A concussion is a serious brain injury that can have permanent, and sometimes tragic, consequences if not dealt with properly. So it should be no surprise that research indicates rushing back to the classroom too soon after a concussion can cause as much damage as rushing back to the playing field. Careful management of the student in the classroom by teachers allows him or her to continue making academic progress through allowances that help avoid permanent damage to their academic record. It is crucial that the student return to the classroom slowly and methodically.
In 2010 Barbara Csenge, Director of Learning Enrichment at St Michael’s College School, met a student at the school who was requesting support from the learning center because of a history of concussions that had caused cognitive changes and requiring accommodations and extra time for his academic work. The school had an established Learning Center that supported other learning profiles (eg. ADHD, Anxiety, L.D) and it seemed like a good fit for this student’s current needs. In 2011 she consulted medical professionals from the University of Toronto and developed “Return to Learn”, which returns the student to a full academic workload with a six-level graduated program. Beginning with total bed rest at home, the program then gradually reintroduces class time, screen time and homework. Ms.Csenge took some time to give us some more information on her ground-breaking new program.
How heavily did your experience as a community liaison at a children’s rehab hospital influence your decision to design the program?
My experience supporting students with a head injury who were transitioning from a hospital setting to a community school setting was the ideal skill set for developing an in-house school program. Working at a rehab hospital gave me experience with a variety of students who were returning to many types of schools. I was in a unique position to understand the key components in a successful reintegration…. and also the pitfalls to plan away from. By working in a hospital with a multi-disciplinary team I also developed an appreciation of the importance of developing an informed team or case communication so that there was coordinated programming based on current data and professional direction.
How long did it take to come up with the six-step program?
The six steps of Return to Learn are a complement to an existing six-step program for return to sports. Our students understand the Return to Play protocol developed by ThinkFirst Canada and it seemed like a good idea to capitalize on their prior understanding. It is a solution that currently works in our school but it is arbitrary and it may not be the solution for all communities. I know of a return program in Massachusetts that uses four steps based on colors green, yellow, orange, red, to show the progression from stop activity to green light for full activity. The concept is a gradual progression to more activity as tolerated without symptoms. With that specific concept articulated the specific design or schema is flexible to the communication tastes of the target audience.
When it came time to implement it in your school, did you face any resistance from staff?
There were a lot of questions about the necessity for reduced activity in what seemed like healthy young men. A significant challenge with supporting concussion is the lack of obvious physical damage in the student affected. There are also concerns about prioritizing a return to academics over a return to sport. Our school community has learned a lot about good concussion management and this involved replacing prior, longstanding attitudes. We are coming a long way quite quickly when you appreciate that concussions were historically overlooked from a managed recovery perspective. By seeing the great outcomes that managed recovery brings our students, teachers, and parents are becoming highly supportive of this strategy.
Is the program still evolving?
Yes, the Return to Learn program continues to evolve. We are refining our communication strategy – with doctors, parents, students, and teachers. It is important that these team members communicate clearly and with current data about the student’s step in the recovery progression. I have come to understand that confidence and participation in the program are dependent on knowledge and education about the benefits of good management and confidence in the professionalism of the other team members. Professional development has been a priority this year and that has paid immediate dividends.
Concussions are a serious problem for the young student-athlete, a problem that can set them back academically and derail their futures. It is critical that their recovery is managed properly, with full consideration that while the symptoms of a concussion may vanish quickly, the effects may linger for weeks and months.
Barbara Csenge has presented the Return to Learn strategy at conferences and St. Michael’s College School hosted a Concussion Symposium in April 2012 with more planned in the future. For any school interested in learning about the program, Ms.Csenge can be contacted via email at St.Michael’s and she will happily share her experiences with concussion management and engage in a dialogue with other schools that are working on a solution that would fit their students' needs.