Returning to Learning Following a Concussion

Abstract

Following a concussion, it is common for children and adolescents to experience difficulties in the school setting. Cognitive difficulties, such as learning new tasks or remembering previously learned material, may pose challenges in the classroom. The school environment may also increase symptoms with exposure to bright lights and screens or noisy cafeterias and hallways. Unfortunately, because most children and adolescents look physically normal after a concussion, school officials often fail to recognize the need for academic or environmental adjustments. Appropriate guidance and recommendations from the pediatrician may ease the transition back to the school environment and facilitate the recovery of the child or adolescent. This report serves to provide a better understanding of possible factors that may contribute to difficulties in a school environment after a concussion and serves as a framework for the medical home, the educational home, and the family home to guide the student to a successful and safe return to learning.

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

“…More recently, experts 1,2 have recommended following a similar progression for return to cognitive activity before return to physical activity. 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.…”

“…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.…”

“…In the school setting, formalized assistance for healthrelated conditions is available in 2 types: (1) an individualized education program (IEP), and (2) a Section 504 plan. 2 An IEP outlines the modifications to schoolwork load and attendance as well as other resources available for students eligible to receive special education services. A Section 504 plan outlines academic accommodations related to a documented health condition, which may be appropriate for students who experience postconcussion syndrome.…”

“…A Section 504 plan outlines academic accommodations related to a documented health condition, which may be appropriate for students who experience postconcussion syndrome. 2 Because most concussions resolve within 2 to 3 weeks, student-athletes will likely not qualify for an IEP or a Section 504 plan; however, informal academic-support strategies may be necessary to balance recovery and prevent cognitive overload throughout the return-to-learn progression. 2 School nurses are often involved in the facilitation of 504 plans and have reported their involvement in monitoring adolescents' return to learn after concussion.…”

“…2 Because most concussions resolve within 2 to 3 weeks, student-athletes will likely not qualify for an IEP or a Section 504 plan; however, informal academic-support strategies may be necessary to balance recovery and prevent cognitive overload throughout the return-to-learn progression. 2 School nurses are often involved in the facilitation of 504 plans and have reported their involvement in monitoring adolescents' return to learn after concussion. 10 However, little is known regarding athletic trainers' (ATs') role in the return-to-learn process.…”