Return to Learn
CRM: Return to Learn
Concussion Recognition & Management
Module 5 Management

Return to Learn

silhouette at desk, Return to Learn
Return to Activity begins with a Return to Learn Progression. Although Return to Learn is the last of the four components of the Nebraska Concussion Awareness Act, it is actually the most important part of the law. It appears last only because it was added as an amendment to the original legislation. (See Module 1.)

For your patient, Return to Learn is of higher priority than Return to Play. The Return to Learn Progression should always precede the Return to Play progression, because the activity required for the return to learning involves less risk than returning to physical activity, especially rigorous athletics.


To carry out the Return to Learn Progression, you and your patient will need support, because although concussion is a medical diagnosis, concussion management is a team process. Communication is essential to this process.

Mutual respect will enhance your communication with school staff, parents, coaches, athletic trainers, and other team members striving to help your patient recover. You need to delineate the medical picture for the team. Working closely with the schools, your team will determine the best course of action together.

For more detail about building and working effectively as a management team, consult resources such as Nebraska Department of Education’s Bridging the Gap. It provides responses to intervention that are student-centric, with family, medical, school, and coaches / athletic personnel supporting the process.
NDE’s Bridging the Gap
team of doctor, school, teacher, parent, child

Of Special Note: Working With Schools

Bear in mind:
  • Your role is to say where the student is in terms of recovery. Since school staff members (such as athletic trainers) see the student on a daily basis, they can provide you with valuable data and / or offer observations.
  • You can provide schools with recommendations regarding what you see as best for the student, which the schools can use in planning the actual accommodations. It’s a good idea to present your ideas as feedback from a medical perspective, not as orders.

  • You need to provide specific recommendations and to follow up on symptoms and symptom trends rather than just to issue an order such as "no football for five days" with no further assessment.

  • Accept that while schools will welcome your ideas, some may perceive such recommendations as "telling teachers how to teach". Maintaining a team mindset will help you keep the lines of communication open and equip you to encourage compliance with your guidance.

Return to Learn Progression

Return to Learn has its own stages. Prior to beginning a Return to Learn Progression, if there is no increase in symptoms, the individual can engage in daily living activities, undertake relaxation exercises, listen to soft music, listen to an audio book, and so on, adding intervals of 20 minutes at a time.

The Return to Learn Progression itself should be individualized and gradual. Students may start at any of these steps, depending on the symptoms. It’s up to the team to continually monitor and assess in order to recommend where the student should be at any point.

Return to Learn Progression: 1 rest 2 reading 3 sunglasses at school 4 teacher helps student 5 test 6 hands typing on laptop computer





HOME: Acute
Cognitive & physical rest.
  • Limited mental exertion.
Light mental activity.
  • Up to 30 minutes mental exertion.
SCHOOL: Part Time
Maximum adjustments.
  • Shortened day and / or schedule.
  • Quiet environment.
  • Provide extra time and help.
SCHOOL: Part Time
Maximum adjustments.
  • Modified classroom testing.
  • Moderate decrease of extra time and help.
SCHOOL: Part Time
Minimal adjustments.
  • No standardized testing.
  • Routine tests OK.
SCHOOL: Full Time
No adjustments.
  • Attends all classes.
  • Full homework and testing.

BIRSST Return to Academics Progression

Once the student is back at school part-time, there are various types of accommodations available to help the patient handle various symptoms.

Short Term Accommodations

A Return to Learn Progression involves short term, temporary accommodations for the student in the classroom. Patients may recover very quickly, but also may be symptomatic for a few months. Short term accommodations may be needed.

It will be up to the school to decide which accommodations are necessary and useful for a particular student. For example, you may recommend dark glasses to help the student cope with light sensitivity. But school staff may know that this particular youth is inclined to doze off when wearing dark glasses, so dimming lights would be a better accommodation for him.
dimmer switch

Accommodations may include:
student on sidelines watching game
Informal accommodations, such as eliminating nonessential parts of assignments so the student can focus on essential material, building rest periods into class, and limiting participation in practices for non-sport activity.
clock at 10am
Formal accommodations, such as being allowed to attend for half days when first back in school to avoid overwork, later start times for the school day, and shorter class periods.
computer with no symbol
Modifications of curriculum, especially during the first week, such as limiting requirements that involve computer use, extending deadlines, or limiting homework, papers, and tests.
lunch sack, sandwich, and apple
Environmental modifications, such as dimming lights, allowing the student to wear earplugs to reduce noise or sunglasses to reduce glare, or eating lunch somewhere darker and quieter than a bright, noisy cafeteria.
clipboard with Return to Play Progression
Monitoring by medical or academic staff. As discussed earlier, you can help the student self-monitor and know when to limit or quit an activity.
BIRSST Tips for Teachers
(to help with accommodations for an injured student)

504 and IEP plans

Long Term Accommodations

In a very small percentage of cases, the patient’s symptoms may be chronic. The concussion management team, in this case led by the school, may determine that the patient may benefit from a Section 504 Education Plan for services, accommodations, or educational aids. In rare cases, more permanent conditions may require an Individualized Educational Plan (IEP). Long term accommodations will be discussed in greater detail in Module 6.
Section 504 Education Plan

Module 5 Management

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