Importance of ‘Return-to-Learn’ in Pediatric and Adolescent Concussion

Abstract

CME Educational Objectives 1. Prescribe physical and cognitive rest for pediatric and adolescent concussion. 2. Implement a gradual “return-to-learn” plan for student-athletes after concussion. 3. Communicate specific school-based accommodations to facilitate a gradual reintegration to full school activities. The concept of “return-to-play” after concussion is familiar to pediatricians who routinely care for injured student-athletes. Premature return-to-play of a student-athlete who is still injured from a concussion may result in more severe and potentially long-lasting deficits. 1

Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms

“…Such accommodations allow for relative cognitive rest in the setting of the school year and are an important first step in the management of concussion. 13,[22][23][24] Given our findings, it is likely that academic accommodations can speed the recovery process. It is worth noting, however, that although those in the highest quartile of cognitive activity experienced a substantially longer duration of symptoms, those engaged in the 3 lower quartiles of cognitive activity had similar trajectories of symptom duration (Fig 1).…”

Examining Academic Support After Concussion for the Adolescent Student-Athlete: Perspectives of the Athletic Trainer

“…The gradual return to learn consists of (1) cognitive rest, (2) light cognitive activity, (3) return to school (part time and with academic adjustments), (4) increased school attendance with decreased academic adjustments, and (5) full return to school without academic adjustments. 2,3 The progression of cognitive and physical activity is intended to prevent the recurrence of symptoms, which may hinder timely and full recovery. 3 Cognitive rest (eg, limiting or restricting text messaging, watching television, reading, completing schoolwork) is based upon the conceptual framework that an increase in the brain's energy demands while performing cognitive tasks may exacerbate symptoms.…”

“…2,3 The progression of cognitive and physical activity is intended to prevent the recurrence of symptoms, which may hinder timely and full recovery. 3 Cognitive rest (eg, limiting or restricting text messaging, watching television, reading, completing schoolwork) is based upon the conceptual framework that an increase in the brain's energy demands while performing cognitive tasks may exacerbate symptoms. 3 Yet compliance with cognitive rest may pose challenges for adolescents during the academic year.…”

“…3 Cognitive rest (eg, limiting or restricting text messaging, watching television, reading, completing schoolwork) is based upon the conceptual framework that an increase in the brain's energy demands while performing cognitive tasks may exacerbate symptoms. 3 Yet compliance with cognitive rest may pose challenges for adolescents during the academic year. 4 Patients have often reported returning to school before concussion symptoms have subsided, 5 which may prolong recovery and affect academic performance.…”

An international perspective on educators’ perceptions of children with Traumatic Brain Injury

“…For decades, it has been clear that a crucial factor in establishing appropriate educational supports for students with TBI is their teachers' understanding of how to do so (Master, Gioia, Leddy, & Grady, 2012;Ylvisaker, Todis, Glang et al, 2001). Recent studies have shown that educators continue to have limited training in TBI (Davies et al, 2013) and a poor understanding of effective instructional and behavioral support strategies (Ettel, Glang, Todis, & Davies, 2016;Linden, Braiden, & Miller, 2013;Mohr & Bullock, 2005).…”