Table 2.
Gradual Return to Academics
| Stage | Description | Activity Level | Criteria to Move to Next Stage |
|---|---|---|---|
| 0 | No return, at home | Day 1 - Maintain low level cognitive and physical activity. No prolonged concentration. Cognitive Readiness Challenge: As symptoms improve, try reading or math challenge task for 10–30 minutes; assess for symptom increase. |
To Move To Stage 1: (1) Student can sustain concentration for 30 minutes before significant symptom exacerbation, AND (2) Symptoms reduce or disappear with cognitive rest breaks* allowing return to activity. |
| 1 | Return to School, Partial Day (1–3 hours) | Attend 1–3 classes, with interspersed rest breaks. Minimal expectations for productivity. No tests or homework. | To Move To Stage 2: Student symptom status improving, able to tolerate 4–5 hours of activity with 2–3 cognitive rest breaks built into school day. |
| 2 | Full Day, Maximal Supports (maximal supports required throughout day) | Attend most classes, with 2–3 rest breaks (20–30’), no tests. Minimal HW (< 60’). Minimal-moderate expectations for productivity. | To Move To Stage 3: Number & severity of symptomsimproving, needs only 1–2 cognitive rest breaks built into school day. |
| 3 | Return to Full Day, Moderate Supports (moderate supports provided in response to symptoms during day) | Attend all classes with 1–2 rest breaks (20–30’); begin quizzes. Moderate HW (60–90’) Moderate expectations for productivity. Design schedule for make-up work. | To Move To Stage 4: Continued symptom improvement, needs no more than 1 cognitive rest break per day |
| 4 | Return to Full Day, Minimal Supports (Monitoring final recovery) | Attend all classes with 0–1 rest breaks (20–30’); begin modified tests (breaks, extra time). HW (90+’) Moderate- maximum expectations for productivity. | To Move To Stage 5: No active symptoms, no exertional effects across the full school day. |
| 5 | Full Return, No Supports Needed | Full class schedule, no rest breaks. Max. expectations for productivity. Begin to address make-up work. | N/A |
*
Cognitive rest break: a period during which the student refrains from academic or other cognitively demanding activities, including schoolwork, reading, TV/games, conversation. May involve a short nap or relaxation with eyes closed in a quiet setting.