Background

The Brain Injury Association of Virginia notes that it is important for all families, students, and education professionals to be aware of the issues surrounding brain injuries and how they can affect the student's abilities in the educational setting. When a child is known or suspected to have sustained a concussion, either from a sports injury, motor-vehicle crash, fall, or other cause, the resulting impairments can be multidimensional and may include cognitive, behavioral, and/or physical deficits.

Impairments can be mild or severe, temporary or prolonged. Because no two concussions are alike, it is difficult to determine the period of recovery. Concussions are a medical and educational issue and are considered to be among the most complex injuries in medicine to assess, diagnose, and manage. The concussed brain requires mental and physical rest to recover. Developing brains are highly variable and concurrent issues may affect cognitive recovery. Every concussion is different, and each student will have unique symptoms and recovery times.

Concussion symptoms may have a significant impact on learning and academic achievement. A concussion may interfere with a student's ability to focus, concentrate, memorize, and process information. This cognitive impairment may cause frustration, nervousness, anxiety, and/or irritability, and further affect mood or previously existing irritability or anxiety.

The "return to learn" (RTL) academic concussion management plan is divided into graduated phases to promote recovery, considering all factors in this complex injury. Some students may need a short period of rest with a gradual return to school, while others will be able to continue academic work with minimal instructional support.

The "return to play" (RTP) protocols following a concussion are also a stepwise process in which the student-athletes will progress to the next level when physical exertion does not exacerbate symptoms or cause the re-emergence of previously resolved symptoms. If any post-concussion symptoms reoccur while in the stepwise process, the student-athlete would revert back to the previous level, rest, and try to progress again after a period of rest is completed. Most students who experience a concussion can recover completely as long as they do not "return-to-learn" or "return-to-play" prematurely. Premature return to learn/play may delay and/or impede recovery. Return-to-play should not occur before the student-athlete has managed to return to a full day of academic activities.

The effects of repeated concussions can be cumulative, and after a concussion, there is a period in which the brain is particularly vulnerable to further injury. If a student sustains a second concussion during this period, the risk of prolonged symptoms increases significantly, and the consequences of a seemingly mild second concussion can actually be very severe and potentially catastrophic (i.e., "second impact syndrome").

Definitions

A concussion is a traumatic brain injury and is defined by the 4th International Conference on Concussion in Sports (2012) as a complex pathophysiological process affecting the brain and induced by biomechanical forces. Several common features that incorporate clinical, pathologic, and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include the following:

Concussion may be caused either by a direct blow to the head, face, neck, or elsewhere on the body with an "impulsive" force transmitted to the head.

• Concussion may be caused either by a direct blow to the head, face, neck, or elsewhere on the body with an "impulsive" force transmitted to the head.
• Concussion typically results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously. However, in some cases, symptoms and signs may evolve over a number of minutes, hours, or days.
• Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury with no abnormality seen on standard structural neuroimaging studies.
• Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. It is important to note, however, that symptoms may be prolonged in some cases.

Appropriate licensed health care provider means a physician, physician assistant, osteopath physician, or athletic trainer licensed by the Virginia Board of Medicine; a neuropsychologist licensed by the Board of Psychology; or a nurse practitioner licensed by the Virginia State Board of Nursing.

Cognitive rest means limiting cognitive exertion and careful management of neurometabolic demands on the brain during recovery.

Return-to-learn (RTL) refers to instructional modifications that support a controlled, progressive increase in cognitive activities while the student recovers from a brain injury (i.e., concussion) allowing the student to participate in classroom activities and learn without worsening symptoms and potentially delaying healing.

Return-to-play (RTP) means participate in a nonmedically supervised practice or athletic competition.

Non-interscholastic youth sports program means a program organized for recreational athletic competition or recreational athletic instruction for youth.