1. A student recovering from a brain injury shall gradually increase cognitive activities progressing through some or all of the following phases. Some students may need total rest with a gradual return to school, while others will be able to continue doing academic work with minimal instructional modifications. The decision to progress from one phase to another should reflect the absence of any relevant signs or symptoms, and should be based on the recommendation of the student’s appropriate licensed health care provider in collaboration with school staff, including teachers, school counselors, school administrators, psychologists, nurses, clinic aides, or others as determined by local school division concussion policy.
a. Home: Rest
Phase 1: Cognitive and physical rest may include
- minimal cognitive activities – limit reading, computer use, texting, television, and/or video games;
- no homework;
- no driving; and
- minimal physical activity.
Phase 2: Light cognitive mental activity may include
- up to 30 minutes of sustained cognitive exertion;
- no prolonged concentration;
- no driving; and
- limited physical activity.
Student will progress to part-time school attendance when able to tolerate a minimum of 30 minutes of sustained cognitive exertion without exacerbation of symptoms or reemergence of previously resolved symptoms.
b. School: Part-time
Phase 3: Maximum instructional modifications including, but not limited to
- shortened days with built-in breaks;
- modified environment (e.g., limiting time in hallway, identifying quiet and/or dark spaces);
- established learning priorities;
- exclusion from standardized and classroom testing;
- extra time, extra assistance, and/or modified assignments;
- rest and recovery once out of school; and
- elimination or reduction of homework.
Student will progress to the moderate instructional modification phase when able to tolerate part-time return with moderate instructional modifications without exacerbation of symptoms or reemergence of previously resolved symptoms.
Phase 4: Moderate instructional modifications including, but not limited to
- established priorities for learning;
- limited homework;
- alternative grading strategies;
- built-in breaks;
- modified and/or limited classroom testing, exclusion from standardized testing; and
- reduction of extra time, assistance, and/or modification of assignments as needed.
Student will progress to the minimal instructional modification phase when able to tolerate full-time school attendance without exacerbation of existing symptoms or reemergence of previously resolved symptoms.
c. School: Full-time
Phase 5: Minimal instructional modification - instructional strategies may include, but are not limited to:
- built-in breaks;
- limited formative and summative testing, exclusion from standardized testing;
- reduction of extra time, assistance, and modification of assignments; and
- continuation of instructional modification and supports in academically challenging subjects that require cognitive overexertion and stress.
Student will progress to nonmodified school participation when able to handle sustained cognitive exertion without exacerbation of symptoms or re-emergence of previously resolved symptoms.
Phase 6: Attends all classes; maintains full academic load/homework; requires no instructional modifications.
2. Progression through the above phases shall be governed by the presence or resolution of symptoms resulting from a concussion experienced by the student including, but are not limited to
a. difficulty with attention, concentration, organization, long-term and short-term memory, reasoning, planning, and problem solving;
b. fatigue, drowsiness, difficulties handling a stimulating school environment (e.g., sensitivity to light and sound);
c. inappropriate or impulsive behavior during class, greater irritability, less able to cope with stress, more emotional than usual; and
d. physical symptoms (e.g., headache, nausea, dizziness).
3. Progression through gradually increasing cognitive demands should adhere to the following guidelines:
a. increase the amount of time in school;
b. increase the nature and amount of work, the length of time spent on the work, or the type or difficulty of work (change only one of these variables at a time);
c. if symptoms do not worsen, demands may continue to be gradually increased;
d. if symptoms do worsen, the activity should be discontinued for at least 20 minutes and the student allowed to rest
1) if the symptoms are relieved with rest, the student may reattempt the activity at or below the level that produced symptoms; and
2) if the symptoms are not relieved with rest, the student should discontinue the current activity for the day and reattempt when symptoms have lessened or resolved (such as the next day).
4. If symptoms persist or fail to improve over time, additional in-school support may be required with consideration for further evaluation. If the student is three to four weeks post injury without significant evidence of improvement, a 504 plan should be considered.
5. A student-athlete shall progress to a stage where he or she no longer requires instructional modifications or other support before being cleared to return to full athletic participation (return-to-play).
The American Academy of Pediatrics (AAP) Return to Learn Following a Concussion Guidelines (October 2013), and the American Medical Society for Sports Medicine (AMSSM) Position Statement (2013), are available online to assist health care providers, student-athletes, their families, and school divisions, as needed.
Adopted: August 18, 2015