In FCCPS, Return-to-Learn Protocols Are Well-Seasoned

Second of three parts
By Christine Kilgore
Special to the Falls Church Times
Sept. 3, 2014

Virginia’s recent expansion of its student-athlete concussion law calls upon high schools to ramp up the attention given to the cognitive aspects of concussions. But George Mason High School is ahead of the curve.

Legislation passed in the 2014 Virginia Assembly not only requires recreational sports teams that use school property to have concussion policies in place; it also addresses the issue of academic accommodations for high school athletes who have suffered concussions.

Where the state’s original concussion law from 2010 focused on removal-from-play and return-to-play issues in interscholastic sports, it did not elaborate on the cognitive side of head injury. The new legislation expands this law, mandating that school personnel, student athletes, coaches, and parents be informed of the effects of concussions on student-athletes’ academic performance. A second, related bill passed in the 2014 General Assembly requires the state Board of Education to include a “return-to-learn protocol” in its guidelines for school division concussion policies.

These new mandates are gratifying to Vicki Galliher, Mason’s athletic training coordinator, who for several years now has led training sessions for teachers and staff on concussion recovery and the importance of cognitive rest and academic accommodations.

A return-to-learn (RTL) protocol that she developed has garnered attention outside the City for its thoroughness. Last year, she described the FCCPS protocol in a professional webinar that was tapped by educators and athletic trainers across the country.

“You can’t push through a concussion,” Galliher said in a PTSA-sponsored presentation last fall. “I always tell our parents and kids, it’s better to take a week, two weeks, or two months [significantly limiting cognitive activity] than to try to push through each day and end up missing an entire school year or, 25 years from now, not being able to remember what high school you went to.”

Cognitive recovery-regaining the ability to function cognitively without exacerbation of headache or other symptoms-has in recent years come to be viewed as a prerequisite for return-to-play or the resumption of any significant physical activity after a concussion. No two concussions are the same, experts now say, so the pace and course of recovery can vary significantly among individuals.

A return-to-learn (RTL) process, whereby students are gradually integrated back into school and the rigors of classroom participation and study, provides a framework to support this recovery. Last year, the American Academy of Pediatrics issued a report on “returning to learn”-the first such report in the medical community.

Under the FCCPS RTL protocol, which the athletic department says will be formally incorporated into the school system’s student-athlete concussion policy, Ms. Galliher works with students and their families and physicians on tracking symptoms and guiding their cognitive recovery. Periodic neurocognitive testing is utilized as needed.

Ms. Galliher advises teachers and staff on the needs and limitations of each injured student-how often breaks are needed, and how much the student should participate and study, for instance. Often, this process of defining limits on cognitive exertion and monitoring academic accommodations requires daily review and communication. A student may be instructed to have maximal 10-minute study periods, for instance, or be a more passive learner for a while, listening to discussions but not taking notes until symptoms are diminished.

The challenge for the City’s school system when it comes to RTL-as with other school systems throughout the Washington region-is that RTL processes are tied to the high school’s athletic program. Exactly how a student who sustains a concussive injury outside of high school sports will be supported has been unclear and/or variable.

High school athletic trainers have the most knowledge and are best positioned to serve as academic liaisons-doing what Ms. Galliher does-when concussions occur. But do athletic trainers have the time to help all students who need them?

Asked recently about concussions in non-high school athletes, the athletic training administrator for Fairfax County Schools, John Reynolds, just laughs. “We’re working through these issues right now.”

“On one hand, it’s a good thing (to be able to help non-student-athletes with concussion recovery),” he said. ” On the other, it creates an additional challenge…How much of the process can we take on?”

Overall, the size of the City’s school system may be helpful in this regard. Ms. Galliher publicly said for the first time last fall that she is the “go-to” person for academically supporting all FCCPS concussed students, regardless of their age or place of injury.

In the 2013-14 school year, Ms. Galliher was given more time to devote to this role, though undoubtedly there is a limit to how many student concussion cases she could thoroughly oversee at any one time. (During the 2013-14 school year, she handled 40 medically confirmed concussions, each of which necessitated an individualized RTL protocol.)

Athletic director Tom Horn said that with a physician’s diagnosis and orders to do so, Ms. Galliher can perform neurocognitive testing and can help guide a concussed student in any of the FCCPS schools through a period of academic accommodations. “If a physician says there is a need to intervene academically, then by all means she is here,” Mr. Horn said.

Tomorrow: George Mason High School Takes on Concussion Research