From the Guidelines
Students should return to school gradually after a concussion, typically beginning with a modified schedule after 24-48 hours of rest, as recommended by the most recent guidelines from the American Heart Association and American Red Cross in 2024 1. This approach is supported by the Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children, which emphasizes the importance of individualized return-to-school programming and collaboration among medical, school, and family systems to minimize cognitive and physical overexertion 1. The gradual return to school should start with 1-2 hours of school attendance daily, gradually increasing as symptoms allow, with academic accommodations such as extended time for assignments, reduced workload, frequent breaks, and avoiding noisy environments like cafeterias or assemblies. Physical activity should be reintroduced progressively following a stepwise protocol: first light aerobic exercise, then sport-specific exercise, non-contact training, full-contact practice (once medically cleared), and finally return to competition, as recommended by the American Academy of Pediatrics 1. Students should not return to full physical activities, especially contact sports, until completely symptom-free and cleared by a healthcare provider, to avoid the risk of reinjury and prolonged recovery. This gradual approach is necessary because cognitive exertion can worsen concussion symptoms and potentially prolong recovery, and the brain needs time to heal, as supported by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. Most students can return to full academic participation within 2-4 weeks, though some may require longer accommodation periods depending on symptom severity and individual recovery rates.
From the Research
Guidelines for Returning to School after a Concussion
The guidelines for returning to school after a concussion (mild traumatic brain injury) are as follows:
- A return to school plan should be tailored to the individual symptoms of the student 2
- The plan should focus on school adaptation in four main areas: timetable/attendance, curriculum, environmental modifications, and activity modifications 3
- A balance of cognitive rest and timely return to school should be considered for returning any student to school after a concussion 3
- Students can progress simultaneously through return to school and return to activity/play protocols during stages 1-3 4
- Full contact sport should be delayed until full and successful reintegration back to school has been achieved 4
Key Considerations
- School professionals play important roles in designing and implementing the supports outlined in return to school plans 2
- A team-based approach is preferred for school-based concussion management for students 2
- Consistent use of written instructions from healthcare providers is needed to help guide return to learn accommodations 2
- Pediatric-specific guidelines are needed for return to activity and return to school after mild traumatic brain injury/concussion, as the most comprehensive guidelines are currently focused on adults 5
Accommodations and Support
- Academic accommodations, such as modifications to curriculum and timetable, may be necessary to support students with concussion 3, 6
- Physical therapy, cognitive rehabilitation, and medication may be required for students with prolonged recovery courses, persistent symptoms, and significant deficits in cognitive functioning 6
- School professionals should be knowledgeable about concussion and the importance of helping students recover, and should be able to recognize the signs and symptoms of concussion and communicate with students and parents about this injury 2