After a concussion, students need flexibility and understanding at school, new guidebook says

High school student Jenna Smith was skateboarding at a park near her Markham, Ont., home two years ago when she grabbed the back of a friend's bicycle. She remembers she was moving very fast and becoming scared, before she let go and fell.

"I don't remember anything after that," said Jenna, 16. 

Her unprotected head hit concrete and her skull fractured on that August day. It would take months to recover from the concussion, so returning to school just a few weeks later proved harrowing. 

Apart from the physical symptoms of a concussion — like headaches and dizziness — victims can also have trouble focusing and emotional reactions like anxiety, anger or sadness.

"The first week I found it really hard to focus," she said. "It was very frustrating and I felt embarrassed."

For most young people, the symptoms resolve within a month. But about one-third of them experience long-term effects, according to a new guide aimed at making their return to school easier. School First, published earlier this month by brain injury experts in the Canadian Family Physician's Journal, demystifies concussions and outlines best practices for students and educators. Teachers say it's an important tool kit when tackling in-class concussion recovery.

Wide range of effects

For Jenna, her head trauma initially left her with nausea, facial paralysis, a ruptured eardrum, no sense of taste or smell, debilitating headaches and light and sound sensitivities.

All this with school about to restart in the midst of a pandemic. 

"I was not absorbing a lot of the information and reading really bothered me," said Jenna.

She says teachers tried to help, but there was no set protocol around returning to class after a concussion.

Studies also became a challenge for Samantha Simone, 16, after she was concussed during a hockey game. Her team had made it to the provincial playoffs when she was hit in front of the net. 

"I felt very out of it," Samantha told Peter Armstrong, host of CBC Radio's Day 6. 

"I always excelled, and I did well and I actually enjoyed school, and I think that was the frustrating part because I think it was pretty hard to focus.

"Everyone — except our training staff on our hockey team — didn't really see it as a huge issue. There were no guidelines."

Return to play and learn

In Canada, the sports community has long helped young athletes return to play after concussions, but supporting the return to school hasn't received the same attention. 

"Traditionally we have associated concussion with the sport community and the real goal of getting you back on the ice or getting you back on the court," Nick Reed, the Canada Research Chair in pediatric concussions at the University of Toronto, told Armstrong.

"I think along the way, we realize that there are so many more implications of this injury that weren't just about playing that sport or putting that puck in the net or the ball in the hoop."

Reed helped create the School First guide, which offers information, links and resources to help develop policies that aid students returning to class after a concussion. He says research shows that about 70 per cent of students have difficulties when they return to school after a concussion.

"It's a struggle for many," Reed said.

Reed and others would like to see schools take initiatives similar to those of sports teams to help young people recover. 

What is a concussion?

A concussion is a complex and traumatic brain injury caused by a bump, blow or jolt to the head, causing the brain to jiggle or twist in the skull. Like other injured parts of the body, the brain often needs time to rest to allow recovery, which can mean no screens or even reading, for some time.

"It can make it really hard to participate in life and in particular to participate in school. And that's not only affecting how one learns, but also how one interacts with others socially and how they feel about their performance," said Reed.

This can be devastating for a teen trying to fit in and catch up on homework.

The guide advises schools to create a supportive culture and "concussion champions." Students who have school administrators, parents, peers and friends who understand, can readjust and get back to the "things they love," said Reed.

How to help

The guide suggests that educators:

• Ensure any student who is concussed gets medical care.
• Allow a return to school as quickly as possible.
• Strategize how to best help each individual student with support.
• Be aware of the effects of a concussion on the brain.
• Allow the student to have accommodations, such as audio books.
• Adjust the environment if possible by dimming artificial lights and keeping sounds low.
• Be flexible if a student needs to leave because they are overwhelmed or don't feel well.
• Understand there will be setbacks.

In the past, concussion injuries have been dealt with differently in different schools, according to the president of the Canadian Teachers' Federation, Sam Hammond.

The physical education teacher says the new guide is useful because it created a consistent framework for schools across the country.

"This kind of information within this tool is extremely important," said Hammond.

For Jenna, returning to the physical school environment was a hurdle. There, she couldn't control things like the lights and sounds that hurt her head. She often had to leave class early if she fell ill — or step out for a break.

She was grateful to teachers who allowed her to use audio books and offered to dim classroom lights.

"My teachers were understanding, but I don't think there was a set system for concussion protocol or how to get back to school. It was more like – you just do it yourself," said Smith.

Now, two years, after her head hit concrete, Smith says she's fully recovered, except for the odd moment when her one eye closes slower than the other.

Smith hopes sharing her experience — and highlighting the importance of the new guide — helps to smooth recovery for others trying to come back to class despite the often debilitating effects of a concussion.

Written by Yvette Brend. Produced by Rachel Levy-McLaughlin.