Concussion is a buzzword that is used quite often in sports and schools. If helping students safely return to school after a concussion is not on your agenda, then this is something you need to read! Even if you do have protocols in place, we promise you’ll learn something new.
“Return to Learn” means a step-by-step progression of helping students get back into the classroom following a concussion. This process plays an important role in appropriate recovery.
In fact, the most recent international consensus statement on concussion in sport encourages schools to implement thorough sport-related concussion policies, including education for the prevention and management of concussion for teachers, staff, students and parents. Further, the authors suggest that accommodations may need to be made during the return to learn process, and more importantly, that children and adolescents should NOT return to sport until they have successfully – and fully – returned to school.
Guided return to learn and sport
Complete Concussion Management practitioners utilize the standard Return to Play strategies that national and international sport governing bodies currently recommend. These are often based on the international consensus statement.
Because most athletes also participate in school and/or work, we include Return to Learn and/or Work steps (before Return to Play) to enhance the concussion protocol and encourage appropriate recovery in all aspects of life.
This allows kids to focus on returning to a full learning pace, meanwhile completing light physical activities or activities of daily living that do not provoke symptoms.
Given the above recommendation, the questions become:
- Where do schools begin to support students following concussion?
- What’s their role in providing appropriate guidance?
- How can they help injured kids successfully reintegrate into school and learning?
Return to Learn is recommended as a gradual process (similar to the well-known Return to Play protocol). This means that a student should remain symptom-free at one stage until they are ready and able, and permitted, to go to the next stage.
If symptoms increase at any stage, the student should drop back to the previous stage for at least 24 hours. They must not have any symptoms before attempting the higher stage again.
If a student is having difficulties completing a certain stage, they may require individualized accommodations to create a more supportive environment.
Check out some helpful hints for creating a supportive environment for students going through the Return to Learn process below. Remember: every concussion and every student is unique. Each student has different needs that should be taken into account.
Examples of Return to Learn accommodations:
- Start with light homework while not attending class
- Partial day attendance (e.g., half day and/or limiting classes)
- Rejoin class environment with no added pressures (e.g., no tests, homework, or note taking; notes provided to student on paper instead of projection screens)
- Frequent breaks (e.g., access to quiet areas for mental recovery, as needed)
- Clearly defined work expectations by the teacher to help reduce student anxieties
- Avoid busy environments (e.g., student travels to next class before bell rings and no recess)
- No physical education classes (especially where there is potential for any contact or collision, and risk for further injury)
- No recess in at risk environments (i.e., avoid possible physical activity in playground)
Working with your healthcare provider
It is important that injured students involve an experienced healthcare provider with training in concussion management.
There is a fine balance that needs to be struck between cognitive rest, symptomology and returning to learn too soon. Further, a trained healthcare provider will carefully consider the potential for social isolation, excessive activity restrictions and prolonged postponement of return, which may negatively impact the student.
Therefore, once the student can tolerate cognitive activities well at home (i.e., for 30 – 45 minutes), a healthcare provider may recommend transitioning them to the classroom, and provide suggested accommodations to help avoid known symptom triggers.
Effective communication between the medical team and teachers is important to help this process happen smoothly for each student. The Concussion Tracker is a mobile communication tool that helps to facilitate this process.
Despite more concussion education in schools and growing awareness about the potential for long-term consequences as a result of concussion, high rates of under reporting remain an issue.
This is thought to be related to the perception of peers and is ultimately still an issue in sport culture. With this knowledge, the “tough guy” mentality needs to be continuously challenged and broken down. Together, we must change the discussion to change our action.
Culture change will not occur overnight; however, by continuing the conversation within our schools and reducing the stigma, then hopefully, we will see positive impacts among our youth athletes.
About the Author
Aerin DiLeva is Australian Physiotherapy Association (APA) titled Sports Physiotherapist. Through her work with multiple National and International Winter Sports teams, she has developed a strong interest in the areas of concussion education and management. She has experienced firsthand how these injuries can impact patients and athletes alike. Her passion is to educate and inform all those impacted by concussions on the evolving evidence-based approaches related to risk reduction and the management of concussion. Connect with her on Instagram @concussionphysio.
 McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med Published Online First: 26 April 2017. doi: 10.1136/bjsports-2017-097699
This article is not intended as a substitute for the medical advice of doctors and/or healthcare professionals. The reader should consult their physician and/or healthcare providers in matters relating to their health, and in particular, with respect to any concussion and/or symptoms that may require diagnosis or medical attention.