Accommodations for Individuals with Post Concussion/Whiplash Syndrome

Rodney Taylor, Doctor of Audiology, Advanced Studies in Tinnitus and Hyperacusis, Certified by the American Institute of Balance for Concussion and Vestibular Rehabilitation.

 


 

Concussions are serious brain injuries that have a significant influence on the brain’s ability to function at its normal capacity.  The key to recovery from a concussion is both physical and mental rest, followed by a gradual progression back to activity-both in the classroom or work place.  Some concussion symptoms linger and have the potential to cause long-term academic and social implications for an individual.  If unmanaged, these problems have the potential to significantly impact the individual’s academic and work place career.  Proper management of a concussed individual will allow them to continue to progress through accommodations designed to prevent permanent damage.

No two concussions are exactly the same, so individualized treatment is necessary.  For various reasons, some individuals take longer to recover than others.

Academic or work demands result in focus, memory and concentration-and all of these are likely to be affected by a concussion.  Decreasing the amount of activity in the brain will help to decrease the symptoms and begin the healing process.  Avoiding excessive computer use, testing, television and loud music can make the brain work harder to process information and may exacerbate symptoms and slow the recovery process.  Physical activity after a concussion often magnifies existing symptoms.  There is also the risk of Second Impact Syndrome, a potentially life-threatening event that may result from a second, often minor, blow to the head suffered before recovery from the initial injury has occurred.  Ultimately, the key to a speedy recovery is both physical and mental rest.

For In-Class Learning or Meetings

Individuals may be very sensitive to lighting (fluorescent or LED, light from windows, etc.).  Ensure the individual is comfortable and has no sensitivity issues in a room-dimly lit rooms may work well.

Repeat or Rephrase key information throughout learning sessions, meetings, etc.

Give signals to the individual in meetings of important points that are being made.

Seat the individual near the main speaker/teacher away from doors and windows.

Speak clearly and slowly when presenting information.

Allow the individual to use any assistive listening at their disposal to make it easier to hear the teacher’s/speakers voice.

Use visual tools such as a white board or computer to support spoken lessons (some computer screens can cause issues).  In some cases, patients may opt to wear Blue Block glasses.

Use images and gestures to enhance the individual’s understanding.

For Classwork and Test Taking

Provide a quiet area for independent work.

Arrange for a colleague to share notes with the individual.

Provide opportunities for the individual to show and use their strengths in class.

Provide extended time for testing.

Break down test or classwork instructions into short, written steps.

Don’t Penalize the student for spelling errors.

For class or Meeting preparation

Have the individual read and become familiar with new material before it is taught in class or become familiar with minutes before a meeting.

Provide written homework instructions and a homework list for the week.  A written “to do” list may be also helpful if there are any actions required after meetings.

Provide a list of key vocabulary and concepts for upcoming lessons or meetings.

Interventions

Initial limitation of activities.  No activities that exacerbate the symptoms, such as television, videos, computer use, testing, or loud(ish) music.  Initially, limited physical activity, which includes anything that increases the heart rate (but not limited to)-weightlifting, sport practices and games, gym class, running, stationary biking, push-ups, sit-ups, etc.

When symptoms have decreased to a manageable level, slow integration into the school or workplace can commence.  Symptoms may be exacerbated by certain mental activities that are complex, difficult, and/or have a long duration.  Balance rest with gradual re-introduction.  Avoid tasks that produce, worsen or increase symptoms.  Avoid symptom triggers.

Part day attendance with a focus on core subjects: prioritize what classes/meetings should be attended and how often.  Symptoms reported should be addressed with specific accommodations.  Eliminate busy work or items not essential to learning priority material.  Emphasis in the initial integration phase should target learning and maintaining essential workplace tasks; rest is necessary once out of school or the workplace and homework should be eliminated.  Physical activity should be kept to a minimum.

When symptoms have decreased in both number and severity, the symptoms may still be exacerbated by certain activities, but short time spans with known symptom triggers do not have a drastic effect on symptom levels in this phase.  As the individual improves, gradually increase demands on the brain by increasing the amount of work, length of time spent on work, and the type or difficulty of work.  Gradually re-introduce known symptom triggers for short time periods.

When an individual has symptom relief or has mild symptoms that are often intermittent, further integration can occur.  Accommodations can be removed when an individual can function fully without them.  In this phase, it is useful to construct a plan to finish completing missed work and to keep stress levels low.  There should be limited physical activity unless it is recommended by a healthcare provider.

When symptoms are not present, no accommodations are warranted.  Before returning to a gym or sports, the individual should complete the gradual return-to-play progressions as indicated by their healthcare provider.

Finding out “how much is too much?” may be a trial and error process to start.  As the individual improves, gradually increase the demands on the brain by increasing the amount of work, the length or time spent on work, or the type or difficulty of work.  If symptoms do not worsen, demands may continue to be gradually increased.  If symptoms do worsen, the activity should be discontinued for at least 20 minutes and the individual should be allowed to rest.  If the symptoms are relieved with rest, the individual may re-attempt the activity at or below the level that produced the symptoms.  If the symptoms are not relieved with rest, the individual should discontinue for the day and re-attempt when symptoms have lessened (such as the next day).

Every concussion/whiplash is different and each individual may have different complaints.  Therefore, the accommodations an individual needs post-concussion will vary.  Employers/educators should be prepared to offer sympathy and understanding with symptom specific accommodations and prioritization.

Educators and employers may be used to hearing excuses as to why work is not completed and therefore, may be skeptical in nature.  Since a concussion is an invisible injury, it may be difficult to understand why a particular individual is still complaining of symptoms and taking so long to heal.  A concussed individual may need to hear from their superiors that they understand what a concussion is and what the individual may be experiencing.  The individuals need reassurances that they will not fail a class or be penalized for work that is slow to be completed when days are missed in the recovery process.  The message that an individual with a concussion needs to hear should be consistent from everyone that is involved in their care.  This in turn reduces stress and will help in the recovery process.

It is very easy for a concussed individual, who is behind in work, to become stressed, frustrated and emotional.  In combination with the chemical changes taking place in the brain as a part of the syndrome, making up work may seem downright impossible and lead to undue emotional distress that can worsen overall symptoms.  Educators and employers must decide what is essential and what is not.  Prioritization should occur.

A concussed brain must work harder and longer to process information.  Allowing for the postponement of assignments, projects, and tests until they feel better will help keep the injury from adversely affecting achievement.  When the individual feels well enough to resume work, certain accommodations can be made based upon the specific areas where there is difficulty.  For those that feel well enough to take a test or do interviews, extend the time to give the brain longer to process information.  Break down assignments into small, manageable chunks that can be completed in a short period of time.  Provide a break before moving onto the next task.  Issue short and concise written instructions or have the individual write instructions down in a step-by-stem sequence.  Allow individuals to take tests in a separate, quiet room.  Move the individual’s seat to the front of the room in class or meeting settings so that they may be better observed and less easily distracted.  Use color coding or highlighting to emphasize important information.  If the individual has light or sound sensitivity, move the individual away from windows or dim the lights in the room.  Allow the individual to wear sunglasses and/or a hat.  Avoiding large assemblies or meetings or eating lunch in a quiet location may be beneficial.  In general, allow the individual sanctuary from areas of loud noise and bright lights.

If memory issues exist or there is an indication of auditory processing issues due to the concussion, provide notes or allow the individual to tape record lectures, meetings, or conversations.  Allow the use of fact sheets on tests or tasks to reduce the demand on memory.  For tests, multiple-choice and open-book tests rather than short answer or essay, may minimize the demand on memory.  It may be useful to devise ways to memorize information (mnemonic devices, association, rehearsal, repetition, etc.).  The use of a planner to keep track of tasks and dates may be beneficial.  Diagrams, time lines, and charts may help to organize information and projects.  “To-do” lists and checklists should be encouraged.  Assess the individual’s comprehension of directions or instructions and allow the individual to restate the information in their own words.

Signs that an individual’s symptoms are worsening

Greater irritability-increased problems paying attention or concentrating-increased difficulties paying attention or concentrating-more emotional than normal or emotional reactions that are disproportionate to the situation-less ability to cope with emotions than normal-increased difficulty learning or remembering new information-difficulty organizing tasks-increased forgetfulness-inappropriate or impulsive behaviors-repeating themselves.

 

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