Every concussion is different, and therefore, some students may need to miss school to allow healing for varying amounts of time, while others will be able to continue their work with some accommodations.
In general, a full “return to school” may be completed in five phases. Because symptom severity and length of recovery vary from student to student, some students may not need every phase. The purpose of each phase is to identify what the student can do without increasing symptoms (as increasing symptoms may delay recovery) and avoiding the “triggers” that worsen symptoms. Examples of common school-related symptom triggers include reading, computer use for class work, and prolonged concentration, although triggers are variable and will differ from student to student.
Phase 1: No school
In this phase the student may have a high level of symptoms that prevent them from being able to benefit from being in school. Physical symptoms tend to be the most prominent and interfere with even basic tasks. Treatment in this phase is rest of the brain and body as much as possible. Interventions in Phase 1 include:
- no school and no schoolwork as well as no activities that exacerbate symptoms, such as TV, texting, video games, computer use or loud music
- no physical activity, which includes anything that increases the heart rate, such as (but not limited to)
weightlifting, sports practices and games, gym class, running, stationary biking, push-ups, sit-ups, etc.
- any other triggers that worsen symptoms need to be watched for, noted and avoided to help promote healing
Phase 2: Half-day attendance with accommodations
In Phase 2, the student’s symptoms have decreased to manageable levels, but the symptoms may still be exacerbated by certain mental activities that are complex, difficult and/or long in duration. Treatment in this phase will balance rest with gradual re-introduction to school and avoid tasks that produce, worsen or increase symptoms. Students with a concussion may require brief rest periods such as putting their heads down in class. Known symptom triggers are still to be avoided.
Interventions in Phase 2 include part-day school attendance with focus on the core subjects. Prioritization of courses and frequency of attendance needs to be determined. Any symptoms reported by the student will be addressed with specific accommodations. “Busy work” or items not essential to learning priority material should be eliminated. Students with a concussion may require another student to take notes for them during this phase.
In this phase, emphasis is on in-school learning since rest is necessary outside of school. Homework should be greatly reduced or eliminated and the student will still refrain from physical activity. It is recommended the students do not take tests during this phase.
Phase 3: Full-day attendance with accommodations
In this phase, the student’s symptoms have decreased in both number and severity. Symptoms may still be exacerbated by certain activities, but short time spans with known symptom triggers do not have drastic effects on symptom levels.
Treatment as the student improves includes gradually increased demands on the brain by increasing the amount of work, length of time spent on the work, and the type or difficulty of work. Gradually re-introduce known symptom triggers for short time periods.
Assignments, tests and projects still need to be prioritized and the student should be limited to one test per day. Continue to prioritize in-class material, minimize workload and promote best efforts on important tasks. Gradually increase the amount of homework. Address reported symptoms with specific accommodations, but reduce or eliminate accommodations as symptoms wane and resolve. The student will still refrain from physical activity in Phase 3.
Phase 4: Full-day attendance without accommodations
In Phase 4, the student may not have any symptoms or may have mild, intermittent symptoms. Accommodations are removed when the student can function fully without them. Emphasis now is on constructing a plan to complete missed academic work AND keep stress levels low.
The student will not resume physical activity until release by a health care provider.
Phase 5: Full school and extracurricular involvement
At this point no symptoms are present and no accommodations are needed. Before returning to gym class, weightlifting and/or sports, the student should complete the gradual return-to-play progression as indicated by the health care provider.