BY: RACHEL HOPMAYER
WASHINGTON — Multiple testimonials from non-athletes at American University argue that school administration does little in helping them transition back to academics after sustaining concussions.
Three students interviewed in an effort to review university attention on concussions sustained by students that are not athletes for the varsity programs show an increasing absence of help transitioning from concussion protocol to full academic strength, with no enforcement or existence of a return-to-learn process geared toward guiding students back to the classroom and full academic performance.
Today, American University has no enforced return-to-learn protocol through the student health center or Academic Support and Access Center. Varsity student-athletes have their own separate staff dedicated to injury recovery and academic accommodations.
“Most of our support programs are identical, it is just the model by which the service is provided looks a little different,” said Ashley Rozendaal, program director of the Student-Athlete Support Program within ASAC.
American University athletes have trainers and medical staff within their program, so they are constantly tested for injury progress.
“Athletics’ protocol is clear as day; I get updates throughout the entire process,” Rozendaal said. “I might get updated on one athlete up to four times in a week because they’re testing for progress every single day, while I find that non-athletes, they’re having to — while concussed — navigate that return themselves, with their medical provider.”
“We get information about the original concussion and if we ask for an update we get it, but there is no constant back and forth relationship with the student’s medical provider,” said Lindsay Northup-Moore, the director of disability support for ASAC.
WHAT STUDENTS SAY
Stephanie Osber, a senior at American University, was hiking in Great Falls, Virginia this fall when local kids accidentally threw a rock at her head.
“I wasn’t sure at first if it was a concussion until I got nauseous in the car ride home,” Osber said. “I was nauseous and dizzy so I went to urgent care the next day.”
“The physician’s assistant told me she could not diagnose it was a concussion without me going to the ER or a neurologist, but since I ‘passed’ their neuroexam, as long as I rested I would be fine,” Osber said.
Over the next few days, Osber’s symptoms fluctuated so she sought out more medical help.
“I was frustrated with the contradicting information I was receiving. For example, one doctor told me I could use screens and others told me I should not. However, by going to this many doctors I received a note which exempted me from school that I gave directly to my professors. I did this to get extensions that first week after the concussion when I couldn’t be in class. Some were understanding, but some were more hesitant to accept my doctor’s note.”
Throughout this entire process, Osber had no idea that school resources and administrators could have provided further help and that some processes are established through the school to help students get accommodations.
“I did not go to the Dean’s office until I was told I needed to by my professor. I did not realize the Dean of Students was where I should be going. I emailed my advisors to see how to get in contact with the Dean of Students, and then I went to the Dean’s open hours,” Osber said.
“It would have been nice if the deans note offered a protocol for professors to set up a meeting to work with each student individually to work out a plan to catch up on things. I talked to all of my professors in person, but it would have been nice to have that protocol in play. That way it could be easier for students to get on top of it when they are recovering from a concussion,” Osber said. “It is difficult coming back from a concussion to go to classes and catch up on old material, and it is up to the students to figure out a plan for how to catch up. It is all very overwhelming.”
Emily Frieband is also a senior at American University. She was on the club rugby team freshman year when she collapsed on the sidelines of a rugby match at Temple University in Philadelphia.
“My head was impacted three times over a series of tackles and kicking,” Frieband said.
At Sibley Memorial Hospital, an emergency room doctor diagnosed her with a severe concussion and extreme whiplash. She was given Naproxen, an anti-inflammatory pain reliever, for the pain and a note from the doctor to give professors about missing school. Frieband’s rugby coaches advised her to set up an appointment with ASAC to look into getting accommodations while she suffered from concussion symptoms.
“The advisor asked me what preferences I would need out of options. They were able to make my classes give me a note-taker and to allow me to take tests in a dimly lit room with extra time,” Frieband said. “The accommodations helped a lot seeing as it was my first semester of college.”
Getting the academic support was an easy task, but renewing them was impossible. Because her symptoms outlasted her accommodations, she failed a major assignment which impacted her final grade.
“My college writing professor was not helpful at all and I ended up getting a C in the class,” Frieband said. “I had the accommodations only for the first semester and it was tough when they expired because my symptoms were not completely over.”
Another senior at American University, who wishes to remain anonymous, was concussed after a violent assault two years ago and expressed similar sentiments about difficulties transitioning from initial accommodations to asking for further support.
“Not only was it a traumatic event in itself but then when I came back to school, I didn’t really say anything about my concussion immediately because I did not know I was concussed at first, I was overwhelmed, and the school was going through a lot of Title IX drama and I was hesitant to get involved in that,” she said.
After confiding in her academic advisor about what she had experienced, the advisor took her to the Wellness Center where she reported the crime that happened to her and resulting injuries. The Wellness Center employee listened to her story and walked with her to the Dean of Students’ office, but gave no further help.
“If somebody comes to you and reports a crime in the District of Columbia, you have to call the police,” she said. “She just brought me to the Dean of Students, and that ultimately was not helpful in the end either. There are just so many things I wish could have been done differently.”
The Dean of Students promptly wrote her a letter to excuse her from class for two weeks, but offered nothing further there.
“To put it in a time frame, three weeks before finals,” she said. “So I’m missing two weeks of classes right before finals of a spring semester. Once I came back from those two weeks, my professors, not knowing anything that happened, still made me take my finals which I failed because I was still concussed. The university was not helpful in getting any sort of accommodations for those finals, they would not let me take incomplete grades in those classes, and they were not helpful with any sort of trauma support for anything that had happened from the assault.”
The number of visits to the Student Health Center coded as post-concussion treatment has doubled in the past two years. The data in the graph below was provided by Edythe-Anne Cook, the associate director of administrative services at the Student Health Center. No further data on the visits can be accessed publicly due to HIPAA laws and student privacy regulations.
“Since they have their own team physicians, many student athletes don’t come to the health center after they are diagnosed with a concussion,” Cook said. There is no organized data selection to determine anything differential from the visits logged to the Student Health Center other than what they were coded as when the appointments were booked by the students.
If university staff is overwhelmed by the growing number of cases treated at American University, then future budgeting should focus toward providing more resources on brain injuries for students as well as employees of the Student Health Center. As of now, there is no contracted or recommended neurologist from the university that accepts university health insurance. Cook commented that they refer many cases to Medstar National Rehabilitation Network’s Concussion Clinic that has four locations in Washington, D.C. On the university website, the staff listed includes Medical Director Dr. David Reitman, four advanced practice clinicians, one psychiatric health practitioner and two registered nurses.
All students who approach the Academic Support and Access Center with a sustained concussion are directed to go through the Dean of Students’ office to get an initial letter providing excused absences if necessary due to injury.
It is crucial that universities provide equal health care and concussion support to all students, according to Madeline Uretsky, a clinical research intern at Boston University’s CTE Center, the world’s leading research group that focuses on chronic traumatic encephalopathy and other long-term impacts of brain injuries.
“The student should come first at a place of higher education,” Uretsky said. “It shouldn’t matter what activities they’re involved in, academics come first. If a student sustains a brain injury, then they should get the support needed to continue to thrive academically.”
Not all doctors agree though, and more research must be done across the board to understand head injuries on a deeper level.
“As it is, if a kid, and I’m thinking about my two sons, they do something goofy and end up with a concussion, is the school obligated to take care of them and provide the treatment just like they would for a guy who is on the field of combat and representing the school?” said Dr. Brent Masel, the medical director for the Brain Injury Association of America. “I think it’s a little different.”
“All you read about in the literature these days is about return to play — we see so very little about returning to school and to academics,” said Dr. Masel, a neurologist by trade. “Quite frankly, the overwhelming majority of concussions occur in non-competitive athletic situations where their goal is returning to the classroom. Returning to the field of play is minor.”
However, the medical field is enraptured by CTE and what can happen years after concussions, not in the immediate aftermath.
“It’s just not sexy,” Dr. Masel said. “It hasn’t caught the public’s attention yet.”