City ranked 5th for student concussions in state last year
Experts say it's due to better reporting
NORWALK — The city’s public schools ranked fifth in Connecticut for recorded student concussions last academic year — a rank experts say is likely because the district does a better job reporting them.
The district reported 76 concussions to the state last school year, an increase of 19 from the prior year, according to state Department of Education data provided to Hearst Connecticut Media as part of an investigation that revealed a significant gap in Connecticut school districts’ reported concussion numbers. Norwalk’s student population is one of the largest in the state.
“Do we want to see 76 concussions?” asked David Wang, the sports medicine director and head team physician at Quinnipiac University in Hamden. “No. But it’s not necessarily a bad thing that you see Norwalk ranked fifth. Because, while there are concussions, it means that Norwalk is reporting them.”
Katherine Price Snedaker, executive director and founder of Pink Concussions based in Norwalk, said that reporting concussions, even at a high rate, is better than the alternative: underreporting and not identifying concussions. The Hearst investigation revealed that about one-third of Connecticut’s school districts ignored state law at least once in the last two years requiring them to report student concussion statistics.
“We’re doing a good job,” said Snedaker, whose organization advocates for women and girls with brain injuries, including concussions, from sports, violence, accidents or military service.
Snedaker and Wang said better concussion prevention and care is needed across the state because of the negative effects these injuries can have on students’ health and academics.
Norwalk Public Schools Health Services said in a statement that it adheres to recommendations on how to care for students with concussions.
“We support students diagnosed with concussions by working with their medical provider regarding limitations and accommodations required during the school day,” the statement said. “Collaboration with the medical provider and family is imperative to the success of the student. This collaboration is ongoing until symptoms have resolved and the student is fully cleared to return to academics and activities.”
So far this school year, the district has seen 29 separate concussions, said Emily Morgan, media relations specialist for Norwalk Public Schools.
The district reported 57 concussions in the 2021-22 school year and 12 in 2020-21, a year where school districts across the state recorded fewer concussions due to COVID-19, according to the state data. Norwalk schools saw 103 concussions in 2019-20, according to the data.
The figures school districts must report to the state each year include concussions that occurred in a variety of settings, including during school sports, gym class, recess, town sports and others outside of school, such as a fall at home or from a car crash.
Concussion prevention
After a concussion, immediate care involves physical and mental rest, Wang said.
But there exists a different kind of concussion care: prevention.
“It comes down to resources,” Snedaker said, noting that fulltime athletic trainers are crucial to identifying concussions and providing consistent and reliable in-school care.
Both of Norwalk Public Schools’ high school campuses have a full-time athletic trainer, Morgan said.
A full-time athletic trainer can develop a rapport with a student athlete and establish a behavioral baseline, experts said.
“It’s so important for the athletic trainers to know the kids and know their personalities,” Snedaker said. “So they can know when they’re not right.” Wang agreed.
“A lot of school districts don’t have athletic trainers,” he said.
In fact, only 30 percent of Connecticut schools have full-time athletic trainers, according to current data from the University of Connecticut’s Korey Stringer Institute Athletic Training Locations and Services survey.
The amount of full-time trainers reported in the survey, 71, is equal to schools without athletic trainers and with only part-time athletic trainers combined. In total, the survey reports that only 47.5 percent of all the schools have access to athletic training.
Wang said it’s crucial to increase schools’ access to fulltime trainers to prevent athletic concussions — the University of Michigan reports there are nearly 4 million sports-related concussions in the U.S. each year.
“Athletic trainers would probably be helping with sports-related concussions,” Wang said. “But guess what? People get concussions at school for other reasons than sports.”
Kids can get concussions anywhere, Norwalk Public Schools’ media relations specialist said in an email.
“Concussions that are reported by Norwalk Public Schools don’t necessarily occur during the school day or on school property,” Morgan said. “A student may suffer a concussion at home or during an after-school or weekend activity. Students report a concussion to their school nurse so it can be marked in their health records and a safe plan put into place, if needed.”
That’s why it’s important to have proactive concussion reporting protocols and training outside of athletics, both experts said.
“(Otherwise,) the medical care that we’re giving our kids is determined on their value as an athlete to the school,” the Pink Concussions founder said.
Snedaker said the city took a good first step in concussion prevention and care when Norwalk Common Council approved concussion guidelines in 2015.
The guidelines require any sports team permitted to use city fields, gyms or courts to record concussions, remove athletes from play after a concussion, train coaches, athletes and parents on concussion safety, and obtain permission from a health care professional to return to play.
Snedaker said state concussion policy could improve with protocols that emphasize elementaryand middle schoolerage concussions.
At least 11 elementary- and middle school-age Norwalk students had concussions in the 2021-2022 academic year, according to the Hearst Connecticut Media investigation. In 20222023, at least 17 elementary- and middle school-age students had concussions, the data shows.
John Frassinelli, director of school health, nutrition, family services and adult education at the state Department of Education, said good concussion care is also about attitudes.
“I think what schools can do to keep kids safe is create a climate where students and families are encouraged to report suspected blows to the head,” he said. “Encourage students to speak up, talk to the nurse, report it to the nurse so it can be looked into and, if necessary, obviously follow up with the physician and keep the student healthy while they’re resting up.”
Negative concussion outcomes
When concussions go unnoticed, children can experience serious setbacks, Wang said.
First, Wang said concussions show textbooks signs: what the patient looks like after impact to the head.
“Someone staggering, or disoriented, holding their head, maybe even throwing up, showing signs of confusion, walking to the wrong sideline,” he said, referring to immediate indications of concussion.
The Quinnipiac head physician said concussed individuals next will experience a “laundry list” of symptoms: what the patient feels like after a blow to the head.
“Oftentimes it is a headache, light sensitivity, noise sensitivity, dizziness, unsteadiness, cognitive fogginess and feeling slowed down or muddled thinking,” Wang said. “Changes in heart rate and feeling faint when standing up, not being able to remember things.”
But past the immediate impacts of a concussion, Wang said that longer-term effects depend on what the concussed “brings to the table.”
“What you are before the concussion can be amplified and complicated after,” the Quinnipiac sports medicine director said. “Those people with ADHD get a concussion and may say, ‘oh gee, my ADHD is a lot worse than it used to be.’ Those people with depression? ‘Oh man, my depression is so much worse after this head injury.’”
He said students often need academic accommodations after a concussion; the Hearst investigation data shows that 60 of Norwalk’s 76 concussions last school year required academic accommodations. Another seven required implementation of Section 504 plans — plans used to accommodate students with disabilities.
Those 60 students needed academic accommodations for an average of 341 days, according to the state data. The seven concussions that required Section 504 implementation used the plans for an average of 210 days.
Wang said that long-term concussion symptoms can hamper a student’s performance. But for all modern advancement and knowledge about concussions, he said experts like himself are constantly left with more questions:
How many concussions lead to permanent damage, like CTE? Why do girls experience concussions more severely than boys?
Wang said there is plenty of room for further concussion research.