Return-to-Learn Protocol after Concussion/Mild TBI

Children and adolescents who have sustained a concussion (or mild traumatic brain injury, or TBI) can display a variety of symptoms, such as headaches, dizziness, slowed cognitive processing, reduced attention and concentration, impaired memory abilities, reduced reading speed, etc.  Many of these difficulties impact a student’s academic functioning.  In addition, scientific studies have suggested that careful consideration be made for how a student fully and most effectively recovers from a concussion.  It is widely known that full recovery depends on the timely implementation of both physical and cognitive rest for the individual.  Failure to do so can lead to a worsening of symptoms and a longer recovery.  Furthermore, studies indicate that the careful and gradual re-introduction of the child or adolescent to increased cognitive activity is essential for his or her full recovery and health moving forward.

The following guidelines aim to support any Alcuin student who has recently been diagnosed by a physician with a concussion.  By following this “return-to-learn” protocol, Alcuin School strives to provide a supportive, medically sound approach (with appropriate accommodations) in supporting a student’s recovery from a concussion and his or her ability to gradually return to full academic and physical participation.  Alcuin School faculty and administrators will follow the below protocol, and we hope and expect parents, under the direct guidance of the student’s treating physician, to cooperate with the protocol and to collaborate with the school in communicating any relevant information with school personnel so that we can all work together to support the student in his or her recovery.

These guidelines are adapted from information provided by the Ann & Robert H. Lurie Children’s Hospital of Chicago Institute for Sports Medicine, the Brain Injury Association of Vermont, Texas Orthopaedic Associates, and fellow Dallas-area ISAS schools.

STAGE	SIGNS AND SYMPTOMS	ACADEMIC STATUS AND ACCOMMODATIONS	CONTACT PERSON(S)
1. (NOT AT SCHOOL)	Severe headaches, Dizziness, Difficulty thinking        clearly, Slowed processing, and/or Sensitivity to light and sound	·  Student is not at school ·  Complete cognitive rest (i.e., no homework or school participation of any kind expected)	·   School Nurse
2. (SCHOOL - NON-LEARNING)	Once headache-free for 48 hours, student may return to school Slowed processing Sensitivity to light and sound May be on headache medicine May need frequent breaks, rest Endurance may be limited	·  Student is at school but on a limited basis ·  Student’s presence at school is about being back in the school environment rather than participating in classes ·  Partial day attendance ·  May need frequent breaks ·  May need a quiet and/or dark location to rest ·  May need to wear sunglasses, headphones, earplugs ·  May need to visit School Nurse to rest or if symptoms return or worsen ·  No music, recess, PE classes, or Athletics ·  No in-class academic work ·  No homework ·  No reading ·  No screen use	·   School Nurse ·   Director of Student Support

3. (SCHOOL - LIGHT LEARNING)	Has tolerated being back in school environment without recurrence of headaches and/or increase in symptoms Symptoms are decreased Recovering, but still may show slowed processing May be on headache medicine	·  Decreased/excused assignments ·  No math or science work ·  Extended time for work completion, extended due dates ·  Limited reading requirements ·  Modified quizzes/tests (extended time, reduced/no essay, limited multiple choice, options for oral assessment, etc.) ·  No study or memorization activities ·  No music, recess, PE classes, or Athletics ·  Limited screen time (15-20 minutes) ·  Student may need occasional breaks, quiet and/or dark location to rest ·  Student may need to visit School Nurse to rest or if symptoms return or worsen	·   School Nurse ·   Director of Student Support
4. SCHOOL - MODERATE LEARNING)	Catching up some, but processing may still be somewhat delayed Has been able to handle stage 3 Symptoms are decreased in both number and severity	·  Student begins to make up missed quizzes ·  Adjusted assignment length (e.g., provide volume reduction when possible) ·  May begin limited math and science work ·  Modified tests ·  Extended time, due dates ·  Occasional breaks, as needed ·  Limited screen time ·  No music, recess, PE classes, or Athletics	·   School Nurse ·   Director of Student Support

5. SCHOOL -(ACADEMIC CATCH-UP)	Student is doing well with increased energy and is continuing to catch up	·  Student makes up assignments/tests while balancing current workload ·  Extended time, due dates still granted ·  Math, science classes and assignments are OK as long as there are no symptoms ·  Music classes are OK to attend ·  Screen time is OK as long as there are no symptoms ·  Physical activity (recess, PE classes, Athletics) may be cleared at this point; written clearance to be provided by the treating physician before physical activity resumes	·   School Nurse ·   Director of Student Support ·   Director of Athletics and PE
6. SCHOOL -(FULL LOAD)	Student has tolerated stage 5 No symptoms Normal activity	·  Full work load ·  Physical activity OK; full participation in recess, PE, Athletics (as indicated by treating physician’s written clearance)	·   School Nurse ·   Director of Athletics and PE