What we talk about when we talk about concussions: More questions than answers

Are you in the same situation as me? Do you have multiple students who suffer from concussions each year? Some of my practice has been changed forever by students suffering from concussions. I’ve worried and fretted about how to support them. But I have looked and found few answers. While I cannot really figure out how to go forward, I cannot help but want to have policies in place in support of students with the range of symptoms that come with head trauma. So, with one of my at-home students currently confined to a dark room from a concussion, I thought I would throw the question out here: do you have policies or practices in support of concussed students? Do you feel like it would be a helpful issue to address? Do you have ideas on where to start?

In past years – and based on an admittedly quick search now – I have not found any literature in our field on this topic. One student with whom I became quite close spent close to 12 months over the course of her her 5-year high school career shut in dark rooms suffering from concussions from increasingly benign activities – we have talked quite a bit about her experiences.* I am currently parenting through my own child’s second, non-athletic concussion. And, in addition to multiple concussed students each year in our school’s general population, I am currently mentoring two second-semester seniors in our college-level historical research course who live with persistent concussion symptoms on a daily basis.

So. Here is what I’ve anecdotally got:

The student experience

One of the challenges of concussion protocols is that symptoms vary widely, so it is not – I am told by experts – possible to come up with a one-size-fits-all policy.

School concussion protocols acknowledge that light and screens can be particularly painful. Reading is hard. Students need to rest frequently. According to my students, the corollary is not only that they cannot focus on threads of ideas or remember what they hear for more than a few moments at a time, but that they simultaneously feel the need to be polite and engaged, and so tend to cover for their cognitive deficit when they are interacting with me.

They report that they continue to interact, even though it hurts and is confusing, because one of the hidden outcomes of the earlier stages of concussion is profoundly overwhelming boredom, sometimes partnered with depression. Existing in a dark room for days (or significant chunks of days) on end without company is emotionally excruciating. One can only sleep so much. In fact, with all the lying around it becomes hard to sleep at night. But all those awake hours with nothing to do are so very, very hard. The result can be profound depression, along with an inability to engage with emotion.

Coming back to school, there exists a tension among competing forces of teachers wanting to support students, wanting students to learn the content of their classes, and wanting to help students catch up. The general result seems to be that in our sincere desire to support concussed students in all the ways (as one school’s learning specialist once told me: “We do not cut content, just work. A student who completes a class is just as well prepared as his classmates.”) students experience teachers saying they are following the protocols but not actually doing so. Add to that situation the oft-observed student practice of having both sides of a conversation with a teacher by themselves, without the teacher’s knowledge, and you get experiences like: “Sure, my physics teacher said to only worry about completing this reflection, but that means he expects me to catch up on all the daily work too, he just did not write it in the plan.”

So, where does the librarian fit into this?

How we interact


It seems helpful to tell a student up-front that I know that head trauma makes it hard to concentrate for long. I let her know I will be checking in at regular intervals (aka, every few minutes) and I am in support of her telling me when her concentration runs out. And then actually asking and responding appropriately. If I just pop out with that question mid-conversation, without the up-front warning, students tend to pretend they are okay when they are not.

Audiobooks

I learned to love audiobooks due to careful cultivation by my former five-year high school student. Her first concussion kept her in a darkened room for something like six months; music and audiobooks were the only activities she could manage. While she was a font of knowledge that got me hooked on the genre, she also had a lot to say about the kinds of audiobooks that worked for her during recovery: slow moving, not too much emotion, often well below her reading level so they took less cognitive effort to follow but did keep her mind active.

One of her favorites provides a good example of what worked for her when she missed a significant portion of tenth grade: Saffy’s Angel, by Hilary McKay. The book was character-driven, with a slow-moving story. The characters are engaging, and the book is quietly funny. School Library Journal rates it for 4-6 grades. The humor is very helpful when stuck in a dark room, but laughing hurts and so quietly amusing seems to work well. Again, students report that emotional content can be impossible to process, and I believe that a particularly well-crafted story for an audience younger than the student herself can make for a good fit. Slow-moving stories make it easier to process when you find you cannot remember all that you hear.

Based on advocacy by this student, we determined to add audiobooks in our Overdrive collection (though she may just be learning that fact from reading this post). I would love to crowdsource a list of audiobooks that can provide a sort of emotional “high-low” listening experience that might work for concussed students of different ages.

Additionally, while our library does not tend to collect curricular books – or focus on providing fee-per-use audiobooks of reading from our curriculum – it might be worth considering a special budget category (above and beyond your budget as it stands) for supporting concussed students. Anyone have anything like this in place?

(Another parent’s point of view on concussions and audiobooks can be found here.)

Research

Generally, my colleagues seem to cut back on research assignments for concussed students, but I am also aware that there are plenty of assignment that fall into that gray area that classroom teachers do not call “research” (at least, for the purposes of considering collaboration) but that require both searching for and navigating information resources.

This is where I feel we would really benefit from having a policy in place that gets rolled into the school’s concussion policy. I would like to have well-informed practices in place that would automatically involve our library staff in helping teachers think through the necessary learning objectives around a project. Is this assignment intended to help her learn to pick search terms? To pick good results? Or to navigate content in sources? She should not have to do them all, nor should she be responsible to complete steps that lengthen the use of her eyes and focus when they are not helpful to fulfilling the learning objectives. So, how can we help lighten the load?

I’ve not really gotten beyond this point in my thinking, and would truly love to hear from others how they handle this element of our work.

Reading

Overall, I am a huge proponent of teaching students how to read academically, especially in the latter years of high-school. The notion of reading scholarly works from the outside in should be, I believe, a central part of any college prep curriculum that involves reading journal articles, as should discipline-specific guidance helping students understand the parts of articles and what a high school/early college student does and does not need to actually understand in an article. (For example, I’ve distilled this article into a three-page outline that I often share with students reading in the social sciences and some sciences.) Textbooks create a different kind of challenge in reading, since they are written for compact delivery of factual information.

But I think a strong base in reading for different purposes and a curricular acknowledgement that good reading does not always involve reading and understanding and taking notes on every line of text is good for all students. And then we have a base to build upon for supporting recovering students in being selective in not only what pieces they read, but how they approach reading them.

(And now I want to learn more about how visual note taking may or may not be a useful tool with students recovering from head trauma.)

Thoughts?

So – this lengthy post is more thinking and wondering than answers, but I would be so very grateful to hear your thoughts and practices, as well. As schools seek to improve their care of students suffering from brain injuries, librarians have another opportunity to offer thought leadership and compassionate care.

*This story with my alum’s permission.

1 thought on “What we talk about when we talk about concussions: More questions than answers

  1. A lot to think about here, and not just for librarians! I shared with my grade level deans and learning services, too. I’m especially interested in being explicit about expectations as a crucial piece of their recovery. Thanks, Tasha.

Leave a Reply

Your email address will not be published.