Anjali Verma was sitting in the gymnasium, fluorescent lights beaming down, Advanced Placement test booklet open—and she found that she couldn’t 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’d 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’t 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’t felt like herself after the game, but it wasn’t until the AP exam that she realized something was wrong. Later, when she went to the doctor, she failed every concussion test. Badly.
She’d had a concussion before and thought this one would go like that: Sit around in the dark, and she’d be fine in two weeks.
“That was not the case for me,” said the senior from West Chester, Pa. “I thought I was going to be cleared. I was not.”
The injuries happened in May of her sophomore year. It’s been 19 months, and Anjali is still experiencing symptoms. She’s 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, according to research. A TBI is a brain injury caused by a blow, bump, or jolt to the head or body and can cause physical, cognitive, and perception symptoms—things 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 at least a dozen states have concussion laws on the books with language about injured students resuming normal academic activities.
Physicians say there’s a communication gap between hospitals and schools that limits supportive school reentry—which 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’t ever needed supports before—or for students who can’t compensate for learning differences they’d had before their head injury. Students can easily fall through the cracks.
“It becomes a little bit of a game of hot potato, where families are kind of bumped around,” 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’s Hospital. “Oftentimes, 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.”
Brain injuries are common, but return-to-school mandates aren’t
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’re common, and most students will recover fully, relatively quickly.
But there’s still a window when students are particularly vulnerable.
“If 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’s to a C, a B-minus, God forbid C-minus, a D, or worse—her chances of getting into one of those elite schools are drastically diminished,” said David Kracke, a lawyer who serves as Oregon’s brain-injury advocate coordinator for the Center on Brain Injury Research and Training at the University of Oregon. “Our belief is, let’s nip that in the bud. Let’s give this student accommodations to make sure that she doesn’t end up with that one semester or quarter on her transcript.”
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 passed the state legislature in 2020, requiring the state’s 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—Immediate Temporary Accommodation Plan.
The form describes academic accommodations the district may make for the student—essentially, 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—which 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—but because they don’t have a physical disability, the school and family looks at them and thinks they’re fine.
“What can be particularly a challenge to treat those students is they may not have insight into their new deficits,” Johnson-Kerner said. “Particularly if they’re a teenager, they may not want treatment because that involves a disruption in their schedule, a change in their sense of self. It’s a whole disruption.”
Students have to navigate a new normal as they recover from brain injuries
It’s been two years since Justin Bello’s 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’t 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’t remember his time there very much; from stories Justin’s been told, he’s 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—a 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.
“I felt a lot of comfort there with my teachers, with them doing all of that,” he said. “They would check in to make sure everything was OK, and if it wasn’t, then they eased back a little bit or gave me some grace with assignments.”
There are still vestiges from the accident, though he’s made significant progress in recovery, Justin said. He can’t read at the same pace as his peers. It can be frustrating when everyone’s finished reading a section of text and he’s not. But this year, now a senior, he’s 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.
“I worried a lot that things weren’t going to get back to normal. They don’t get back to normal, but you get accustomed to everything, you get used to it,” Justin said. “You learn how to manage it, how to navigate the TBI where it’s almost as normal. I think that’s the thing—you just work your way around it.”
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’s still taking hard classes—she’s in six AP classes this year—and is maintaining good grades. She’s 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’s Hospital of Philadelphia for neurological rehabilitation, which is physically and mentally challenging, she said. And she’s still not cleared to return to lacrosse, a sport she’s played since 1st grade that feels core to her identity. It’s made her even more passionate about student-athlete mental health, as concussions make up roughly 9 percent of injuries in high school sports, and brain-injury survivors are two times more likely to die by suicide.
She called on educators—teachers, administrators, nurses—to have empathy for students like her, who have persistent symptoms long term.
“Even if students seem like they’re doing perfectly fine in their classroom, you don’t know what it’s 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’s happening through a recovery that is as individualized as a TBI,” she said. “We have to make sure our students don’t fall into the idea that they have to prioritize their academics over their health, because getting better should be their top priority.”
