Return to Learn Stepwise Approach
Return to Learn Stepwise Approach
Step 1 – Cognitive Rest (Typically Same Day of Injury)
Following your concussion, you may need cognitive and physical rest for the first 24 to 48 hours. Limit activities that make your symptoms worse. The following steps are critical to follow during the initial days after your injury.
Activities that require high cognitive energy, such as class or laboratory attendance, homework, and “screen time” (i.e., phone, computer, and video game use), reading, driving, bright lights, and loud noises should be limited if your symptoms increase. If symptoms worsen, stop the activity or remove yourself from the environment that resulted in your increased symptom severity.
An increase in symptom severity (e.g., increased dizziness) should not worry you, rather, it's your body’s way of saying it is not prepared to do that type of activity yet. Please review the red flag changes under the Frequently Asked Questions that should prompt Emergency Department visit.
Activities of daily living (e.g., walking) are encouraged to the extent that they do not worsen symptoms.
Step 2 – Begin Limited Cognitive Activity
1. Begin cognitive activities such as homework, reading, or attending class for a maximum of 30 min followed by 15-minute rest periods. If your symptoms do not increase, cognitive activity can be increased to 45-minute periods followed by 15 minutes of rest in an environment that does not worsen your symptoms.
2. Request modifications from your professors for classes or activities that result in worsening symptoms. For example, if your classes are cognitively challenging, have labs, or require excessive computer use your professor or instructor may be able to provide alternative activities for you. If a class is unable to be modified, discuss alternative learning options with your professor/instructor. Please ensure you communicate what makes your symptoms worse to help your instructors/professors modify your classroom experience.
3. Communicate with instructors/professors when you are experiencing symptoms and ask to leave class/take breaks to minimize concussion symptoms.
4. You may ask your instructors/professors to delay quizzes or exams and/or request extended time for assignments.
If symptoms develop while/after participating in classroom activities, rest until symptoms subside in an environment that does not worsen your symptoms. When you can complete a partial day of classes without the onset of concussion symptoms, progress to Step 3.
Step 3– Increased Cognitive Activity (With Minimum Modifications)
Return to all of your classes and take breaks as necessary. Begin to take quizzes or tests (consider asking for an oral or written test/quiz instead of computer if screens continue to cause symptoms). You should begin to make up any missed academic work. When you can attend all classes without the onset of concussion symptoms, progress to Step 4.
Step 4 – Full Cognitive Activity (No Modifications)
Return to your classes as usual, fully participating and taking all quizzes or tests in the original format. Continue to work with professors and instructors to complete any missed work. If you experience a return of concussion-related symptoms, you should follow-up with a medical professional.
Return to Physical Activity
Return to Physical Activity:
Light exercise including walking and activities of daily living may help you recover from your concussion and can be started during the first 48 hours from time of injury. Light exercise is exercise that raises your heart rate and is prescribed by your healthcare provider. You may experience a mild increase in your symptom severity (i.e., 2 points on a 10-point scale with 0 being no symptoms and 10 most severe). If your symptoms increase beyond 2 points, stop exercising and rest. The Return to Sport table 2 below is an example provided by the Amsterdam 2022 concussion conference. Please reach out to a medical provider for an individualized plan.
*NOTE*
JMU Club Sports and ROTC participants: Follow-up with Athletic Trainers at UREC or at the University Health Center before progressing to practice, activity, or game play.
Frequently Asked Questions
General
As defined by expert panel at the 6th International Conference on Concussion in Sport, concussion is “a traumatic brain injury caused by a direct blow to the head, neck or body resulting in an impulsive force being transmitted to the brain that occurs in sports and exercise-related activities. This initiates a neurotransmitter and metabolic cascade, with possible axonal injury, blood flow change and inflammation affecting the brain. Symptoms and signs may present immediately, or evolve over minutes or hours, and commonly resolve within days, but may be prolonged. No abnormality is seen on standard structural neuroimaging studies (computed tomography or magnetic resonance imaging T1- and T2- weighted images), but in the research setting, abnormalities may be present on functional, blood flow or metabolic imaging studies. Sport- related concussion results in a range of clinical symptoms and signs that may or may not involve loss of consciousness. The clinical symptoms and signs of concussion cannot be explained solely by (but may occur concomitantly with) drug, alcohol, or medication use, other injuries (such as cervical injuries, peripheral vestibular dysfunction) or other comorbidities (such as psychological factors or coexisting medical conditions).”
A concussion can occur from a direct blow/injury to the head, neck, or body. Though we often hear of concussions that occur in sport, the majority of concussions occur from falls, bicycle/scooter incidents, and motor vehicle collisions associated with every day life.
Concussions can have a large variety of presentations. Only 10% of concussions result in a loss of consciousness or “blacking out.” Common symptoms after a concussion include:
- Headaches
- Nausea
- Fatigue
- Sleep difficulty
- Vision changes
- Sensitivity to lights, inclusive of screens (i.e., laptops, tablets, and phones)
- Sensitivity to noise
- Trouble focusing
- Feeling slowed down
- Inability to concentrate
- Difficult remembering things
- Irritability
- Mood swings
- Sadness
- Nervousness
A concussion can occur from a direct blow/injury to the head, neck, or body. Though we often hear of concussions that occur in sport, the majority of concussions occur from falls, bicycle/scooter incidents, and motor vehicle collisions associated with every day life.
Recovery from concussions is highly variable. Many concussions resolve in about 14 days, but some can take up to one month or longer. Early initiation and adherence of concussion-specific guidelines or protocols for cognitive and physical activities has been shown to shorten time of recovery.
Concussions are diagnosed through a medical history, physical exam, and the evaluation of balance and cognitive function as well as symptoms. Contrary to popular myth, concussions cannot be diagnosed through routine brain imaging scans (CT or MRI) or blood testing at this time.
Seek medical care immediately if you or a friend with a concussion experience any of the following:
- Significantly worsening headache or severe headache that does not improve with quiet/rest
- Multiple episodes of vomiting
- Seizures/convulsions
- Prolonged loss of consciousness (LOC) at the initial injury or repeat LOC since
- Persistent double vision or loss of vision
- Slurred speech
- Increased drowsiness or inability to wake
- New or worsening confusion
- Unusual behavior (e.g., agitation, combativeness)
- Moderate to severe neck pain
- Any weakness
- Tingling or burning in the arms or legs
A simple approach to RTL includes the following:
- Seek medical care/evaluation at the University Health Center
- Brief cognitive and physical rest
- Gradual return to classroom and physical activity
- Follow-up at the University Health Center when symptom free
A sample guide based on review of evidence-based publications and consensus statements is presented in the Return to Learn Stepwise Approach at the top of the webpage.
Faculty
In general, students diagnosed with concussions are instructed not to attend class or labs for the first 24 hours after injury. Once you are made are of your student’s concussion, ask them what makes their symptoms worse. For example, screens may worsen symptoms after a concussion for some patients. Therefore, screens should be greatly limited during the first 24 hours . After the initial 24 hours, students can gradually engage in limited chunks of academic activities with prescribed breaks. The stepwise return to learn is symptom-based. Recovery from a concussion is highly individualized and variable, however, return to learn adjustments may only be needed for the initial two weeks after a concussion. As symptoms improve, students will gradually engage in longer portions of class and assignments. Students will continue to need academic adjustments during their recovery Standard approved academic adjustment examples may be found on the letter provided to the student; however, students may need more individualized support tailored to their specific symptoms.
Please make sure that your student has presented to the University Health Center for a suspected concussion. All students should have a neurologic evaluation and be educated on steps for their recovery. You may find a copy of the stepwise approach for a full return to the classroom at the top of the webpage. Following the stepwise approach and the approved accommodations will provide your student with the best opportunity to return to normal routine activities of daily living.
If you are an instructor of a student in kinesiology or a class requiring physical activity, please review the return to exercise guidelines in the table above. All Return to Learn and Return to Physical Activity prescriptions will be made by the JMU healthcare provider.
Yes! The Office of Disability Services has a variety of tips and tools that can help you. You can visit their website at ODS: Faculty and Staff FAQ - JMU for more information.
Students
If you are having difficulty receiving academic adjustments, please first speak to your instructor about your concerns. If this does not resolve the issue, please email academicquestions@jmu.edu
If you are experiencing new or worsening symptoms of mood please seek evaluation at the Counseling Center (3rd floor Student Success Center, Suite 3100) or through TimelyCare (timelycare.com/jmu). If you are experiencing thoughts or plans to kill yourself or seriously harm others, go directly to the Emergency Department. After hours, call 540-568-6552 and press "1" to connect to the after-hours crisis line or go to the ER.
The Return to Exercise guidelines outline a general stepwise plan to return to exercise or sport. You should not return to any sport until:
- Your symptoms have completely resolved
- You are back to full academic activities without accommodation.
- You are reevaluated by a healthcare provider who can provide sports-specific steps toward return.
It is impossible to prevent all accidents from happening but there are steps you can take to minimize your risk.
- Always wear your seatbelt when in a motor vehicle.
- Use a helmet when riding a bicycle, scooters, skateboards, mopeds, or motorcycles
- Avoiding alcohol when riding bicycles, scooters, skateboards, or participating in sports. Moderation of alcohol in general can minimize risk of falls or head trauma.
- If you participate in a sport that is higher risk for head injury, please wear sport-specific head protection.
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