Brain & Memory

Helping students return to school after concussions


October 14, 2016

‘Return to Learn’ guidelines will give schools guidance on easing students back into the classroom after concussions.


Tennessee is about to join a handful of states with “Return to Learn” guidelines that recommend how to help students who have suffered concussions ease back into the classroom.

The Vanderbilt Sports Concussion Center has worked closely with the Tennessee Department of Health, the Tennessee Department of Education and the Tennessee Disability Coalition in drafting the protocols, which will not be mandatory policy but will provide guidance for schools.

The guidelines could be available in early 2017, said Alex Diamond, D.O., MPH, director of the Program for Injury Prevention in Youth Sports at Vanderbilt University Medical Center.

The “Return to Learn” guidelines follow “Return to Play” policies that stipulate when athletes can go back on the field or court after suffering a concussion.

“All 50 states have ‘Return to Play,’” Diamond said. “Only three states currently have ‘Return to Learn’ that I am aware of — Nebraska, North Carolina and Colorado. Tennessee will be next.”

Diamond and other staff at the Vanderbilt Sports Concussion Center, including Tim Lee, ATC, MHA, and Gary Solomon, Ph.D., have worked with Tennessee officials for a year to devise the guidelines. They range from excused absences from class to preferential seating in the classroom. The goal is to have students return to school as soon as possible — typically when they exhibit the ability to carry on light mental activity, such as continued conversation or reading a book, for 20 to 30 minutes, Diamond said.

“What we have learned is that if you take an active, healthy, social kid and remove him or her from everything that is important to them, everything that makes their life go, they become isolated,” Diamond said.

The result is a counterproductive focus on their symptoms and a slower recovery. Schools can aid in recovery by making accommodations for the lingering symptoms of a concussion, which include headaches, difficulty concentrating or remembering and balance problems.

Those accommodations can include extended testing time, use of recorded books and temporary assistance from a tutor.

“The guidelines will assist the school districts in adopting the plan that works best for them and their situation,” Diamond said. “It is not a cookie-cutter policy that everyone has to accept or do a specific way.”

The accommodations should be individualized and tailored to a student’s needs, he said. For instance, a child whose main symptom is a headache might require frequent breaks, reduced exposure to lights or computer work and avoidance of noisy environments.

“If one of their major symptoms is dizziness, allow them to put their head down on their desk and give them early dismissal so they can get through the hallways easier,” Diamond said.

Continuity of communication is crucial for an effective concussion recovery plan.

“One of the big keys of this is creating a concussion management team that includes the healthcare professional, the parents and the school having a designated person to help facilitate within the school the connections to teachers, counselors, sports folks and back up into the health care system and back down — a concussion management point person,” Diamond said.

Without guidelines, parents and school officials may think the best course of action is to keep a student home from school for several days, but that could result in a slower recovery and the student getting behind on academic work.

“There will be a very small, small percentage that may need to be out of school for a period of time, whether it is short term or long term, but the overwhelming majority should be back to school and can be back in school,” Diamond said. “They just need our help in order to do that.”

Once the guidelines are implemented, a free manual will be available to school officials. Plans are also in the works for webinars.