Concussions and concussion management have been given a large amount of attention the past decade. There is an abundant amount of research focused on the safe return to play (RTP) for a student-athlete to their sport post-concussion. While a proper RTP protocol for an athlete is extremely important, the research on concussion management has focused more heavily on the athlete aspect, instead of the student aspect of the student-athlete post-concussion.
The Center for Disease Control (CDC)1 and American Medical Society of Sports Medicine2 agree on the importance of student-athletes returning to their “academic baseline” before a RTP protocol can begin. With academics as a precursor to begin RTP, there should be an emphasis on the importance of a return to school (RTS) protocol to ensure a student has reached their academic baseline.
When a concussion occurs, the athlete may have symptoms that affect them physically, emotionally, and cognitively. Cognitive rest is giving the brain the time it needs to heal after an injury. Just like a broken arm must be placed in a cast and given time to heal, the brain needs time away from stresses, just like a broken bone. Cognitive rest is extremely important for the student-athlete to fully recover from a concussion. If the brain is pushed to perform too quickly, this can lead to an increased recovery time.
The following is a suggested pediatric specific five-stage RTS protocol with the following stages:3
Stage 1: Brain Rest – No School Focus on cognitive rest (NO TV, video games, computer screen, reading, etc) No school until symptom free.
Stage 2: Getting Ready to Go Back Begin gentle activity: walking, 15 mins screen time, reading. If symptoms worsen or return, reduce activity.
Stage 3: Back to School/Modified Academics Focus on getting lots of sleep.
Back to school for increasing time periods:
One hour, then half days or every other day
Less stressful environments and classes.
No tests, homework in symptom free increments
Stage 4: Nearly Normal Routine Back to school full days, but less than 5 days a week if needed; maximum of one test per week
Stage 5: Full Activation Gradual return to normal activities including attendance, homework, tests, and extracurricular activities
If your child receives a concussion, it is of utmost importance to speak to your school’s athletic trainer, school nurse, or other health care professional, as well as the school counselor, to ask about a return-to-school protocol.
1. Centers for Disease Control and Prevention. (2015). Returning to Sports and Activities. Retrieved June 26, 2016, from http://www.cdc.gov/headsup/basics/return_to_sports.html
2. Harmon, K. G., Drezner, J. A., Gammons, M., Guskiewicz, K. M., Halstead, M., Herring, S. A., … Roberts, W. O. (2013). American Medical Society for Sports Medicine position statement: concussion in sport. British Journal of Sports Medicine, 47(1), 15–26. http://doi.org/10.1136/bjsports-2012-091941
3. DeMatteo, C., Stazyk, K., Giglia, L., Mahoney, W., Singh, S. K., Hollenberg, R., … Randall, S. (2015). A Balanced Protocol for Return to School for Children and Youth Following Concussive Injury. Clinical Pediatrics, 54(8), 783–792 10p. http://doi.org/10.1177/0009922814567305
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Brittani Cookinham, PT, DPT, ATC, LAT
Is the Physical Therapy Manager at EXOS, a sports training facility in Frisco, Texas, and a United States Olympic team sports medicine volunteer. She attended Sacred Heart University where she obtained her Bachelors of Science in Athletic Training and her Doctorate in Physical Therapy.