Chris G. Koutures, MD, FAAP Pediatric and sports medicine specialist

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Proud physician:
USA Volleyball Mens/Womens National Teams
CS Fullerton Intercollegiate Athletics
Chapman University Dance Department
Orange Lutheran High School

Co-Author of Acclaimed Textbook

Pediatric Sports Medicine: Essentials for Office Evaluation

Orange County Physician Of Excellence, 2015 and 2016

 

Filtering by Tag: return to learn after concussion

4 Points that Matter about Post-Concussion Return to Learn

Completely enjoyed learning from Brenda Eagen-Brown- one of the true passionate authorities on post-concussion return to learn, and wanted to share some key "take-away" points from her awesome presentation.

All pictures are from her slides, and comments afterward are mine.

Make sure there is consistent agreement on terms describing what assistance students may receive after a concussion.

Make sure there is consistent agreement on terms describing what assistance students may receive after a concussion.

Absolutely essential to have all providers ask about these key historical aspects that can and often will impact concussion recovery. If a patient appears to have a more prolonged or difficult post-concussion course, very likely one or more of these items will be a factor. Don't hesitate to ask at multiple encounters as many patients won't initially offer or give sufficient details about pertinent past history.

Absolutely essential to have all providers ask about these key historical aspects that can and often will impact concussion recovery. If a patient appears to have a more prolonged or difficult post-concussion course, very likely one or more of these items will be a factor. Don't hesitate to ask at multiple encounters as many patients won't initially offer or give sufficient details about pertinent past history.

Great summery of changes that not only teachers should be assessing but also provide the framework for medical providers and families to address classroom difficulties.  One of Brenda's key points- recall issues after concussion tend to be difficulties with information retrieval ("on the tip of my tongue") than true memory deficits.

Great summery of changes that not only teachers should be assessing but also provide the framework for medical providers and families to address classroom difficulties. One of Brenda's key points- recall issues after concussion tend to be difficulties with information retrieval ("on the tip of my tongue") than true memory deficits.

Many benefits to a standing protocol for initial return to learn that doesn't need medical clearance that immediately addresses student need. Extra emphasis on the  scheduled rest breaks  as waiting until symptoms erupt only slows the recovery process. These efforts attempt to reduce over-stimulation or emotional flooding that more readily occurs during post-concussion recovery as the brain's "filters" are not functioning properly. 

Many benefits to a standing protocol for initial return to learn that doesn't need medical clearance that immediately addresses student need. Extra emphasis on the scheduled rest breaks as waiting until symptoms erupt only slows the recovery process. These efforts attempt to reduce over-stimulation or emotional flooding that more readily occurs during post-concussion recovery as the brain's "filters" are not functioning properly. 

August 27th is Date for 2016 OC Concussion Return to Learn Seminar

 

We are pleased to have the renown educator and speaker Brenda Eagen-Brown, MEd, CBIS return to the OC to review practical recommendations for post-concussion Return to Learn protocols and management.

We encourage school and district-based teams to bring Return to Learn protocols, success stories, and challenging cases to create an interactive opportunity for professional growth and collaboration.

Location: CHOC Childrens Hospital Wade Center (455 S. Main, Orange, CA 92868)

Date: Saturday, August 27th

Save the Date, Share with Colleagues and Stay Tuned for Cost, Times, and Registration Links

Objectives: Participants will have a firm understanding of:

1. Concussion impact on classroom performance

2. Strategies and accommodations to reduce student symptom severity

3. Collaborating with other interdisciplinary professionals (medical/rehab/athletic) for

optimum student concussion management

4. Why schools should identify professionals at the school building level to monitor

symptoms and academics through recovery

5. Identifying key barriers to treatment for minority or underrepresented populations.

(per American Academy of Pediatrics cultural diversity requirement)

Who would benefit from attending?

  • Classroom Educators
  • School Nurses
  • Special Education Instructors
  • School Psychologists
  • Principals and Assistant Principals
  • Guidance Counselors
  • Speech and Language Therapy Specialists
  • Athletic Trainers
  • Community Pediatric Health Care Professionals
  • Mental Health Specialists
  • Neuropsychologists
  • Physical Therapists
  • Neuro-Optometrists
  • Strongly recommend forming school-based teams to attend and maximize the learning experience

Click here for information on the 2015 OC Concussion Return to Learn Seminar

 

15-20 Minute Blocks of Activity: A Guideline for Post-Concussion Recovery

In the midst of the usual complexities of recovering from a sports-related concussion, I have found that one simple mantra of "re-start activity in 15-20 minutes blocks" can be an anxiety reducing guideline..

Looking to return to homework or other school-based activities?

Start with 15-20 minute blocks.

How much can I spend on my phone?

Start with 15-20 minute blocks.

As we discover that absolute rest and removal from usual duties might be counter-productive to recovery, the counter-concern over returning with too much activity, too quickly, or too soon is valid. 

Enter the 15-20 minute block recommendation.

When to start?

Usually within a few days after a concussion, and I will counsel patients that at a "good part" of the day where headaches or other symptoms are at a lower point, they should select one activity to start in a quiet room without other stimulation (loud music, bright outdoor light, texts on phone, etc). 

While most young people would immediately select their phone, the usual first choice is light reading from a book or magazine rather than a computer screen. 

Set a timer for 15-20 minutes, and once that period passes, stop all activity and take a break.

If successful, try another 15-20 minute block of similar activity again later in the day, and if that goes well, can increase to 20-30 minute blocks the next day.

Don't advise going past the "max" time recommendation. Better to finish "early" without symptoms than to muscle forward, develop a headache, and suffer a setback.

For those trying to decide when to return to school, have found that being able to complete 20-30 minute blocks of work 2-3 times a day is a minimum criteria for considering a partial (likely half-day) return to the classroom.

Once able to do at least 2 blocks of activity per day, can add a block of more "fun" which might include cell phone use, texting, appropriate surfing of internet, music, or even some relatively light video game play.

If unable to get through that initial 15-20 minute block of time due to headache or other symptoms showing up, don't despair.

Take the rest of that day off, and try the next day, again maximizing chances with success by ensuring a quiet distraction-free environment, good food and fluid intake, and hopefully after some restorative sleep.

If a few days of attempting the 15-20 minute activity blocks lead to more failure, then do not hesitate to contact your medical provider for more specific tips and further recommendations.

 

 

New Location: Orange County Return to Learn after Concussion Conference

Designed for classroom educators, administrators, counselors, special education specialists, school nurses, speech/language pathologists, athletic trainers, and other parties who work with student-athletes after concussion.

Featuring renown speaker  Brenda Eagen Brown who will offer practical suggestions based on real-world situations supported by the latest evidence-based research.

I will join other local concussion specialists in a lunch period case-based discussion of return to learn challenges.

Return to Learn after Concussion Training: Coming to Orange County in August

Are you an educator, administrator, counselor, or a medical professional who works with student-athletes who are returning to the classroom environment after a concussion?

Do you have concerns, knowledge gaps, frustrations, or just plain wish to see how others manage these challenging situations?

Well, I wish to bring to your attention a  collaborative effort with the Orange County Concussion Consortium and the Orange County Department of Education to promote an important Return to Learn after Concussion Conference on August 29, 2015 featuring renown expert Brenda Eagan Brown.

Target Audience:

  • School Principals, Vice Principals and other Administrators
  • Classroom Teachers
  • Curriculum Specialists
  • School Nurses
  • School Psychologists
  • School Counselors
  • Special Education Specialists
  • Speech and Language Therapists
  • Athletic Trainers
  • Concussion medical experts
  • Strongly recommend forming school-based teams to attend and maximize the learning experience

Please share this with colleagues and register early as seats are limited!

Studying Role of High School Principals in Return to Learn after Concussion

If there isn't enough frustration and feeling of being overwhelmed after suffering a concussion, the process of returning a student back to academic work can only seem to magnify those concerns.

While return-to-play progression protocols have been established to assist in getting athletes back to sport, similar return-to-learn programs have lagged behind.  The sheer complexity of  meeting particular needs and schedule demands of each student requires an individualized plan created with appropriate understanding of expectations and optimal communication between medical professionals, families and educators.

Often, recommendations include  designating a point person who can advocate for the student and family by communication with fellow educators and monitor of student progress.  This same person might also provide on-going dialogue with outside medical providers. However, finding a person with appropriate knowledge and desire to accept and carry out these roles can be difficult. 

A school-based concussion management and response plan can provide further framework to delineate expectations, potential adjustments, and roles, though the actual implementation and utility of such plans has not received much study.

Given the common findings of frustration and lack of apparent coordination in the return to learn process, I was excited to review the article HIgh School Principals' Resources, Knowledge, and Practices regarding the Returning Student with Concussion  in an effort to gain unique and previously unreported insight into school-based resources and management strategies.

Using a cross-sectional computer-based survey of 465 urban, suburban, and rural public high school principals in the state of Ohio, key findings of this study included:

  • Just over 1/3 of the principals had completed some form of concussion training in the past year, with those who completed such training have higher self-reported concussion knowledge scores and were more likely to have provided or supported concussion training for school faculty who were not directly involved with youth sports
  • When identifying a point person, athletic trainers were most often reported, but about 1/5 of respondents did not know or designate a point person at their school. Schools that identified  more than one point person tended to  have more students, a principal with higher self-reported concussion knowledge, and to have a full or part-time athletic trainer.
  • Athletic trainers were reported as the main agents of communication with medical professionals for concussed student-athletes, while school nurses and counselors assumed this role for concussed students who were not athletes. Principals, assistant principals, and guidance counselors assumed the primary role of communication with parents for all students  (regardless of athlete status).
  •  When asked to respond to a list of short-term classroom adjustments commonly recommended for concussed students, over 90% of principals agreed with all or most of them, with just over 30% requiring a health care provider note to initiate the adjustments.
  • Several principals reported a school response-to-intervention (RTI) team to assess student needs and to develop an intervention plan in terms of academic adjustments and accommodations.
  • About 1/3 of the schools had a written concussion plan, with 75% of those plans addressing academic adjustments and accommodations.

How can we use these findings to better assist our concussed students in their effort to return to the classroom?

  • A principal with concussion knowledge is essential- thus ensure more (and hopefully higher quality) concussion training for principals, which could then translate to more training for school personnel, the identification of point persons to assist concussed students, and better communication between principals and the parents of a concussed athlete.
  • An athletic trainer is essential- thus ensure that every high school campus has a  certified athletic trainer acting as an advocate for concussed students and being on campus for part/all of the academic day (not just for after-school activities) to foster relationships with teachers and help monitor student developments.
  • An intervention team is essential to initiate academic adjustments early after a concussion, preferably without the absolute need of a medical provider note to reduce any obstacles.
  • Providing a concussion management plan that delineates roles and expectations and is shared with all key parties (students, school personnel, families and medical providers) to provide education and on-going assessment of the utility of the plan.

What other recommendations do you have to assist concussed students return to learn? Do these recommendations seem reasonable and practical?

 

 

Concussionconnection.com: On-Campus Resources After Concussion

Thanks to colleagues from concussionconnection.com for publishing my blog post focusing on resources for disabled students on college and university campuses, particularly for student-athletes recovering from concussions.

Check out the blog post and a host of concussion-related resources at http://www.concussionconnection.com/knowing-resources/.



Addressing the Social Impact of Retiring from Sport due to Concussion

My wonderful colleagues at Concussion Connection have been offering their expert perspectives on retirement from sport due to concussion, and I am pleased to offer thoughts on the Social Impact of Retiring. Strongly recommend checking out the entire Concussion Connection site and praise them for the fine work they do in advocacy and education.

Return to Learn: Resources for Concussed Collegiate Student-Athlete

Have had the awesome fortune of meeting fellow Return to Learn after Concussion advocates/experts in Rachel and Katy from The Academic Agency and Lauren and Samantha from Concussion Connection. Been quite inspired by their passion for assisting athletes and families who suffer from sport-related concussion and also becoming more aware about particular nuances of specific return to learn strategies.  

Please click here to visit the Concussion Connection site and I thank them for this opportunity to review specific Return to Learn concerns for the Collegiate Student-Athlete.