Commentary: Establishing the college Return to Learn team for concussion: a practical approach.
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ABSTRACT:
SUBMITTER: Bevilacqua ZW
PROVIDER: S-EPMC10306098 | biostudies-literature | 2023
REPOSITORIES: biostudies-literature
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Commentary: Establishing the college Return to Learn team for concussion: a practical approach.
Bevilacqua Zachary W ZW McPherson Jacob J
Frontiers in public health 20230602
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Project description:The aim of this work is to uncover the preferences and perspectives of college educators as they interpret medical documentation outlining medically requested return-to-learn (RTL) instructions. Participants were recruited from five colleges across campus at a large Midwest public university. They each engaged in a private, one-on-one, audio-recorded interview. All recordings were transcribed and inductively analyzed using a grounded theory approach and two-coder system. All codes and themes were finalized once agreement was reached by both coders. Resultant themes from axial coding had to represent the voices of at least 80% of participants. Three characteristics emerged as being desired by college educators: brevity, clarity, and direction. Educators also expressed considerably less utility with medical documentation designed for pediatric students with concussion. College educators desire medical notes that are brief, clear, and provide straightforward direction, in addition to documentation that is tailored for the college setting.
| S-EPMC9080999 | biostudies-literature
Project description:While awareness and understanding of concussion have improved drastically, post-concussion management in academic settings is still at its infancy. The aim of the study was to examine to what extent concussion influences academic performance and to whether there would be a difference in concussion effects on academic performance between high school and college students. This cross-sectional survey study included students, who were between 14 and 24 years old and sustained a sport-related concussion within the previous year. The study used a modified chain-referral sampling method, by distributing a questionnaire link to 3,000 randomly stratified athletic trainers, who worked in high school or college settings. These athletic trainers were then asked to forward the questionnaire link to students in their team, who have sustained a concussion within the previous year. The questionnaire recorded responses regarding demographics (age, sex, race/ethnicity, number of previous concussions); 22 concussion-related symptoms in a binary scale (presence/absence); perception of difficulties in math, reading, writing, computer use, and attention in a 5-point Likert scale; and asymptomatic duration of academic engagement in a 7-point Likert scale. There were 130 respondents with a history of concussion in the past year (n = 59 high school, n = 71 college). While recovering from concussion, significantly more college students (84.5%) reported "difficulty concentrating" than high school students (68.6%: p = 0.049). High -school students experienced more difficulty with math than college students (p = 0.002), whereas college students experienced more difficulty with reading (p = 0.013) and computer use (p = 0.026) than high school students. Asymptomatic duration of cognitive activity was influenced by age (p = 0.0004), where younger students were less tolerant in performing academic tasks after a concussion than older students. Our data indicate that concussions can induce negative symptoms in the academic setting regardless of age. The post-concussion difficulties in academic performance may be a grade-dependent manner, where concussions triggered difficulty in math among high school students and in reading and computer use among college students. It is clear that there is a need for guidelines and accommodations to support students with concussion in academic settings, and the guideline should reflect the age-dependent response to concussions.
| S-EPMC7065268 | biostudies-literature
Project description:ObjectivesTo gather the perspectives of collegiate instructors regarding how concussion is managed within the college classroom. To introduce the themes surrounding collegiate return-to-learn (RTL) and the classroom management of students with concussion.DesignQualitative grounded theory.SettingLarge, public university in the Midwest.ParticipantsTwenty-three college instructors participated in a private, semistructured, audio-recorded, one-on-one interview. Participants included 12 males and 11 females. Interview recordings were transcribed verbatim, followed by an iterative process of open-coding and axial-coding, performed by two researchers.ResultsThree themes emerged from the coded data: (1) awareness-external knowledge of concussion and previous experiences, (2) legitimacy-medical note provided and no note provided and (3) accommodating the student-instructor's role and feasibility of the accommodation. Psychosocial factors such as small class sizes, graduate-level students and an instructor's empathy appeared to influence an instructor's decision making when accommodating a student recovering from concussion.ConclusionThese novel data provide foundational evidence regarding how college instructors perceive and subsequently manage concussion within the classroom, while also offering accuracy to aims of subsequent collegiate RTL investigations ARTICLE SUMMARY: RTL is an emerging field within concussion management, yet is grossly underexplored within the college setting. By utilising a grounded theory approach, this article introduces the themes that dictate the landscape of RTL for a college student.
| S-EPMC8061863 | biostudies-literature
Project description:AimTo understand academic support structures for Washington state public high school students with concussion during the COVID-19 pandemic.Materials & methodsProspective, repeated cross-sectional study of 21 schools in 2020 and 2021.ResultsAbout 28% of schools reported not providing any return-to-learn (RTL) accommodations for students with concussion throughout the COVID-19 pandemic. RTL accommodation provision was associated with larger student body size (β = 0.002) and higher graduation rate (β = 0.261) but was not associated with presence of RTL school policy. About 38.1% of schools received no guidance on how to provide RTL accommodations during the COVID-19 pandemic, and many reported that students with concussion struggled more.ConclusionSchools struggled to provide RTL accommodations for students with concussion during the COVID-19 pandemic, highlighting the need for evidence-based guidance and resource allocation to vulnerable schools.
| S-EPMC9937029 | biostudies-literature
Project description:AimStudents re-entering the academic setting after a concussion is commonly referred to as return-to-learn and, to date, very few studies have examined the return-to-learn aspect of concussion recovery.MethodologyNine college-aged, full-time students who were diagnosed with concussions were monitored throughout their concussion recovery. The severity for five chief symptoms (headache, dizziness, difficulty concentrating, fatigue, anxiety) were recorded six-times per day through text messages, and daily phone calls recorded participant's behavioral traits.ResultsWe identified five behavioral variables which significantly influenced symptom resolution (music, sleep, physical activity, water and time) (p = 0.0004 to p = 0.036). Additionally, subjects reported math and computer-oriented courses as the most difficult (33 and 44%, respectively).ConclusionWe introduce a novel approach to monitor concussed students throughout their recovery, as well as factors that may influence concussion recovery process.
| S-EPMC6787519 | biostudies-literature
Project description:BackgroundYouth concussion is common but there is a paucity of information on symptoms students report to school personnel and a gap in understanding what accommodations schools can provide.ObjectiveTo examine symptoms and provision of temporary accommodations in schools for students reporting concussion symptoms.DesignSecondary data analysis of a trial implementing an evidence-based student-centered return to learn (RTL) program.SettingThirteen public high schools during the 2021-2022 academic year.ParticipantsSixty-two students diagnosed with concussion who reported symptoms to school personnel.InterventionsThe school-based RTL program, which consists of up to four weekly check-ins with an RTL champion who evaluates symptoms and recommends symptom-tailored accommodations.Main outcome measuresSymptom profile, accommodation type, and accommodation duration.ResultsA total of 46 (74.2%) students received accommodation for ≤2 weeks and 16 (25.8%) students received accommodation for 3 (21.0%) or 4 (4.8%) weeks. Sixty-two students experienced an average of 11.2 unique symptoms during week 1. Compared to students whose symptoms resolved within the first 2 weeks, students who received accommodation for 3 or 4 weeks reported higher initial total symptom severity score (p = .02), and higher initial average severity per symptom (p = .01) at week 1. Physical symptoms were most common and received corresponding accommodations most often (75/90 reports: 83.3% of occurrences). In total, 674 (nearly 11 accommodations per student) weekly accommodations were offered.ConclusionsStudents with concussion report a large number and type of symptoms that necessitate symptom-tailored academic accommodations. High school implementation of an evidence-based RTL program may aid in identifying and addressing many RTL needs after concussion, including potential identification of students with concussion who will require longer-term support.
| S-EPMC11889523 | biostudies-literature
Project description:ContextWith heightened awareness of concussion, there is a need to assess and manage the concussed patient in a consistent manner. Unfortunately, concussion physical examination has not been standardized or supported by evidence. Important questions remain about the physical examination.Evidence acquisitionReview of ClinicalKey, Cochrane, MEDLINE, and PubMed prior to July 2015 was performed using search terms, including concussion, mTBI, physical examination, mental status, cranial nerves, reflexes, cervical, vestibular, and oculomotor. The references of the pertinent articles were reviewed for other relevant sources.Study designClinical review.Level of evidenceLevel 3.ResultsThe pertinent physical examination elements for concussion include evaluation of cranial nerves, manual muscle testing, and deep tendon reflexes; inspecting the head and neck for trauma or tenderness and cervical range of motion; Spurling maneuver; a static or dynamic balance assessment; screening ocular examination; and a mental status examination that includes orientation, immediate and delayed recall, concentration, mood, affect, insight, and judgment. Other examination elements to consider, based on signs, symptoms, or clinical suspicion, include testing of upper motor neurons, cervical strength and proprioception, coordination, pupillary reactivity, and visual acuity; examination of the jaw, temporomandibular joint, and thoracic spine; fundoscopic evaluation; orthostatic vital signs; assessment of dynamic visual acuity; and screening for depression, anxiety, substance abuse disorders, and preinjury psychiatric difficulties.ConclusionVarious elements of the physical examination, such as screening ocular examination, cervical musculoskeletal examination, static and/or dynamic balance assessment, and mental status examination, appear to have utility for evaluating concussion; however, data on validity are lacking.
| S-EPMC4981071 | biostudies-literature
Project description:We sought to discover which oculomotor test (King-Devick [KD], near point of convergence [NPC], and accommodative facility [AF]) would best produce a prognostic model for an RTL time frame. An observational cohort design was used to longitudinally track division I and III student-athletes with concussion at a private university in New York State. Measurements included pre-RTL oculomotor testing (NPC, KD, and AF), along with daily text messages and phone calls. Participants were considered returned-to-learn once they had returned to baseline symptoms and had attended 2 days of classes. Our data promote KD score and class attendance as the best-fit prognostic model, with every second accrued on the KD test equating to 5.29 h of RTL time. Further, attending class throughout recovery, versus not, shortened RTL time by a mean 170.50 h, or 7.1 days. Five variables produced a significant attenuating association with concussion symptoms: time post-injury (p = 0.01); caffeine (p = 0.05); alcohol (p = 0.01); music (p = 0.01); and physical activity (p = 0.01). Three variables produced a significant worsening association with concussion symptoms: screen time (p = 0.05); music (p = 0.01); and class attendance (p = 0.01). The findings present a preliminary evidence-based model to prognosticate RTL time. To our knowledge, this is the second longitudinal study, and the first overall, to present objective data for guiding and prognosticating RTL, respectively. Correspondingly, these data should assist clinicians with objectively steering RTL in-clinic.
| S-EPMC10457635 | biostudies-literature
Project description:Radioligand therapy (RLT) is a targeted approach to treating cancer that has been shown to be safe and effective in a variety of disease states, including gastroenteropancreatic neuroendocrine tumors, lymphoma, and most recently, advanced prostate cancer. In the United States, patient access to this therapy is currently variable. Implementation of new RLT programs and expansion of existing programs are needed to broaden patient access to and standardize the delivery of RLT, especially as new therapies are introduced into clinical practice. Drawing from experience in establishing RLT programs in different settings, we have developed practical recommendations for building and implementing a robust RLT program. In this review, we present our recommendations for minimal requirements and optimal requirements, as well as system considerations, and special issues associated with implementing an RLT program in North American centers.
| S-EPMC10905220 | biostudies-literature
Project description:BackgroundThere is long-standing interest in, and concern about, whether collegiate athletes with a history of concussion will experience worse clinical outcomes, or prolonged recovery, should they sustain a subsequent concussion.ObjectivesThis systematic review examined the association between prior concussion history and clinical outcomes following a subsequent sport-related concussion among college-age student athletes.Study designSystematic review.MethodsWe screened 5,118 abstracts and 619 full-text articles that were appraised to determine whether they met inclusion criteria. We utilized a likelihood heuristic to assess the probability of observing a specific number of statistically significant and nonsignificant studies reporting an association between concussion history and clinical outcomes. We conducted a narrative synthesis of the study findings.ResultsSixteen studies met the inclusion criteria. Thirteen studies reported the number of participants with a history of prior concussions (≥ 1), which totaled 1690 of 4573 total participants (on average 37.0% of study participants; median = 46.0%, range 5.6-63.8%). On the Newcastle-Ottawa Quality Assessment Scale, the risk of bias ratings ranged from 3 to 9 (mean = 5.4, SD = 1.4). Across all studies, 43.8% (k = 7/16) reported at least one statistically significant result among primary analyses showing an association between concussion history and worse clinical outcome. A minority of studies reporting on symptom duration (4/13, 30.8%) and time to return to play (2/7, 28.6%) found an association between concussion history and worse outcome. Studies included in the review reported limited information pertaining to the characteristics of prior concussions, such as presence or duration of loss of consciousness or posttraumatic amnesia, age at first lifetime concussion, time since most recent past concussion, or length of recovery from prior concussions.ConclusionThe question of whether college athletes with a prior history of concussion have worse clinical outcome from their next sport-related concussion remains unresolved. The published results are mixed and in aggregate show modest evidence for an association. Many studies have small samples, and only three studies were designed specifically to address this research question. Important outcomes, such as time to return to academics, have not been adequately studied. Larger hypothesis-driven studies considering the number of prior concussions (e.g., 3 or more) are needed.Trial registrationPROSPERO CRD42016041479, CRD42019128300.
| S-EPMC9617993 | biostudies-literature