Tuesday, February 18, 2014

Returning to Life After the Olympics: Taking Home More Than the Gold?

Sarah Levin Allen Ph.D, CBIS

Within a minute, the life of Saraka Pancochova, a Czech Olympic snowboarder, went from smiles and High Fives to lying prone on the snow of Sochi. I counted the seconds wondering when the medical staff would arrive. Within minutes, Pancochova got up and was applauded for finishing her run. This was after a fall in which she lost consciousness and cracked her helmet down the back. USA Today[i] quoted Pancochava, “I didn't think I really got any concussion, maybe a tiny bit, but nobody told me…I just got really lucky. It could have been worse. I got knocked out, and that hasn't happened in a while, but I was lucky the snow was soft, and you know, it just happens sometime in snowboarding."

She got lucky? Let’s hope so. I would call it lucky if Pancochova could read this blog and respond to it tomorrow. My guess is that she, and the athletic community in Sochi, mean “lucky” in that she could compete in the next round. What about after that round? What about tomorrow when she attempts to read the articles about her?

“Luck” or “success” is not in finishing the race, but in protecting her brain from future injury and ensuring that she can function on a day-to-day basis. Just ask the students with whom I work. My job is helping students who have sustained brain injuries, desperately trying to succeed in the school setting.

As I reflect on these students, I think about what it takes for me to complete this passage. I am suddenly overwhelmed with understanding for students with concussions and other brain injuries. I’m sitting in front of the television dividing my attention, grasping ahold of all the ideas floating in my head, organizing those ideas, sequencing them, and pulling my attention toward my computer and away from the Olympic games. I’m doing all this while occasionally telling my 3 year old not to clobber her brother and telling my 2 year old to choose an activity other than throwing things down the stairs and sliding on his head to the bottom. 

Then I think about typical students. In high school, students must change classes a minimum of 6 times a day, switch their attention from one topic to another every 40 minutes, selectively attend to the teacher and not the Hottie in the front row; not to mention control their emotions which are triggered repeatedly as hormones reek havoc on their bodies. 

When school ends, they are expected to go to practice or debate team, collect coats for the homeless, and finish their homework preparing for 3 tests before falling asleep in front of the television and doing it all again the next day!  Then there is the socialization that is essential during all of this. Socialization that includes constant texting or group chats in which a significant amount of divided attention, focus, and exposure to stimuli is required, without which, a student would be isolated and lack an identity.

With all these daily requirements, my head is spinning. Yet, despite these demands in the setting in which these athletes are required to return, there hasn’t been much discussion about how to help these “typical” students return to full functioning.

There has been a significant amount of conversation about sports concussion. The NFL and NCAA have been in litigation accused of failing to educate athletes on concussions[ii]. Brain injury advocacy groups as well as the NFL have helped to increase awareness around the issue of brain injuries, specifically concussions. In 2011 and 2012, PA[iii] and NJ[iv] respectively passed a youth sports act that required schools to develop “return to play” rules for athletes who have sustained concussions. Once these laws were passed, identification of concussions increased along with the need to support these students once they return to school.

And it’s returning to school that becomes the most difficult. The supports that are typically in place to support students (i.e. 504 plans or IEPs) don’t happen fast enough or are too taxing on an already bleeding system. What do we do when a student shows up to school the next day or the next week and needs help? How do we tell all 6 teachers, physical education instructors, specials instructors, administrators, counselors, and nurses how to support this student? Who is responsible for identifying learning issues, monitoring the rehabilitation that is happening in the classroom, and helping the student gain some self-knowledge into their injury and recovery?

How do we avoid spending 2-4 weeks (up to ½ of a semester) allowing a student to flounder in a typical environment with no supports, before we put things in place to help him/her succeed? These are the questions that have now become the focus of school administrators as the awareness and identification of students with concussions increase.

So, where does that leave those like Pancochova or my high school students? Well, the majority of those with concussions will get better. They’ll need minimal supports for 2-3 weeks, and then they’ll begin to get back to their normal routine. Those with 2 or 3 concussions will struggle more, and those with more significant brain injuries will need even more assistance.  The minimal deficits I experience as a sleep deprived, working mother pales in comparison to the uphill battle these young athletes and students go through as they attempt to get their brains back to normal.

I’ll continue to think about them, and tighten the helmet I have decided to wear around 24 hours a day, as I finalize this blog, change the laundry, break up the wrestling match on the floor of my office, turn off the television, and start dinner. All the while, I’ll be hoping that I never get an injury that could make all these “other jobs” virtually impossible.

For more information on return to school programming for students with concussions see Dr. Allen’s webinar for the BIANJ at http://bianj.org/2013-concussion-in-the-classroom

[ii] http://www.usatoday.com/story/sports/college/2014/01/02/concussion-lawsuits-ncaa-consolidated-adrian-arrington/4293867/
[iii] http://www.epysa.org/assets/947/15/PA_Act_101.pdf

Hale, J.B., Metro, N., Kendorski, J.G., Hain, L.A., Whitaker, J., & Moldovan, J. (2009). Facilitating school reintegration for children with Traumatic Brain Injury. In A. Dvis (ed.), Handbook for Pediatric neuropsychology. Hoboken, NJ: John Wiley & Sons.

"Celebrity" Guest Blogger:
Sarah Levin Allen, Ph.D., CBIS is an Assistant Professor at the Philadelphia College of Osteopathic Medicine. She is a licensed pediatric neuropsychologist, certified school psychologist, and certified brain injury specialist, who specializes in the area of evidence based interventions for schools. Her passion is in promoting and integrating brain based learning approaches in the classroom. Dr. Allen consults with school districts on return to school programming for students with brain injuries and works closely with advocacy groups to promote awareness of concussions in the classroom.