Q&A About School Re-Entry After a Concussion

Q&A About School Re-entry After a Concussion

School Nurse: Why do providers give schools different recommendations for each student?

Matthew Grady, MD: No two concussions are the same. So as a result, the recommendations from a physician regarding school reentry may have to be individualized. As such, some students may be able to transition quickly back to school and may miss little or no time. Other students with more severe concussions may have a prolonged recovery.

The Return-to-Learn plan was developed specifically with the idea that students need to go back to school. The plan is outlined on our website. It's designed to walk someone through step-by-step, gradually increasing their cognitive activity. We hope, if they follow this plan, the recovery will be smooth and faster than if they try to do too much too soon.

Athletic Director: Does a school need to follow the exact recommendations of the physician?

Matthew Grady, MD: I think we should get students back to school as their symptoms allow, and as such, that isn't something that's legislated. Return back to sports is a clearance, and so that's the end of the process. Return back to school is the beginning of the process. So I don't want to delay return back to school due to legal considerations. I would like the schools to be seen as a partner, and so I'm perfectly happy with the schools modifying the plans that I'm giving as long as we're preserving the spirit of the plan. Students and educators are in the school and may be able to come up with more creative or better solutions than a physician in the office can. As such, we would ask our school administrators to help with this process.

School Nurse: Why do some medical providers clear students to return to their sports even though they are still symptomatic in the school setting?

Matthew Grady, MD: Doctors should not be clearing kids to return to play if they're clearly symptomatic. In general, I don't think physicians are intentionally clearing kids to play if they're symptomatic. We know that students may have symptoms in a certain setting but not have symptoms in another setting. And I think, as part of the medical team, we want to make sure that all of the people are working together and we're getting a complete picture for the student athlete. If the communication is not good between the school and the provider and the parents, then a doctor may inappropriately clear a student athlete back to play because they didn't have the correct information. Sometimes in prolonged concussion cases, doctors give partial clearance to return to play. In general, I think of aerobic activity as part of rehabilitation. I will allow athletes to do non-contact activity, such as tennis or swimming or cross-country, because that helps with recovery.