccom-motos o C hs b:

It really helped me when my teachers had class notes already printed out. Tat way I could just highlight what the teacher wasemphasizing and ocus on the concept rather than trying to take notes. Since having a brain injury, I dont really see words on theboard, I just see letters. Tereore, having the notes beorehand takes some o the rustration o o me and I am able to concentrateand retain what is being taught in class. Being able to rest in the middle o the day is also very important or me. I become very

atigued ater a morning o my rigorous classes, so my counselors have helped me adjust my schedule which allows me some down

time so I can keep going through my day. Lastly, taking tests in a dierent place such as the conerence room or teachers ofce hashelped a great deal. Ciera Lund


7/16EDUCATE

REAP suggests the ollowing timerame:TEAM WEEK 1 WEEK 2 WEEK 3

FT

Family TeamHlp chl sth/sh mst b hostpt th tg o

symptoms

Impose REST Assess symptoms daily especial ly monitor

mtc symptoms motol symp-toms.

Continue to assess symptoms (at least3X wk o mo s ), moto symptoms mpovg.

Increase demands and assess symptoms.

Continue with all assessments (at least2X wk o mo s )

Increase or decrease demands basedpo otcom (s PACE).

ST/P

School Team Physical

Coach/ATC/SchoolNurse

(1 pot pso to ovs/mg physcl symp-toms)

REAP suggests immediate removal from play/physcl ctvts!

Assess physical symptoms daily, use objectivetg scl.

ATC/Coach: assess postural-stability(s NAA c RESOURCES).

School Nurse: monitor visits to school clinicI symptoms t school sgct, cotctpts s hom om school.

Continue to assess that symptoms arempovg (t lst 3X wk o mo s).

Step-wise increase in physical demands(s PACE).

ATC/Coach: postural-stability assess-mt.

Continue with all assessments (at least2X wk o mo s ).

Increase or decrease demands basedpo otcom (s PACE.)

ATC/Coach: do postural-stability as-sssmt.

ST/C

School Team CognitiveEducators, School Psy-

chologist, Counselor,Social Worker

(1 pot pso to ovs/mg cogtv/mo-tol symptoms)

*Gt Rls o Iom-to sg mmtly totlk to MD

Reduce all cognitive demands immediately!(Rc, o ot lmt cogtv ms)

Meet with student individual ly to createcmc ccommoto pl o cogtv/motol cto o lt th Dy 2/3 &th ssss g.

Educate all teachers on the symptoms of con-csso (s Cocsso s Mo T Bmpto th H Appx).

Make immediate academic accommodations(s ACCOMMODAIONS).

Continue to assess that symptoms arempovg (t lst 3X wk o mo s).

Slow increase in cognitive demands (seePACE).

Continue academic accommodations as.

Continue with all assessments (at least2X wk o mo s ).

Increase or decrease demands basedpo otcom (s PACE).

Continue academic accommodations as.

Assess if longer term academic accom-motos my to b m (504Pl, IEP, tc.).

MT

Medical Team Assess and diagnose concussion. Monitor that symptoms are improving

thoghot Wk 1 - ot wosg th st48 to 72 hos.

Continue to consult with school and hometms.

Follow-up medical check including:comphsv hstoy, ologc xm,tl ssssmt o mtl stts, cog-tv cto, gt blc.

Continue to consult with school andhom tms.

*It is best practice that a medical proessional be involved in

each and every Return-to-Play decision

Dot b lm tht th symptoms, th gog to b symptoms - symptoms th hllmk o cocsso.T gol s to b wtchg o slow sty mpovmt ALL symptoms ov tm.I symptoms psst to Wk 4, s SPECIAL CONSIDERAIONS.


8/16

ACCOMMODATE

Most Common Cognitive Problems Post-Concussionand suggested accommodations

Areas of concern Suggested Accommodations

Fatigue, specically MentalFatigue

Strategic rest strategic rest is scheduled. Do not wait until the student is so over-tiredthat they meltdown. Adjust the schedule to incorporate a 15-20 rest period mid-morn-

ing and a rest period mid-aternoon.

Missing recess or reading quietly does not constitute a rest period.

Difculty concentratingFeels like being in a fog

Reduce the cognitive load. Smaller amounts o learning will take place during the recov-ery. Since learning during recovery is compromised, you must decide: What is the most

important concept or the student to learn? Do not tax them cognitively.

Slowed processing speed

Feels like being converted from high speed internet todial up internet

Extra time on tests and projects. Assess whether the student has large tests or projects

due during the 3 week recovery period. Remove or adjust due dates.

Difculty with working memoryThe ability to temporarily store and manage informa-

tion during complex cognitive processes such as

learning and reasoning

Initially exempt rom routine work/tests. During recovery, they have limited workingmemory: What is the most important concept(s) you want them to know? Work toward

comprehension o material versus rote memorization.

Difculty converting new learning

into memory

Allow student to audit the material during this time. Remove busy work that is not

essential or comprehension. Making the student accountable or all o the work missedduring the recovery period (3 weeks) places undue emotional hardship on them and may

hamper recovery. Ease student back into ull load.

Emotional symptoms Be mindul o emotional symptoms throughout! Students are oten scared, overloaded,rustrated, irritable, angry and depressed as a result o mTBI. They respond well to educationand support during recovery.

Mo -pth omto commtos c b o th BSARS Ml (s RESOURCES)

School Team Educators

When an athlete is injured, the

coaches keep the athlete engaged

with the team (by attendingpractices, traveling with the team)even when the athlete cannot play.

This concept o keeping the student

involved and engaged in academics,in spite o the concussion, is very

important. Even though it is achallenge, the school team must

devise a plan to keep the student

academically conditioned andengaged in learning throughout

the entire three week recoveryperiod.

Interesting research note:The CDC/Grandview Study

demonstrated that concussedstudents were minimally absent

rom school during their recovery

and yet recovered well. This fndingis reinorced by a 2008 study

showing that concussed studentswho maintained moderate levels

o activity (not 100% bed rest and

not 100% on-the-go) had the mostpositive recovery!6

Me

dicalBox The newest research shows that neuropsychological testing has signicant clinical

value in concussion management, especially with children and especially whenbaseline scores are available. The addition o neuropsychological tests is emerging

best practice. However, limited resources and training are a reality or school dis-

tricts. An extensive list o paper and pencil neurocognitive tests known to be sensi-tive to mTBI can be ound at COkidswithbraininjury.com. I a school district chooses

to include neurocognitive testing o any type, REAP is still the oundation o the

Concussion Management program. Data gathered rom serial post-concussiontesting (by Day 2/3, by Day 7, by Day 14 and by Day 21, i still symptomatic) can

only serve to provide additional inormation. No single test score should ever be

used in isolation. All ethical quidelines o test administration and interpretationmust be adhered to.


9/16

PACE

STAGE ACTIVITY FUNCTIONAL EXERCISE CHILD/STUDENT EQUIVALENT OBJECTIVE OF STAGE

1

No physical activity as long as there are

symptoms (This step could take days or even weeks)Complete physical rest Quiet time with maximum rest Recovery

When 100% symptom free for 24 hours proceed to Stage 2. (Younger children may need a longer symptom-free period.)

2Once 100% symptom-free:Light aerobic activity

Walking, swimming, stationery cycling,10-15 minutes o exercise

Solitary play, quiet parallel play Increase heart rate (light to moderate workout not requiringcognitive attention or high degree of coordination)

If symptoms reemerge with this level of exertion then return to the previous stage. If the athlete remains symptom free for 24 hours after this level of exertion then proceed to the next stage.

3Sport-specic exercise

Skating/running drills, 20-30 minutes in

gym, no head contactSupervised play, low risk activities

Add movement (increased attention and coordination

required)


4Non-contact training drills

Progression to more complex training

drills, high impact aerobicsMay run/jump as tolerated

Exercise, coordination (mimics athletes sport without

risk of head injury)


5Full-contact practice

Following medical clearance, participate

in normal training activities; ull exertion

Normal participation in non-contact

activities

Restore condence and assess unctional skills

by coaching sta(or family)


6 Return to Play Normal game play Normal playtime No Restrictions

Physical:Once symptom-free, increase

physical demands via step-wiseprogression

Physical:Do symptoms return or worsen

with added physical demand?

Physical:Continue to progress through

steps until Return-to-Play (RTP)GraduatedPacing

ConcussionD

ay1

REST

If NO

If YES

Cognitive:Once symptoms abate, increase

cognitive demands slowly

Cognitive:Do symptoms return or worsen

with increased cognitive oremotional demands?

Cognitive:Continue to slowly increase

cognitive demands until Return-to-Full-Learning

Return to previous step where child/student was without symptoms. Rest 24hours before attempting the next higher step again.

Graduated Return-to-

Learning/Cognitive ReturnRsmpto o oml cogtv ctv-ty ollows th sm pcpls s th -smpto o gt physcl ctvty

wth mtl st tl symptom th gl cs o cogtv -ms. (s ACCOMMODAIONS)Ulss chl/stt s ctly llom th cocsso, h/sh my tto school wthot sgct ly slog s cmc ccommotos plc. Cogtv ctvty s gllycs s log s th stt mssymptom . I symptoms mg

wth mtl xto, th th cog-

tv ctvty s g c tl thstt s bl to complt tht lvl ocogtv lo wthot symptoms.

The 2008 Zurich Consensus Statement on Concussion in Sport Recommends

A Graduated Return-to-Play (RTP)


10/16

PACE

A mcl octo, whth th Emgcy Dptmt o t yo ollow-p clc, cot pct th lgth th cos o covy om cocsso. T bestssssmt o whth stt s y to t 100% to ply o to

lg s:

are symptoms resolving?

do symptoms worsen or return upon exertion?

Tt omto s oly vlbl o ly bss to th stt, th pt th school tm. Ev th most -volv mcl octo wl l lkly ot b bl to s th stt o ly bss, tho, th ssssmt motogo symptoms mst b collct by th school tm, th mly tm mst b sh wth th mcl octo. T kyto sccss s communication and collaboration!

In the spirit of teamworkthe decision for the child/student to return to full 100% activities (or play) cannot or shouldnot be made by any one single member of the team.. For example, an ATC should not return a child/student to contact playwithout educator/parent/medical professional input and support. Likewise, an outside medical professional should not make

a RTP decision without the school and home team input. In other words, the RTP/R-to-Learning decision must be madeby consensus of the Concussion Management Team, in consultation withmedical professionals.

When Symptoms do not Resolve as ExpectedAppoxmtly 10% to 20% o cocssos o ot solv 3 wks. Wh

symptoms (physcl, cogtv, motol o mtc) o ot solv s xpct,t s sggst tht th ch l/stt wok wth th mcl possol to ps

mo spclz otptt vlto (mcl o psychtc).As stt thoghot th ml, complct cocsso wll glly -

solv wth th wks. It s xtmly cot-ct o chl/st-ts to b bst om school (oth th th st y o two wh th cocsso smost ct). Howv, th log-tm sql o th cocsso css o qs xt bsc om school /o slts th o spc lz ssssmt/o pogmmg (IDEA o 504 Pl), t wol b ws to clssy th stt shvg b jy st thogh B Ijy svcs. It s byo th ocso ths ml to ct th scop o ssssmt pogmmg o b jy,howv, my school stcts hv B Ijy ms o cosltto sppot.Gls to hlp ctos cos b jy schools c b o o th

COkswthbjy.com wbst. My oth b jy socs lst th RESOURCES scto.

A parent should

awaken their child

each time they allasleep ollowing a

head injury.

False! Ct m-cl vc s tht t sot gos to llow chl to slp t h jy, octhy hv b m-clly vlt. T bst

ttmt o cocs-so s slp st.

Management o Concussion is Difcult Because it is a Moving Target


11/16

SPECIALCONSIDERATIONS

Long-Term MonitoringSts hv ot b bl to stmt th mbs

o chl/stts who, tlly, cov wll om mBI/cocsso bt s lt om lg, mo-tol, bhvol sss. A thos poblms lt toth l mBI/cocsso? No o c sy o sbt ctos sspct th my b som cocto, s-pclly th cs o mltpl cocssos. T REAPPojct povs tmplt by whch schools, pts mcl possols c mg th shot-tm, thwk covy post-jy. Howv, th sco phs oth REAP Pojct s to h o th log tm moto-g o cocss chl/stts to th B Ijyms th 4 ptcptg school stcts ChyCk, Dv, Ao Lttlto Pblc Schools. TREAP Pojct th Coloo Dptmt o Ec-to thk ths 4 school stcts o th wllgss toollow ths chl/stts ov tm - to btt ssssth log-tm pct o mBI/cocsso. It s ot c-ssy to hv B Ijy m school stct toollow chl/stt log-tm post-REAP. Ay cgcto o kowlgbl pt c wtch ov chl/

stt thogh th ls o mBI s cog tos lm cocs mg lt th school c.

CDC/Grandview StudyT most mpott lsso l om th

CDC/Gvw sty s tht goo cocssomgmt gos byo ocogtv scg

th RP cso. Goo cocsso mg-mt goo mBI mgmt volvs xcp-tol commcto collboto btw School tm, Fmly tm th Mcl tm.Althogh gg poplty t ths tm, o osgl ssssmt (comptz, pp/pcl oothws) shol v b s solto to mk RP/RLg cso. Wh mkg s-os cso bot th hlth wll-bg o chl/stt, t s bst pctc to tlz mltpl

t pots, collct om mltpl socs. Tt sth chss o th Commty-Bs CocssoMgmt REAP Pojct.

Medical Box

Students who have Attention Decits,

Learning Disabilities, a history o migraine

headaches, sleep disorders, depression or

other psychiatric disorders may have more

difculty recovering rom a concussion.

Students who have had multiple concus-

sions, a recent prior concussion or who aregetting symptomatic ater less impact may

be at risk or long term complications.

Special Considerations...

REFERENCES

1. Colls, MW, Lovll, MR, Ivso, GL, I, , Moo, J.Exmg cocsso ts t to ply hgh school

ootbll plys wg w hlmt tchology: A th-ypospctv cohot sty.Neurosurgery2006;58:275-286

2. Fl M, Colls MW, Lovll MR, Moo J. Dos g ply ol covy om spots-lt cocsso? A compso ohgh school collgt thlts. J Pediatrics. 2003;142(5);546-53.6.

3. Lglos JA, Rtl-Bow W, Wl MM. T pmology mpct o tmtc b jy: b ovvw.J Headrauma Rehabil. 2006;21:375-78.2.

4. Ct RC. Sco mpct syom. Clin Sports Med.1998;17:3744.

5. McCoy, P., Mwss, W., Johsto, K., Dvok, J., Aby,M., Molloy, M., Ct, R. Cosss Sttmt o Cocs-so Spot: T 3 Ittol Coc o Cocs-so Spot Hl Zch, Novmb 2008. J Athl rain.2009;44(4):434-448.

6. Mjsk, CW, Mhlk, J P, R, D, Colls, MW, Ry, CC,Lovll, MR, Wg, AK. Cocsso spots:Postcocssvctvty lvls, symptoms, ocogtv pomc,J Athlrain. 2008;43(3): 265-274.


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RESOURCES

RESOURCES

Center or Disease Control (CDC): www.CDC.gov 1-800-CDC-INFO

Colorado TBI Trust Fund: www.tbicolorado.org 303-866-4779

CO Child/Adolescent Brain Injury website www.COkidswithbraininjury.com

Brain injury Association o Colorado (BIAC) www.biacolorado.org 303-355-9969

Brain Injury Association o America (BIAA) www.biausa.org

BrainSTARS www.lapublishing.com

National Association o Athletic Trainers (NATA) www.nata.org/ www.journaloathletictraining.org

Colorado Department o Education www.cde.state.co.us 303-866-6779

Acknowledgements Special thanks to: REAP thanks:

T REAP Pojctckowlgs th CDC/Grandview Study: pcplvstgtos - JDs-Lws, Ph.D., TChls Hosptl, Ao,Coloo Hl Lws,

Ph.D., JFK Pts,Uvsty Hosptl, Dv,Coloo. T sty wscoct t GvwHgh School, Chy CkSchool Dstct om 2004to 2007 th clclcto o K McAvoy,Psy.D.

L Fox, og GHSPcpl, Hy Bll, GHSPcpl thoghot CDCsty, th GHS Amsttvm

o McKch, GHS AC,Ncy Mkl, GHS SchoolNs, Alc Py, GHS

chcl Sppot

All o th GHS tchs,cochs stts

My Chsly, CCSDSptt thChy Ck School DstctLvl Amsttv m

CCSD Mcl AvsoyBo

T REAP Avsoy m: D. S Klk,D. Chyl Mlck, D. Sz Rosbg,D. Wy McB, Do Gb, Psy.D.,Nopsychologst, Cg Hosptl

T Chy Ck BI m, KstMcCllom wth Dv Pblc Schools,Shyl M wth Ao Pblc Schools Bb Rtch/Nt Tompso wth

Lttlto Pblc Schools, C mm, REAPEctol Lso

T N (BI Ntwokg ms) StgCommtt

Kll Jtz, Sho Jtz, th Jtz/Skbg mls

N L, C L th Lmly

T Coloo BI st F

Ly Bll, CCSD Dstct Athltc Dcto ll CCSD Ct Athltc s

Te REAP Project is dedicatedin memory of:

JacobSnakenberg

April 19, 1990 September 19, 200

To prevent future loss of life

to concussion

All questions or comments can bedirected to:

Karen McAvoy, Psy.D.

Coordinator o Mental Health ServicesCoordinator o the Brain Injury Team

Cherry Creek School District

720-554-4252 or

[email protected] or

720-554-4272 fax


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APPENDIX

Concussion In ChildrenIts more than just a bump on the head!Cocssos chl c cs tmpoy chgs how thy ct, thk, l. I yo chl hs h cocsso, h o sh mght ct tly pobbly wll b

mo t o whl. Its goo to lt yo chl hv w ys o om school, tk mo st hv w xpcttos to mt o th xt wk o two. Ov th xtsvl wks, wtch o ths possbl chgs:

Changes in Behavior and Energy Changes in Thinking Changes at School Changes in Feelings

Has lots o headaches Is very tired; sleeps too much or too little

Tantrums; impulsive or aggressive at times; short use

Quiet, shy, or talking less than usual

Doesnt seem motivated; not concerned aboutperormance

Doesnt listen when corrected; doesnt seem to care whenin trouble

Not interested in usual activities

Has trouble getting started on work or activities

Not organized; doesntcomplete tasks

Forgets or cant rememberthings

Is upset by noises, lights,crowds, or busy places

Forgets assignments or doesnot hand in work

Does well one day andpoorly the next; grades areworse

Messy, incomplete, ordisorganized work

Doesnt pay attention inclass

Big emotional reactions Gets upset easily; more

worried or moody

Quiet or sad

Seems easilyoverwhelmed

Kp m tht w poblms ctg, thkg, o lg c b to yo chl s cocsso. Rmmb tht yo c gt hlp o ths poblms.ll yo chls octo, yo school s, school psychologst, tchbot th cocsso. Ask yo school psol to c th ms o yochl o th xt w wks. T Coloo Dptmt o Ecto (CDE),B Ijy Assocto o Coloo (BIAC) COkswthbjy.comhv hlpl omto o mBI mgmt o th wbsts.


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APPENDIX

POST-CONCUSSION SYMPTOM SCALE

SYMPTOMS SEVERITY RATING

Headache0 1 2 3 4 5 6

Nausea 0 1 2 3 4 5 6

Vomiting 0 1 2 3 4 5 6

Balance Problems 0 1 2 3 4 5 6

Dizziness 0 1 2 3 4 5 6

Fatigue 0 1 2 3 4 5 6

Trouble Falling Asleep 0 1 2 3 4 5 6

Sleeping More than Usual 0 1 2 3 4 5 6

Sleeping Less than Usual 0 1 2 3 4 5 6

Drowsiness 0 1 2 3 4 5 6

Sensitivity to Light 0 1 2 3 4 5 6

Sensitivity to Noise 0 1 2 3 4 5 6

Irritability 0 1 2 3 4 5 6

Sadness 0 1 2 3 4 5 6

Nervous/Anxious 0 1 2 3 4 5 6

Feeling More Emotional 0 1 2 3 4 5 6Numbness or Tingling 0 1 2 3 4 5 6

Feeling Slowed Down 0 1 2 3 4 5 6

Feeling like In a Fog 0 1 2 3 4 5 6

Difculty Concentrating 0 1 2 3 4 5 6

Difculty Remembering 0 1 2 3 4 5 6

Visual Problems 0 1 2 3 4 5 6

Other 0 1 2 3 4 5 6

TOTAL


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APPENDIX

GRADED SYMPTOM CHECKLIST (GSC)SYMPTOM TIME OF INJURY 2-3 HOURS POST-INJURY 24 HOURS POST-INJURY 48 HOURS POST-INJURY 72 HOURS POST-INJURY

Blurred Vision

Dizziness

Drowsiness

Excess Sleep

Easily Distracted

Fatigue

Feel In a Fog

Feel Slowed Down

Headache

Inappropriate Emotions

Irritability

Loss o Consciousness

Loss o Orientation

Memory Problems

Nausea

Nervousness

Personality Change

Poor Balance/Coordination

Poor Concentration

Ringing in Ears

Sadness

Seeing Stars

Sensitivity to Light

Sensitivity to Noise

Sleep Disturbance

Vacant Stare/Glassy Eyes

Vomiting

NOE: T GSC shol b s ot oly o th tl vlto bt o ch sbsqt ollow-p ssssmt tl ll sgs symptoms

hv cl t st g physcl xto. I l o smply chckg ch symptom pst, th AC c sk th thlt to g o scoth svty o th symptoms o scl o 06, wh 0 = ot pst, 1 = ml, 3 = mot, 6 = most sv.


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TheREAPProject is a Partnership between:

Rocky Mountain Hospital or Children

Swedish Medical Center

Sky Ridge Medical Center

and

Aurora Public Schools

Cherry Creek SchoolsDenver Public Schools

Littleton Public Schools

Endorsed by the: Colorado Department o Education

Made possible by a grant from the: Colorado TBI Trust Fund

Authored by: Karen McAvoy, Psy.D.

McKercher - REAP Project Manual4

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