Jim Wright
Jim WrightResearcher

As the new school year approaches, students will not only be returning to the classroom but also to the playing field for the fall sports season, where they may encounter various injuries. One of the most common athletic and recreational injuries children and adolescents sustain is a mild traumatic brain injury. These are more commonly referred to as a concussion, accounting for approximately 70-90% of all traumatic brain injuries sustained annually in the United States. An individual sustains a concussion when force is applied to the head or neck, triggering a response within the brain that may present with various symptoms. Consistently reported symptoms include headache, dizziness, blurred vision, depression/anxiety, sleep-related disturbances, and changes to cognitive functioning, such as disrupted attention or disruptions to the ability to plan or problem solve.  

For students returning to athletic competition following a concussion, all 50 states in the United States utilize a return-to-play (RTP) protocol to return the student to the field safely. Typically, an RTP protocol consists of a series of evidence-based steps to progress during recovery to be cleared to play after concussion symptoms have resolved. Although the RTP process provides a road map to a safe return to sport, educators and school administrators lack a similar, evidence-based process to successfully return students to the classroom after sustaining a concussion. There is a critical need for evidence-based return-to-learn (RTL) protocols, as sustaining a concussion can have significant academic impacts on students, such as a decrease in grades, an increase in missing or incomplete work, and a decrease in school attendance.  

Although there is a lack of research on RTL, researchers have proposed models that could guide the RTL process. So, what could that look like, and what is getting in the way of making this happen?  

Let’s discuss the five core components of putting RTL into practice and identify the obstacles for each component:   

  1. Multidisciplinary Team Participation: As previously stated, a concussion may result in various clinical symptoms requiring consultation or treatment from various providers within and outside the school setting. Physicians, neuropsychologists, physical therapists, speech-language pathologists, athletic trainers, or school nurses can all contribute to identifying, assessing, and monitoring the needs of students during recovery. Students must be able to access the type of provider they need to best address their symptoms, which is the biggest obstacle to multidisciplinary team participation. Not every school has someone on staff trained in concussion management, and not every student can access the medical care they need outside of school. This is why it is so critical to identify and close these gaps to the access students need.  
  2. Medical to School Communication: Establishing communication between the medical and school teams is essential. The medical team can inform the school of the student’s health needs, and the school team can relay information about academic needs to the medical team. With clear and consistent communication between teams, the student will likely experience a faster recovery and return to pre-injury academic functioning. A primary obstacle to establishing communication is identifying a point of contact within each team to facilitate communication. One successful method to ease communication between medical and school providers occurs in the state of Oregon, where their state-wide TBI team uses liaisons to serve as an intermediary between the medical and school staff.  
  3. Identification, Assessment, and Progress Monitoring Protocols: The education team needs to have a clear policy to identify and assess symptoms and academic needs consistently and accurately following a concussion to increase or decrease support provided to the student as they transition through the RTL protocol. Measurements like the Post-Concussion Symptom Scale, Concussion Learning and School Survey, and the Behavior Rating Index of Executive Functioning are examples of measurements that can be collected in the school setting to provide ongoing assessment of student needs. The obstacle to this component is putting these measurements in the hands of educators on a wide-scale basis.  
  4. Interventions for Student Needs: Most students will fully recover from their concussion within 10-30 days and will not require prolonged interventions beyond temporary academic adjustments or accommodations. However, 10-15% of concussion cases develop prolonged concussion symptoms (PCS), where the individual experiences at least three or more symptoms three months following their injury. When an individual enters the stage of PCS, more targeted treatment from providers that align with the individual’s symptom profile is warranted. My personal research in the field of speech-language pathology has evaluated PCS treatment in the adolescent population to explore the feasibility of treating prolonged cognitive symptoms post-concussion in the adolescent population.Here are some resources if you are interested in learning more about this work: 
  5. Professional Development: One of the biggest and most consistent obstacles to establishing RTL protocols in schools is the overall lack of knowledge about concussions and their impact on student learning. To reduce this knowledge gap, administrators should provide more frequent professional development opportunities to inform educators about concussions and resources on how schools can deploy RTL.  

Ultimately, implementing RTL in every school does not need to look the same. Still, it is critical to provide administrators and teachers with the evidence-based tools necessary to adapt RTL protocols to meet the needs and resources of their school.