Anjali Verma was sitting in the gymnasium, fluorescent lights beaming down, Advanced Placement test booklet open鈥攁nd she found that she couldn鈥檛 remember anything about physics. Everything looked too small; she had no idea what she was reading. Her head was pounding.
The day before, guarding the lacrosse goal, she鈥檇 taken two hits to the head. The first happened during warm-ups. The shot came from just 4 feet away. Even though she was wearing a helmet, she remembers crying from the impact.
She was the only varsity goalie, though, and she felt obligated to stay strong for her team. Besides, she didn鈥檛 think she was very hurt. She told her coach she thought her emotional reaction was just because she was scared. Face hits are rattling, she said. It was a shock. But then the second hit came, in the middle of the game.
Anjali hadn鈥檛 felt like herself after the game, but it wasn鈥檛 until the AP exam that she realized something was wrong. Later, when she went to the doctor, she failed every concussion test. Badly.
She鈥檇 had a concussion before and thought this one would go like that: Sit around in the dark, and she鈥檇 be fine in two weeks.
鈥淭hat was not the case for me,鈥� said the senior from West Chester, Pa. 鈥淚 thought I was going to be cleared. I was not.鈥�
The injuries happened in May of her sophomore year. It鈥檚 been 19 months, and Anjali is still experiencing symptoms. She鈥檚 one of thousands of students who recover from a traumatic brain injury, or TBI, during their K-12 education.
More than 50,000 children are hospitalized each year nationwide with an acquired brain injury, . A TBI is a brain injury caused by a blow, bump, or jolt to the head or body and can cause 鈥攖hings like headaches, nausea, confusion or disorientation, changes in sleep patterns, frustration and irritability, sensitivity to light and sound, or fatigue. A concussion is a mild form of a TBI.
More than a decade ago, Washington state and Oregon passed the first concussion laws intended to protect student-athletes. In the years since, all 50 states have approved legislation focused on return to play: protecting students from jumping back into the game too early and therefore increasing their risk for compounding concussions and traumatic brain injuries.
But return-to-school protocols are hard to come by. The Society of Health and Physical Educators, or SHAPE America, has reported that have concussion laws on the books with language about injured students resuming normal academic activities.
Physicians say there鈥檚 a communication gap between hospitals and schools that limits supportive school reentry鈥攚hich is important, as school is where students may struggle most with the symptoms of their brain injuries.
That can make returning to class challenging for students who hadn鈥檛 ever needed supports before鈥攐r for students who can鈥檛 compensate for learning differences they鈥檇 had before their head injury. Students can easily fall through the cracks.
鈥淚t becomes a little bit of a game of hot potato, where families are kind of bumped around,鈥� said Dr. Bethany Johnson-Kerner, a professor of neurology and pediatrics and program director of pediatric neurorecovery at the University of California San Francisco Benioff Children鈥檚 Hospital. 鈥淥ftentimes, the school will say go to the doctor, and the doctor will say go to the school. It can be kind of confusing for families to know where to go.鈥�
Brain injuries are common, but return-to-school mandates aren鈥檛
In any given classroom, teachers can expect to have at least one student with a history of a concussion or a brain injury, Johnson-Kerner said. They鈥檙e common, and most students will recover fully, relatively quickly.
But there鈥檚 still a window when students are particularly vulnerable.
鈥淚f a student is on track to get into a top-notch college out of high school and all of the sudden, she suffers a concussion and is not given appropriate accommodations and has a semester where she goes from straight A鈥檚 to a C, a B-minus, God forbid C-minus, a D, or worse鈥攈er chances of getting into one of those elite schools are drastically diminished,鈥� said David Kracke, a lawyer who serves as Oregon鈥檚 brain-injury advocate coordinator for the Center on Brain Injury Research and Training at the University of Oregon. 鈥淥ur belief is, let鈥檚 nip that in the bud. Let鈥檚 give this student accommodations to make sure that she doesn鈥檛 end up with that one semester or quarter on her transcript.鈥�
Kracke, who was behind the push for return-to-play protocols in the state in 2009, is part of the ongoing effort to roll out best-practice return-to-school policies in Oregon. One such effort , requiring the state鈥檚 education department to produce a resource that schools can use when a student has been diagnosed with a concussion or brain injury. (Kracke said they use the term brain injury, rather than TBI, to make sure the language covers as many kids as possible.)
It was the first formal foray into what Kracke calls ITAP鈥擨mmediate Temporary Accommodation Plan.
The form describes academic accommodations the district may make for the student鈥攅ssentially, providing if/then scenarios. If a student has light sensitivity, then they can sit in the back, or wear sunglasses, or take a break. If they struggle cognitively, then they can have more time for homework, or homework is eliminated altogether.
This legislative session, advocates like Kracke hope to see an expansion of the bill鈥攚hich in part would mandate that schools use the form and have accommodations in place within five days of notification of brain injury. Through a review process, educators would determine if the student was improving and the accommodations were sufficient or if things were getting worse and a 504 plan should be pursued.
ITAPs cover the majority of students who have head injuries and concussions and will recover fully.
They can also help students who Johnson-Kerner said tend to fly under the radar: those who have moderate TBIs, spent time in the hospital, and have changes in an MRI scan鈥攂ut because they don鈥檛 have a physical disability, the school and family looks at them and thinks they鈥檙e fine.
鈥淲hat can be particularly a challenge to treat those students is they may not have insight into their new deficits,鈥� Johnson-Kerner said. 鈥淧articularly if they鈥檙e a teenager, they may not want treatment because that involves a disruption in their schedule, a change in their sense of self. It鈥檚 a whole disruption.鈥�
Students have to navigate a new normal as they recover from brain injuries
It鈥檚 been two years since Justin Bello鈥檚 traumatic brain injury. It was September 2022, and he was on his way to his Nashville, N.C., high school when he and his friends were in a car crash. Justin wasn鈥檛 wearing a seat belt and was thrown from the car. He was airlifted to an area hospital where he spent about a month in recovery.
He doesn鈥檛 remember his time there very much; from stories Justin鈥檚 been told, he鈥檚 gathered that he had a hard time.
After the injury, which impacted his frontal lobe, he struggled with cognitive abilities, but by October, looked normal, he said. He was in speech therapy and occupational therapy, which he said was exhausting.
In January 2023, Justin resumed school. It was rough at first, adjusting from recovery to academics while still combating exhaustion.
Justin remembers feeling anxious going back to school鈥攁 knot in his chest. But he returned to a welcoming, thoughtful community. And, importantly: understanding educators. He started with homebound instruction in two classes, and his teachers were great at helping him navigate the coursework. When he returned to in-person school, he started out with two classes at first, then went up to four.
鈥淚 felt a lot of comfort there with my teachers, with them doing all of that,鈥� he said. 鈥淭hey would check in to make sure everything was OK, and if it wasn鈥檛, then they eased back a little bit or gave me some grace with assignments.鈥�
There are still vestiges from the accident, though he鈥檚 made significant progress in recovery, Justin said. He can鈥檛 read at the same pace as his peers. It can be frustrating when everyone鈥檚 finished reading a section of text and he鈥檚 not. But this year, now a senior, he鈥檚 in AP Literature, and taking a class like that is new for him, he said. His teacher pulled him aside on the first day and reassured him that she was there for him, if he needed it.
鈥淚 worried a lot that things weren鈥檛 going to get back to normal. They don鈥檛 get back to normal, but you get accustomed to everything, you get used to it,鈥� Justin said. 鈥淵ou learn how to manage it, how to navigate the TBI where it鈥檚 almost as normal. I think that鈥檚 the thing鈥攜ou just work your way around it.鈥�
It was hard for Anjali to accept accommodations. She felt like she was cheating or that her peers might look down on her. She now goes to a new school that has allowed her to take classes in person and asynchronously. Her guidance counselor encouraged her to get a 504 plan, which helps with her symptoms: headaches, loss of focus, brain fog, and vision problems.
She鈥檚 still taking hard classes鈥攕he鈥檚 in six AP classes this year鈥攁nd is maintaining good grades. She鈥檚 president of the National Student Council.
But simple tasks take her four times as long, she said, and sometimes, she needs breaks because she gets dizzy or fatigued.
Anjali has a weekly appointment at the Children鈥檚 Hospital of Philadelphia for neurological rehabilitation, which is physically and mentally challenging, she said. And she鈥檚 still not cleared to return to lacrosse, a sport she鈥檚 played since 1st grade that feels core to her identity. It鈥檚 made her even more passionate about student-athlete mental health, as concussions make up roughly , and brain-injury survivors are two
She called on educators鈥攖eachers, administrators, nurses鈥攖o have empathy for students like her, who have persistent symptoms long term.
鈥淓ven if students seem like they鈥檙e doing perfectly fine in their classroom, you don鈥檛 know what it鈥檚 like when they have to go home and try to complete their homework, and they have to take maybe multiple breaks, and probably start crying over their homework. You never know what鈥檚 happening through a recovery that is as individualized as a TBI,鈥� she said. 鈥淲e have to make sure our students don鈥檛 fall into the idea that they have to prioritize their academics over their health, because getting better should be their top priority.鈥�
