Concussion: Return to Learn/Play
The return to play decision after a possible concussion is a decision that should be made very carefully and with the help of trained medical professionals. It is also critical to address the return to learn (school) process as most schools do not have any written policy.
We strongly recommend that you read the guidelines published in the Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016.
Our intent is to help you sort through these guidelines and terminology so you can arrive at a carefully considered decision for your child and know the exact date that your child can safely return to their sport(s).
1. Do not return your child to sport for at least 24 hours after a possible concussion.
2. Seek professional medical advice before returning your child to sports and school.
3. Most sports organizations (schools, leagues, clubs) require a doctor's note before return to play clearance is granted. The return to learn process frequently requires direct contact with school administrators.
"Concussion protocol" vs "Return to Sport (Play) protocol"
Yup, it is confusing! The terminology in the professional guidelines vs. and the terms the media use are not consistent. The "Concussion Protocol" has no professional definition. The media typically uses this terminology to mean that the athlete has been removed from play for a possible concussion and the athlete has not yet been returned. The Return to Sport protocol is a professional term. This is explained in detail below.
Click here. What does the date on the doctor's note mean? Please read the explanations below.
1. The note asks the doctor to confirm that he/she is familiar with the most current concussion care guidelines. This way you know your doctor "knows."
2. The note has 4 options:
□ No Concussion/Head Injury. This athlete has been fully evaluated. The diagnosis that explains the athlete’s current condition is: ___________________________________________________________________ Athlete may immediately resume all activities without restriction on this date: ___________________.
** This option means that the doctor is confirming that there is NO concussion/head injury and that your child may return to play on the date provided.
□ This athlete has sustained a concussion/head injury. Do NOT return to strength and conditioning, sports practice, or sports competition at this time. Return for further evaluation in ____________ days or ___________ weeks.
** This option means that the doctor says your child has sustained a concussion, may NOT return to strength and conditioning, sports practice, or sports competition and must return for further evaluation before any return to play date is provided.
□ Concussion/Head Injury Resolved - May Begin Return to Sport Protocol on this date: ___________. Return to Sport Protocol must be supervised by a health care provider.
** This option means that the doctor says your child may begin the Return to Sport protocol on the date provided. The Return to Sport protocol does NOT mean your child can return to playing sports just yet. It means that your doctor is recommending that a medical professional supervise a step by step return to physical activity which ends with your child returning to his/her sport. See below for a full explanation of the Return to Sport Protocol.
□Concussion/Head Injury Resolved. Athlete is medically eligible to Return to Play on this date: _________________.
** This option means that the doctor says your child is ready to return to play and the date provided is the day that your child can return to play - meaning return to all practices (sports and strength and conditioning) and games.
Return to Learn
Move forward to the next stage only when symptom free for 24 hours. If symptoms re-appear, go back to the previous stage and make sure symptoms vanish. Contact your physician or seek medical help immediately if symptoms worsen.
American Academy of Pediatrics Return to Learn Doctor's Note.
Stage 1: No School "Cognitive Rest"
Day of injury
Until asymptomatic at rest (see Concussion Symptom Evaluation form)
No television, video games, computer use, phone, texting or loud music
Stage 2: School Part Time - Maximum Adjustments
Up to Half Day attendance with appropriate academic adjustments
No homework or testing
Stage 3: School Part Time - Moderate Adjustments
Full Day attendance with appropriate academic adjustments
Limited homework (does not cause symptoms to return), no testing
Stage 4: School Part Time - Minor Adjustments
Full day attendance with no academic adjustments
Stage 5: Full Time School with no special accommodations
If signs/symptoms persist, further evaluation by the concussion care team and accommodations by the academic institution must be made. The key is for everyone to be on the same page!
*Suggested accommodation strategies for cognitive problems. See p. 7
*See this chart for the stages of Return to Learn
Return to Play After Concussion = "Graduated Return to Sport"
An initial period of 24–48 hours of both relative physical rest and cognitive rest is recommended before beginning the RTS progression.
There should be at least 24 hours (or longer) for each step of the progression. If any symptoms worsen during exercise, the athlete should go back to the previous step. Resistance training should be added only in the later stages (stage 3 or 4 at the earliest). If symptoms are persistent (e.g., more than 10–14 days in adults or more than 1 month in children), the athlete should be referred to a healthcare professional who is an expert in the management of concussion.
Aim: Symptom-limited activity
Activity: Daily activities that do not provoke symptoms
Goal: Gradual reintroduction of work/school activities
Aim: Light aerobic exercise
Activity: Walking or stationary cycling at slow to medium pace. No resistance training
Goal: Increased heart rate
Aim: Sport-specific exercise
Activity Running or skating drills. No head impact activities
Goal: Add movement
Aim: Non-contact training drills
Activity: Harder training drills, e.g. passing drills. May start progressive resistance training.
Goal: Exercise, coordination/thinking
Aim: Full contact practice
Activity: Following medical clearance, participate in normal training activities
Goal: Restore confidence and assess functional skills by coaching staff
Aim: Return to Sport
Activity: Normal game play