Return to School
Consider a graded stepwise approach to return to school, analogous to the strategy for return to play. This requires coordination with teachers, administrators, school nursing/medical providers, parents, and often classmates. The steps include mental rest, light cognitive activity (e.g., reading familiar material), moderate cognitive activity (e.g., new material in the student’s strongest subject), back to school with accommodations and extra rest, back to school without accommodations, catch up on missed work, then resume extracurricular activities. For complex concussions, reduce barriers to optimal cognitive performance, such as sleep disorders, headache, depression, and anxiety. There is no point in trying to return to school when any of these are substantially impairing. Reduced cognitive activity is associated with faster resolution of concussion-related symptoms, but complete cognitive rest is not necessary. Patients do not have to be completely symptom-free to return to school and to light exercise. Consider using a quantitative measure such as the Behavior Rating Inventory of Executive Function (BRIEF).