Table 1. .
Current Consensus and Position Statement Recommendations Regarding Returning to School and Activity Continued on Next Page
| Statement |
Return to School |
Return to Activity |
| American Academy of Pediatrics2 (2010) | Athletes with concussion should rest, both physically and cognitively, until symptoms have resolved at rest and with exertion.Teachers and school administrators should work with students to modify workloads to avoid exacerbating symptoms. | Pediatric and adolescent athletes should never RTP while symptomatic at rest or with exertion.Athletes should not RTP on same day of concussion, even if they become asymptomatic.Recovery course is longer for younger athletes than for collegiate and professional athletes, and a more conservative approach to RTP is warranted. |
| American Medical Society for Sports Medicine7 (2013) | Students will require cognitive rest and may require academic accommodations, such as reduced workload and extended time for tests, while recovering from concussion. | There is no same-day RTP for an athlete diagnosed with a concussion.Concussion symptoms should be resolved before returning to exercise.An RTP progression involves a gradual, stepwise increase in physical demands, sport-specific activities, and the risk of contact.If symptoms occur with activity, the progression should be halted and restarted at the preceding symptom-free step.After concussion, RTP should occur only with medical clearance from a licensed health care provider trained in evaluating and managing concussions. |
| American Academy of Pediatrics1 (2013) | Students with a concussion may need academic adjustments in school to help minimize a worsening of symptoms.Team approach consisting of medical team, school team, and family team is ideal in helping students return to learning.Education of all people involved with students who sustain concussion is necessary to provide adequate adjustments, accommodations, and long-term program modifications for students. | Students should be performing at their academic baseline before returning to sports, full physical activity, or other extracurricular activities after a concussion. |
| International Consensus Conference on Concussion in Sport4 (2013) | A sensible approach involves gradual return to school and social activities (before contact sports) in a manner that does not result in a significant exacerbation of symptoms.Concept of cognitive rest was highlighted with special reference to child's need to limit exertion with activities of daily living that may exacerbate symptoms.School attendance and activities may need to be modified to avoid exacerbating symptoms. | No RTP should occur on day of concussive injury.Cornerstone of concussion management is physical and cognitive rest until acute symptoms resolve, and then graded program of exertion should be followed before medical clearance and RTP.No return to sport or activity should occur before child or adolescent athlete has managed to return to school successfully.The RTP protocol after a concussion follows a stepwise process. |
| American Academy of Neurology3 (2013) | None | Team personnel should not permit athlete to RTP until assessment by experienced licensed health care provider with training in diagnosis and management of concussion and in recognition of more severe traumatic brain injury.To diminish risk of recurrent injury, persons supervising athletes should prohibit athlete with concussion from RTP (contact-risk activity) until licensed health care provider has judged that concussion has resolved.Licensed health care providers might develop individualized graded plans for return to physical and cognitive activity, guided by a carefully monitored, clinically based approach to minimize exacerbation of early postconcussive impairments. |
| National Association of School Nurses6 (2013) | As student returns to school after concussion, school nurse has significant role in supporting student.School nurse collaborates with parents, school staff, special service providers, health care professionals, and student in providing accommodations as student transitions back to school. | Children with diagnosed concussions require significant cognitive rest and graduated reentry plan to preconcussion activities as determined by licensed health care provider. |
| National Athletic Trainers' Association5 (2014) | Athletic trainers should work with school administrators and teachers to include appropriate academic accommodations in concussion-management plan. | Athlete with concussion should not return to athletic participation on day of injury.No athlete with concussion should return to physical activity without being evaluated and cleared by physician or designate (eg, athletic trainer) specifically trained and experienced in concussion evaluation and management.Physical-exertion progression should begin only after athlete demonstrates normal clinical examination, resolution of concussion-related symptoms, and return to preinjury scores on tests of motor control and neurocognitive function. |
Abbreviation: RTP, return to play.