Post-concussion academic supports in higher education: new efforts to address continuing gaps
By Susan Klein, MD, PhD. This article was initially published in the 8/24/23 edition of our Concussion Update newsletter; please consider subscribing.
If you are a college student with a concussion, how do you work with professors to finish your courses, keep your student aid (which may depend on your grades), and stay on track for graduation? Readers of Concussion Alliance know that we support a systematic approach to return to learn (RTL) for adults in college. A recent report by Memmini and colleagues applies a qualitative research methodology they used to identify key principles of RTL for college athletes to explore how non-athletes fare in the college classroom after a concussion. Memmini et al. conducted structured interviews with students and academic faculty and assembled a panel of concussion experts who used the Delphi consensus-building process to craft recommendations. (The group used the same process to translate their RTL principles into an RTL plan as part of this larger research project.) Published in The Journal of Head Trauma Rehabilitation, the report provides university-level postconcussion policy recommendations.
In the first part of the study, three themes emerged from the interviews with students and academic stakeholders.
(Theme 1) Most students (90%) told their instructors about their concussion and felt their instructors were empathetic.
(Theme 2) Students reported a “lack of guidance and resources;” their institution didn’t have information about how to progress back to learning postconcussion, leaving academic accommodations up to an under-informed dialogue between students and their instructors.
(Theme 3) Students cited a need for concussion education, including the seriousness of the injury, recovery trajectories, and how it would affect their academics. They also reported a need for RTL guidelines, including “pathways to obtain academic support following concussion,” to help them communicate with their professors.
Academic faculty and staff similarly reported inconsistency in knowing what support to provide students with concussions or whom they could contact within the university to help them (Themes 2, 3).
A panel of 22 concussion experts then engaged in a Delphi consensus process, creating the following postconcussion policy recommendations.
Concussed patients need a list of essential recommendations from their medical provider (provided at discharge) about what to do when they are first diagnosed with a concussion, including being informed of their “right to request for additional assistance in institutions of higher education if they experience symptoms that affect their ability to attend class and learn.”
Institutions must identify a core set of essential multidisciplinary supporters of a student’s RTL (medical, disability specialists, and academic).
Each institution should work with stakeholders (medical, academic, and student) to develop a framework of academic adjustments, accommodations, and modifications in the form of a checklist with timelines. Students should be required to check in with the disability office if they need adjustments, accommodations, or modifications beyond four weeks.
Memmini and coworkers first studied barriers to return to learning faced by university students after a concussion by doing individual interviews with 21 non-athlete college students who had a concussion (while attending college) within the last three years and 7 university employees.
Next, 22 concussion experts reviewed published reports on RTL after sports-related concussion. They then completed an open-ended survey on initial medical recommendations after concussion, how those recommendations could be interpreted to include multispecialty support for recovery, and where support could be provided in the higher-education setting.
The researchers used data-reduction software to generate short statements from the expert survey responses, resulting in the emergence of the three categories. Experts then met to rank and prioritize the statements to create a set of recommendations for improving medical discharge documentation, student-institution communication, and academic support structures for all students at the higher education level. The goal of this design (called grounded theory) is to allow raw data, in this case, interviews with university student students about their experience with concussion, to modify what experts recommend for dealing with its aftereffects.
We agree with the researchers’ conclusion that “[C]urrent postconcussion RTL guidelines do not appropriately represent the lived experiences of students recovering from concussion and/or academic stakeholders in the collegiate setting who directly assist students during their concussion recovery.” Memmini and colleagues’ study aligns that lived experience with the expertise of thought leaders, a good place to start on a roadmap for everyone who experiences concussion.