By Elizabeth M. Pieroth, PsyD, ABPP, MPH
During my typical, pre-COVID, workday I would spend a great deal of time writing letters for academic accommodations for my patients who had suffered a concussion. We would review ways to reduce aggravation of their symptoms in the school setting. However, the school setting for most is now their bedroom or some other room in their home. There are no more concerns about avoiding noisy hallways and cafeterias. There are no more requests for removal from gym class to avoid activities that risk further injury. That doesn’t mean there aren’t still accommodations/modifications that students would benefit from in the remote learning environment.
As I noted in my previous article for the AHAI newsletter, Rethinking the Recommendations after Concussion, recommendations for “complete rest” or “resting in dark rooms” were never supported by science and we now know are not effective treatment approaches post-concussion. The data clearly tells us that 1-2 days of relative rest are appropriate but gradual return to activity aids the recovery process. This includes both cognitive and physical exertion. While certain activities may temporarily increase the symptoms, this will not “make the concussion worse” or lengthen the recovery time. The simple mantra is to pay attention to what aggravates the symptoms and adjust the level of activity accordingly.
There are a number of accommodations/modifications that can be considered for remote learning to help reduce the student’s symptoms in the learning environment. Not every student needs every accommodation. Accommodations should be tailored to the student’s individual needs and the school should be informed if these accommodations are going to be used.
- Encourage the use of a laptop or computer screen rather than a smartphone. The bigger screen reduces eye fatigue.
- Increasing the font size on the computer can also reduce eye strain.
- Blue light blocking eyeglasses will be helpful for some.
- Others with significant sensitivity to light may benefit by simply turning down the brightness of the computer.
- Have the student sit away from bright lights or the window if the lights bother them.
- It may be helpful for some to listen to the class lecture and not look at the screen.
- It the student is bothered by motion, have the screen set-up to only see the teacher. The presence of all the other students may be overstimulating.
- Printable paper copies of assignments or class materials should be offered to the students with high levels of sensitivity to light from the computer.
- Audiobooks can be helpful if extended computer use or reading aggravates the student’s symptoms.
- The student should take more frequent breaks if their symptoms increase during school or when doing homework. Just make sure the break does not also involve more screen time (e.g., texting/phone use). A walk outside for fresh air can be great!
- Even a short “eye break” can be helpful (closing eyes for brief period or focusing on something off in the distance for 20-30 seconds)
- If a student is unable to attend a class, record the zoom lesson and listen to it at a later date.
- Homework can be completed, as tolerated, but students should be given extended time to complete their assignments.
- Exams should be delayed until the student can adequately study. For most, this is the first 1-2 weeks after a concussion.
- Exams can be read to the student if they are having significant visual complaints.
- Don’t forget the neck! Tightness of the neck muscles can cause headaches so periodic, gentle stretches of the neck and shoulders can be beneficial.
- PE class no longer involves contact activity but may also need to be revised. Some students cannot make quick movements of the head (e.g., push-up or burpees) so should avoid these activities. Other students may fatigue more easily so cannot complete extensive aerobic exercise but are more likely to tolerate walking.
The goal of any accommodation/modification is to reduce the symptoms so the student can manage the demands of school. These should be phased out as the student is feeling better. If the student is still symptomatic 2-3 weeks after their concussion, encourage them to follow-up with the primary care physician or a concussion specialist.
Elizabeth M. Pieroth, PsyD, ABPP, MPH is a Board Certified Clinical Neuropsychologist and is the Director of the Concussion Program at Midwest Orthopaedics at Rush and Rush University Medical Center. She has been treating patients with concussion for more than 20 years and is the concussion specialist for the Chicago Bears, Blackhawks, White Sox, Fire, and the National Women’s Soccer League.
Dr. Pieroth is the Co-Director of the NFL Neuropsychology Consulting Program. She is also on the Board of Directors of the Brain Injury Association of Illinois and is a member of the USA Football Heads Up Advisory Committee, the NFL Head, Neck and Spine Committee, the US Soccer Concussion Task Force, and the Amateur Hockey Association of Illinois Safety Committee. She has published on concussion management and neuropsychological assessment and recently completed her Masters in Public Health from the Medical College of Wisconsin.
Dr. Pieroth sees patients in Chicago, Naperville, Oak Brook and Oak Park and via telemedicine. Appointments can be scheduled by calling 877-632-6637. The orthopedic program at Rush University Medical Center continues its legacy of excellence with a 2020 ranking by U.S. News & World Report as No. 5 in the nation and as the top-ranked orthopedic program in Illinois and Indiana.