Returning to Learn After a Concussion

Parents, caregivers and patients often have questions about recovering from a concussion, including how to support returning to learn and how to develop a concussion recovery plan. We’ve provided some answers below to frequent questions that we receive from parents, teachers and coaches to help kids and teens succeed in school after a concussion.

The truth about concussions

How long do problems caused by concussions last?

Most young people recover completely from a concussion, but it can take anywhere from a couple of days to several weeks. Symptoms can last longer, but this is rare. Persistent problems can be related to the severity of the injury and to non-injury factors, such as increased stress levels.

Can students go back to school, even with symptoms?

With the involvement of a healthcare provider and appropriate monitoring and support at school, a student who has experienced a concussion can return to school, even if they are still exhibiting symptoms. Most students can return to school within 1-3 days of the injury. Severe symptoms will require additional medical evaluation and follow-up, but keeping a child out of school for an extended period often causes unintended academic, social and emotional problems.

Is complete rest necessary?

In the first 1-2 days after concussion, relative rest can help manage symptoms — meaning “taking it easy” and reducing physical activity, schoolwork and screentime.  However, longer-term rest isn’t recommended. After 1-2 days, students should return to their normal non-sport activities such as going to school, doing homework, socializing and using screens, based on symptoms.

Does my student need long-term adjustments?

In most cases, students don’t need special education services after a concussion. Short-term, informal adjustments for academic support are standard. A Concussion Comeback Plan is a great way to make those adjustments while also allowing a child to resume normal school-related activities. Returning to sports should proceed through a step-by-step return to play protocol under the supervision of a qualified healthcare provider.

The Concussion Comeback Plan

A Concussion Comeback Plan can help a student successfully transition back to school. Every student is different, so these steps should serve as general guidelines. Each student will need a concussion recovery plan tailored to their specific needs and circumstances.

Step 1: Understand concussions

It’s important to know the basics about concussions, including:

Symptoms from concussion are most noticeable in the first few hours and days following the injury. These symptoms should gradually improve.

In the first 1-2 days after a concussion, relative rest can help manage symptoms.

After a couple of days, the student can gradually return to daily routines. This includes going to school, reading, writing and completing schoolwork. However, a slight schedule adjustment may be necessary.

After a concussion, an athlete should only return to play under the approval and supervision of a qualified healthcare provider.

Step 2: Assign a comeback coordinator

A student's comeback coordinator could be a school nurse, counselor, psychologist, special educator or classroom teacher. It should be someone at school who takes the lead in communicating and partnering with the student, family, school staff, athletic personnel and healthcare providers. The comeback coordinator will:

• Help gather information: They understand and can discuss the nature of the injury, status and expected recovery course with the student, the student's caregivers and their healthcare team.
• Provide documentation: They keep a record of progress in the student's school file and athletic file for reference.
• Communicate with school personnel: They convey information verbally and in writing to all relevant school staff, including teachers, administrators and athletic personnel.
• Communicate outside of the school: They inform caregivers and healthcare personnel of symptoms. They also report on the student's management of school demands so that the personnel involved can support as needed.

Step 3: Support the student

The educational team helps provide a “soft landing” for a student when they return to school after a concussion. While many students may be able to return to full-day attendance soon after a concussion, some students may require a more gradual transition, returning to school for only an hour or two a day at first. The student can work toward half days, and then, when ready, resume full days. The educational team should remain flexible with the student’s schedule and workload expectations throughout recovery.

The student may also require a variety of other adjustments at school, which are typically temporary and informal.

Know how to help a student who has had a concussion

General

• Excuse the student from classes or activities that require strenuous or risky physical activity, such as physical education and recess, until cleared by medical personnel.
• Have a comeback coordinator meet with the student regularly to monitor progress, assist with communication inside and outside school, coordinate and monitor adjustments and ensure the student’s workload remains manageable.
• Provide rest time or breaks during the day. For example, allow the student to visit the healthcare office when they are experiencing headaches or other symptoms that interfere with learning and return to class when they are feeling better.

Classroom

• Allow preferential seating for close monitoring and focused attention.
• Give notes that summarize the material covered in class to the student.
• Provide more opportunity for individualized follow-up after class or at the end of the school day to ensure successful learning.

Schoolwork

• Design a reasonable plan of assistance to support completion of missed assignments.
• Excuse missed, non-essential assignments or exams.
• Reduce or modify classroom and homework assignments.
• Grant additional time for homework, exams and assignments.
• Negotiate timing of large assignments and exams so that due dates do not fall at the same time.

Testing

• Carefully consider whether any upcoming standardized tests, such as state testing and college entrance exams, should be rescheduled.
• Reschedule exams if the student is highly symptomatic or coordinate exams to avoid multiple tests in one day.
• Allow the student to take tests in a distraction-free environment.

Step 4: Monitor the student

School staff aware of the student’s injury should carefully monitor the student for several weeks after a concussion. The comeback coordinator should take responsibility for regularly checking in with classroom teachers and other relevant staff until symptoms subside. If problems develop, the comeback coordinator should notify the parents and healthcare team.

In general, school staff should look for the following:

• Any change in the student’s ability to function in the school environment
• A drop in academic performance or grades
• Social or emotional changes
• Unexpected or prolonged absence from school

Step 5: Know when to consult a healthcare provider

It’s rare to see serious complications after a concussion. If they do occur, they’re generally apparent within the first few hours or days of the initial injury. It can be a good idea to stay in close contact with outside healthcare professionals or brain injury specialists when:

• Significant problems after concussion last more than two or three weeks
• There is uncertainty about which physical or athletic activities are medically safe
• The student’s cognitive or academic problems appear especially severe
• A student has sustained multiple concussions
• A student has sustained a brain injury that involved an abnormal CT or MRI scan
• A student has sustained a moderate or severe TBI

Persisting symptoms of a concussion

A small percentage of patients may display persistent problems after a concussion that could interfere with school performance. The specialist you should consult depends on the nature of the complications and the services that specialist can provide. Ongoing physical problems like headaches or dizziness may require help from a medical provider with expertise in concussion.

A concussion specialist who studies cognition and behavior, such as a neuropsychologist, may also be helpful in evaluating patients with persistent symptoms as they can help identify factors that may be interfering with expected recovery. Complicating factors such as underlying emotional, social, learning or attention challenges often play a role.

Contact our concussion experts

To schedule an appointment with the Concussion Program at Children's Hospital Colorado, call 720-777-2806.