Professor Heather Shepherd knows the dangers of concussion well. During her first two years of high school, she sustained four concussions, three of them within a six-month span. After the third concussion, she was taken out of school for the remainder of the academic year.
"I spent months recovering, isolated in a dark room. Not only was it a change in my routine and physical activity, but I lost a lot of the social relationships that came with sport and school."
And she wasn't the only one. Speaking to other adolescents who had sustained a concussion, she realized their journeys often echoed her own; one in four adolescents will sustain a concussion by the age of 18.
Despite this alarming number, many Canadian schools don't have a plan to welcome students back to class gradually and safely.
Although legislation and policies like Rowan's Law and Memorandum 158 exist to promote student safety surrounding concussion, they only exist in Ontario. Even there, these laws and policies are not always known or followed. They also fail to address the personal challenges many teens face when returning to the classroom.
Now a professor in Western's School of Occupational Therapy, Shepherd is building on her previous work to help address this gap.
The sweet spot is a gradual return, according to Shepherd. Evidence shows that progressively returning to activity is the best approach for adolescents' recovery and wellbeing.
"But that's not what we see happening," she said worriedly.
"Schools and teachers often don't have the space, personnel or time resources to provide supports post-concussion. It's not that they don't want to support students - they are limited in what they can feasibly provide." - Heather Shepherd, occupational therapy professor
While working as a school-based occupational therapist, Shepherd saw firsthand how the accommodations recommended for students after a concussion were difficult for educators to implement given resource constraints. Spotting this challenge, she wanted to address the gap in a way that would help students get back to their routine safely, while still being reasonable for educators and schools to implement.
Shepherd said it was like opening pandora's box.
"What started as a small project has really shed light on a challenge so many are facing."
Framework, peer support program help safe return to school after concussion
Shepherd devised the Return to School Framework as a PhD student at University of Calgary. Created in collaboration with the school community, including students, caregivers and educators, as well as her fellow investigators, the framework offers schools a bundle of feasible, practical and accessible strategies to support recovering students.
"It's leveraging the existing resources to make a change, not reinventing the wheel," she said.
One of these supports is the Buddy Program, something Shepherd and her team designed after hearing students request extra social support during when returning after a concussion. The Buddy Program pairs recovering students with a peer, ensuring they have a friend to rely on at school - whether providing encouragement or taking class notes. Ensuring children aren't losing social connections in their formative years was a crucial addition to Shepherd's return-to-school protocol.
The framework also offers guidance and strategies that school boards and teachers can follow once a student endures a concussion. It includes details that often get lost or overlooked - like how schools can best communicate with caregivers.
With Shepherd's framework, it's no longer left to under-resourced teachers to figure out how to welcome a student back to school after a concussion; educators would have a guide they can use, developed in collaboration with school communities, to help students with the tools already at hand.
Now, working as a researcher in the Faculty of Health Sciences at Western, Shepherd wants to determine how the Return to School Framework could be implemented in schoolboards across Ontario, and ultimately, nation-wide.
"In 10 years, I hope students who sustain concussions will have the support of their teachers, guidance counselors and other adults to help guide them back to school in a supportive way that aligns with the supports they need, given their symptoms, while ensuring we're not putting undue hardship on the school. There's an opportunity to make a big difference over the next few years."
And for Shepherd, collaborating with the people who will be using these programs is fundamental. Partnering with educators and connecting with students as part of her research, she's learned both of the challenges and possibilities ahead.
"By engaging the people who have lived the experience, we end up with solutions that are more realistic, more practical and more relevant to what their needs are," she said. "That's what keeps me motivated as a researcher."
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