Eighth-grader Mia Leff was jogging around the soccer field during PE class at Denver’s Skinner Middle School when it happened. As she passed one of the soccer goals last March 13, a gust of wind blew it over.

It hit her on the shoulder, knocked her to the ground and came to rest on her head. It took at least four students to pull the metal frame off her, said her mother Suzanne Leff.

“It was a pretty strong blow,” Leff said. “She was clearly disoriented. She couldn’t remember where she was, what had happened.”

Suzanne Leff became more alarmed by something her daughter said during the car ride to  Children’s Hospital’s emergency clinic. Mia described having back pain “where my wings are.” The strange comment underscored the fact that Mia may have been walking and talking, but something wasn’t right.

It turned out Mia had a severe concussion, which led to a referral to a concussion clinic and weeks of recuperation. As is often the case with concussion sufferers, Mia appeared outwardly normal soon after the incident. Some of her teachers reported that she was a bit quieter than usual, but there was more to it.

She had headaches, blurry vision, light sensitivity, fatigue and trouble concentrating. While preparing for an annual Shakespeare performance in which she’d often played multiple parts with ease, memorizing lines proved so difficult that she barely managed a minor role.

As Mia got better—she’s now a healthy ninth-grader–her parents decided to dig deeper into the district’s concussion training requirements and its system for securing soccer goal posts. What they found was both encouraging and disheartening.

On the plus side was the district’s eventual decision to replace more than 150 mobile soccer goals, including the ones at Skinner, with new tip-resistant, anchoring models. The bad news was that the district’s concussion protocol—a system for handling such injuries and helping students return to school and sports–was absent from the district’s website and routine staff training.

“The protocol looks really great on paper,” said Suzanne Leff.

But when she asked whether school-level staff are advised about the protocol, the district’s Deputy General Counsel Michael J. Hickman replied in an e-mail, “It’s my understanding there is no district-wide implementation.”

That, Leff said, “explains why the school didn’t have a copy of it and there was no understanding of what needed to be done [when Mia returned to school.]”

Sports rules the roost

Experts say many educators lack awareness about “return-to-learn” practices because concussions have long been considered a low-incidence injury that mostly happened in sports. In other words, it’s been the domain of coaches and trainers, not teachers and principals.

Concussion resources

Karen McAvoy, director of the Center for Concussion at Rocky Mountain Hospital for Children, said the first priority for many school districts is to comply with the law, and most states’ concussion laws focus exclusively on the sports side of the equation—requiring things like annual coach training and doctor clearance before kids return to play. That’s the case in Colorado, which passed the Jake Snakenberg Youth Concussion Act in 2012.

“Nowhere in there does it say, ‘You will support them academically at school,’” said McAvoy, author of a highly regarded concussion management protocol called REAP.

The language also leaves out the many children and youth who sustain concussions outside of sports, in car accidents, bike or skateboard crashes or playground mishaps.

“I am not surprised that grade schools and middle schools are not necessarily up to speed,” said R. Dawn Comstock, associate professor of epidemiology at the Colorado School of Public Health.

That’s not where the focus or funding has been as the concussion field has evolved over the last five to eight years, she said. Plus, the question of how schools address concussions gets more complicated because not every family reports suspected concussions and common symptoms of concussion can mirror other conditions.

“This isn’t like a kid who shows up on crutches and in a cast,” said Comstock. “Concussions are a silent injury, particularly for the junior high school or high school age.”

Comstock, who runs the RIO surveillance system that tracks sports-related injuries at the high school level, said finding the sweet spot on concussion awareness can be tough for schools when they have so many other things, including a long list of student health issues, to address.

“One of the problems is providing training to every single educator….it’s expensive,” she said.

McAvoy said while concussion management practice very widely among schools, some districts are ahead of the curve. She cited Jeffco, Dougco, Cherry Creek, Boulder and Mesa County Valley 51,  as districts that have taken advantage of the free resources available, include her trainings, the REAP booklet, and downloadable concussion guidelines from the Colorado Department of Education.

In Denver Public Schools, academic personnel haven’t pursued concussion training or resources with the same vigor that the athletic staff has, she said.

“Their athletics and academics seem separate.”

Still, she’s hopeful that one outcome of Mia’s injury might be to galvanize district leaders around increased concussion awareness and training.

“I think it needs to have enough administrative support to be a districtwide kind of effort”

The slow journey back

When Mia returned to Skinner after her concussion, her parents were persistent about arranging a gradual re-entry to the academic rigors of school. At first, Suzanne Leff contacted the principal and each teacher individually, but eventually a school liaison coordinated communication between teachers and the Leffs.

For weeks, Mia received a number of accommodations. She was excused from TCAP testing as well as non-critical homework assignments. Because she couldn’t tolerate looking at screens, her teachers made print-outs or otherwise modified computer-based assignments.

She used the school elevator because her balance was off and ate lunch in the principal’s office or another quiet place to avoid the hubbub in the cafeteria. She was also allowed to leave classes early so she could navigate the hallways in relative calm. Friends were enlisted to carry her books.

Staff members at Skinner were receptive and accommodating, but Suzanne Leff, an attorney, began to wonder what would happen to other students in Mia’s situation if they didn’t have vigilant advocates.

“If we hadn’t known how to advocate for our daughter, she would have been in a classroom flailing for weeks….We pressed hard with her teachers and principal.”

Scrap metal

While falling soccer goals are hardly a common cause of concussions, they are not unheard of either. Such tip-overs have caused dozens of serious injuries or deaths across the nation over the last thirty-five years, usually because children or teens were climbing or hanging on them.

In Mia’s case, the factors were windy conditions and the fact that the goal had been moved into place for a game that afternoon. Usually, it was stored off to the side, chained to a fence.

The Leffs are pleased with the district’s decision to replace 166 soccer goals with newer models. The replacement effort began earlier this fall with the replacement of 46 goals at a cost of $100,000. An additional 120 goals will be replaced before the start of the spring sports season.

Trena Deane, executive director of facility managment for DPS, said not every soccer goal in the district is being replaced. Some were judged safe by an action team that formed soon after Mia’s injury and assessed all the district’s goals.

The Leffs learned about the goal replacement project in early October, the same weekend that the first set of old goals were cut up for recycling.

Suzanne Leff said Mia was thrilled with the news, saying, “Oh my gosh, I’m so glad they’re doing that…So no one else has to go through what I had to.”