K–12 Students With Concussions

Abstract

This article provides a multipart analysis of the public schools’ responsibility for students with concussions. The first part provides the prevailing diagnostic definitions of concussions and postconcussive syndrome. The second and central part provides (a) the legal framework of the two overlapping federal laws—the Individuals with Disabilities Education Act and Section 504 of the Rehabilitation Act and the varying state laws or local policies for individual health plans and (b) a summary of the developing body of hearing officer decisions, court decisions, and Office for Civil Rights rulings that have applied this framework to K–12 students with concussions. The final part offers recommendations for proactive return to school policies, with the school nurse playing a central supporting role.

Keywords

academic achievement attendance school nurse education policies procedures legal ethical issues collaboration multidisciplinary teams middle junior high school best practices practice guidelines

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References

Alt v. Shirey, 112 LRP 10558 and 113 LRP 6694 (W.D. Pa. 2012).

Amberg

(2012). Protecting kids’ melons: Potential liability and enforcement issues with youth concussion laws. Marquette Sports Law Review, 23, 171–190.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Americans with Disabilities Act legislation, 42 U.S.C.A. §§ 12102 et seq. (2012).

Bd. of Educ. v. Rowley, 458 U.S. 176 (1982).

Bigler

E. D.

(2008). Neuropsychology and clinical neuroscience of persistent post-concussive syndrome. Journal of the International Neuropsychological Society, 14, 122. doi:10.1017/S135561770808017X

Bowling

(2014, January 27). Highland school district to pay former student $20k to settle concussion claims. Pittsburgh Tribune Review . Retrieved from http://triblive.com

BrainSTEPS. (2012). BrainSTEPS presents: Concussions in the classroom – returning to learning. [Webinar]. Retrieved from http://www.pattan.net/Videos/Browse/Single/?code_name=brainsteps_presents_concussions_in_the

BrainSTEPS. (2013). Returning to school after concussion: Recommended protocol. Brain Injury Association of Pennsylvania, Pennsylvania Department of Health, Pennsylvania Department of Education. Retrieved from http://www.brainsteps.net/_orbs/about/2_BrainSTEPS_Protocol.pdf

10.

Brandwein

(2013). Goals and obstacles in legislating concussion management in youth sports. Willamette Sports Law Journal, 10, 28–47.

11.

Brown

Mannix

O'Brien

Gostine

Collins

Meehan

(2014). Effect of cognitive activity level on duration of post-concussion symptoms. Pediatrics, 133(2), 1–6.

12.

CAL. EDUC. CODE § 494.7(f) (West 2012).

13.

Camiolo

C. R.

(2011). Postconcussion syndrome: A physiatrist’s approach. American Academy of Physical Medicine and Rehabilitation, 3, S396–S405. doi:10.1016/j.pmrj.2011.07.012

14.

Centers for Disease Control and Prevention. (2003). Report to Congress on mild traumatic brain injury in the United States: Steps to prevent a serious public health problem. Retrieved from http://www.cdc.gov/ncipc/pub-res/mtbi/mtbireport.pdf

15.

Centers for Disease Control and Prevention. (2009). Heads up: Facts for physicians about mild traumatic brain injury. Retrieved from http://www.cdc.gov/concussion/headsup/pdf/Facts_for_Physicians_booklet-a.pdf

16.

Centers for Disease Control and Prevention. (2010). Heads up concussion: Know your ABCs, a fact sheet for school nurses. Retrieved from http://www.cdc.gov/concussion/pdf/TBI_factsheet_NURSE-508-a.pdf

17.

Centers for Disease Control and Prevention. (2013). Helping students recover from a concussion: Classroom tips for teachers. Retrieved from http://www.cdc.gov/concussion/pdf/TBI_Classroom_Tips_for_Teachers-a.pdf

18.

Cerny v. Cedar Bluffs Junior/Senior Pub. Sch., 679 N.W.2d 198 (Neb. 2004).

19.

Cerra

D. S.

(2012). Unringing the bell: Former players sue the helmet makers over concussions risks in Maxwell v . NFL. Michigan State University Journal of Medicine and Law, 16, 265–294.

20.

Children’s Safety Network. (2013). Interactive maps: State laws concerning sport-related concussions among youth. Retrieved from http://www.childrenssafetynetwork.org/publications/state-laws-concerning-sport-related-concussions-among-youth

21.

Clark Cnty. Sch. Dist., 49 IDELR ¶ 30 (Nev. SEA 2012).

22.

Collins

M. W.

Lovell

M. R.

Iverson

G. L.

Ide

Maroon

(2006). Examining concussion rates and return to play in high school football players wearing newer helmet technology: A three-year prospective cohort study. Neurosurgery, 58, 275–286.

23.

Davies

Russo

C. J.

Osborne

A. G.

(2012). Concussion and student sports: A silent epidemic. West’s Education Law Reporter, 282, 759–766.

24.

Diaz

A. L.

Wyckoff

L. J.

(2013). Concussions: The role of the school nurse. NASN School Nurse, 28, 110–111. doi:10.1177/1942602X12473949

25.

Giza

C. C.

Hovda

D. A.

(2001). The neurometabolic cascade of concussion. Journal of Athletic Training, 36, 228–235.

26.

Halstead

M. E.

McAvoy

Devore

(2013). Returning to learning following a concussion. Pediatrics, 132, 948–957.

27.

Hotz

R. L.

(2013, August 20). Concussion on the field, repercussions in school. Wall Street Journal, pp.D1, D4.

28.

IDEA regulations, 34 C.F.R. §§ 300.1 et seq. (2012).

29.

Impact of concussions on high school athletes: Hearing before the Committee on Education and Labor, House of Representatives, 111th Cong. 2. (2010). (testimony of G. A. Gioia). Retrieved from http://www.gpo.gov/fdsys/pkg/CHRG-111hhrg56354/html/CHRG-111hhrg56354.htm

30.

In re Student with a Disability, 113 LRP 8908 (S.D. SEA 2012).

31.

INDIANA CODE §§ 20-34-5-3 and 20-34-5-13 – 20-34-5-17 (2012).

32.

Individuals with Disabilities Education Act (IDEA) legislation, 20 U.S.C. §§ 1400 et seq. (2012).

33.

Institute of Medicine, National Research Council. (2013). Sports-related concussions in youth: Improving the science, changing the culture. Retrieved from http://www.iom.edu/Reports/2013/Sports-Related-Concussions-in-Youth-Improving-the-Science-Changing-the-Culture.aspx

34.

IOWA ADMIN. CODE r. 281.4104(3)(b) and r. 281.4105(1) (2012).

35.

Iverson

G. l.

Zasler

N. D.

Lange

R. T.

(2007) Post-concussive disorders. In Zasler

N. D.

Katz

D. I.

Zafonte

(Eds.), Brain injury medicine: Principles and practice (pp. 373–403). New York, NY: Demos.

36.

James A. Garfield (OH) Local Sch. Dist., 52 IDELR ¶ 142 (OCR 2009).

37.

Karlen v. Westport Bd. of Educ. 53 IDELR ¶ 17 (D. Conn. 2009).

38.

La. Admin. Code, tit. 28, Pt. CI, § 1509(C)(3) (2012).

39.

Langlois

J. A.

Rutland-Brown

Wald

(2006). The epidemiology and impact of traumatic brain injury: A brief overview. Journal of Head Trauma Rehabilitation, 21, 375–378.

40.

Leddy

J. J.

Sandhu

Sodhi

Baker

Willer

(2012). Rehabilitation of concussion and post-concussion syndrome. Sports Health, 4,147–154.

41.

Letter to Durkeim, 27 IDELR 380 (OCR 1997).

42.

Marshall Joint Sch. Dist. No. 2 v. C.D., 616 F.3d 632 (7th Cir. 2010).

43.

Master

C. L.

Gioia

G. A.

Leddy

J. J.

Grady

M. F.

(2012). Importance of “return-to-learn” in pediatric and adolescent concussion. Pediatric Annals, 41, 1–6. doi:10.3928/00904481-20120827-09

44.

McCrory

Meeuwisse

Aubry

Cantu

Dvorak

Echemendia

… Turner

(2013). Consensus statement on concussion in sport: The 4th international conference on concussion in sport held in Zurich, November 2012. British Journal of Sports Medicine, 47, 250–258.

45.

McDowell Cnty. (WV) Sch., 58 IDELR ¶ 82 (OCR 2010).

46.

McLeod

T. V.

Gioia

G. A.

(2010). Cognitive rest: the often neglected aspect of concussion management. Athletic Therapy Today, 15, 1–3.

47.

McAvoy

(2009). REAP the benefits of good concussion management. Centennial, CO: Rocky Mountain Sports Medicine Institute Center for Concussion. Retrieved from http://ochspioneers.org/sites/default/files/pages/REAP_0.pdf

48.

Minn. Stat. § 121A.2205 (2013).

49.

Miss. Code Ann. § 41-79-5(2)(l) (2012).

50.

Mo. Rev. Stat. § 167.208(3) (2012).

51.

Moyer v. Long Beach Unified Sch. Dist., 60 IDELR ¶ 126 (N.D. Cal. 2012).

52.

Mt. Zion Unit Sch. Dist. No. 3, 111 LRP 51317 (Ill. SEA 2011).

53.

Office for Civil Rights. (2009). Frequently asked questions about Section 504 and the education of students with disabilities. Retrieved from http://www2.ed.gov/about/offices/list/ocr/504faq.html

54.

Office for Civil Rights. (2012). Questions and answers on the ADA amendments act of 2008 for students with disabilities attending public elementary and secondary schools. Retrieved from http://www2.ed.gov/about/offices/list/ocr/docs/dcl-504faq-201109.html

55.

Or. Rev. Stat. § 329.496(4)(b) (2012).

56.

Orentlicher

David

W. S.

(2012). Concussion and football: Failures to respond by the NFL and medical profession. FIU Law Journal, 8, 23–36.

57.

Pennsylvania Department of Education. (2013). Teacher’s desk reference: Concussion. King of Prussia, PA: Author.

58.

P.R. v. Texas Autism Ctr., Inc., 52 IDELR ¶ 222 (W.D. Tex. 2009).

59.

Perrin v. Warrior Run Sch. Dist., 61 IDELR ¶ 257 (M.D. Pa. 2013).

60.

R.N. v. Cape Girardeau 63 Sch. Dist., 858 F. Supp. 2d 1025 (E.D. Mo. 2012).

61.

Reich

(2013). When “getting your bell rung” may lead to “ringing the bell”: Potential compensation for NFL player concussion-related injuries. Virginia Sports and Entertainment Law Journal, 12, 198–231.

62.

Reilly

C. L.

(2012). The NCAA needs smelling salts when it comes to concussion regulation in major college athletics. UCLA Entertainment Law Review, 19, 245–292.

63.

S. C. Code Ann. § 59-63-80 (2012).

64.

Sady

M. D.

Vaughan

Gioia

G. A.

(2011). School and the concussed youth: Recommendations for concussion education and management. Physical Medicine and Rehabilitation Clinics in North America, 22, 701–719. doi:10.1016/j.pmr.2011.08.008

65.

Section 504 of the Rehabilitation Act, 20 U.S.C. § 794 (2012).

66.

Section 504 regulations, 34 C.F.R. §§ 104.1 et seq. (2012).

67.

Silverberg

N. D.

Iverson

G. L.

(2012). Is rest after concussion “The Best Medicine?” Recommendations for activity resumption following concussion in athletes, civilians, and military service members. Journal of Head Trauma Rehabilitation, 28, 250–259.

68.

Tamalpais Union High Sch. Dist., 59 IDELR ¶ 236 (Cal. SEA 2011).

69.

Tex. Educ. Code Ann. §§ 168.003 and 168.008 (2012).

70.

Toporek

(2011, Aug. 10). Concussion law targeting student–athletes on upswing. Education Week, p. 10.

71.

Valovich McLeod

Gioia

(2010). Cognitive rest: The often neglected aspect of concussion management. Athletic Therapy Today, 15, 1–3.

72.

Wanamaker v. Westport Bd. of Educ., 899 F. Supp. 2d 193 (D. Conn. 2012).

73.

Warrior Run Sch. Dist., 113 LRP 39220 (Pa. SEA 2013).

74.

Willer

Leddy

J. J.

(2006). Management of concussion and post-concussion syndrome. Current Treatment Options in Neurology, 8, 415–426.

75.

World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva, Switzerland: Author.

76.

Zirkel

P. A.

(2012a). Independent educational evaluation reimbursement under the IDEA: An update. ELA Notes, 47, 16–18.

77.

Zirkel

(2012b). Section 504 eligibility and students on individual health plans. West’s Education Law Reporter, 276, 577–586.

78.

Zirkel

P. A.

(2013). Is it time for elevating the standard for FAPE under IDEA? Exceptional Children, 79, 503–508.

79.

Zirkel

P. A.

McGuire

B. L.

(2010). A roadmap to legal dispute resolution for students with disabilities. Journal of Special Education Leadership, 23, 100–112.