A review of the literature on pediatric concussions and return-to-learn (RTL): Implications for RTL policy, research, and practice.

O’Neill, Jilian A.; Cox, Molly; Clay, Olivio J.; Johnston, James M.; Novack, Thomas A.; Schwebel, David C.; Dreer, Laura E.

doi:10.1037/rep0000155

Cited by 49 publications

(36 citation statements)

References 68 publications

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“…Two summary statements provided evidence for the time between stages in RTA/RTS protocols,4 29 and one descriptive study reported the probability of complete RTA in adolescent athletes with concussion 30. The RTA/RTS protocols created by the CanChild group provide recommendations on the time between stages 25 31…”

Section: Resultsmentioning

confidence: 99%

“…The time between stages in RTA/RTS protocols should be a minimum of 24 hours to ensure there is no symptom exacerbation before beginning the next stage 4 29. The updated CanChild RTA/RTS protocols recommend that children take a minimum 24 hours between steps 26 31.…”

Section: Resultsmentioning

confidence: 99%

“…Probability estimates predict successful RTP within 7 days after injury, but the times to RTP are highly variable between different strata including sex and age 29 30. A descriptive epidemiological study found the majority of high school athletes would return to play within 7–21 days after sustaining a concussion 30.…”

Section: Resultsmentioning

confidence: 99%

“…Though no retrieved articles evaluated the effectiveness of school accommodations, four consensus documents provided recommendations for school accommodations 1 9 29 37. Their common goal was to increase student participation without exacerbating symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review

DeMatteo

Bednar

Randall

et al. 2020

BMJ Open Sport Exerc Med

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Objective To determine the effects of following return to activity (RTA) and return to school (RTS) protocols on clinical outcomes for children with concussion. The 12 subquestions of this review focus on the effectiveness of protocols, guidelines and recommendations, and the evidence supporting content of the protocols including rest, exercise and school accommodations.Design Systematic review. Data sources PubMed, MEDLINE, EMBASE, CINAHL, ERIC and manual reference list check.Eligibility criteria for selecting studies Studies were included if they evaluated RTA or RTS protocols in children aged 5-18 years with a concussion or if they reported a rigorous study design that provided evidence for the recommendations. Included studies were original research or systematic reviews. Articles were excluded if they did not report on their methodology or included participants with significant neurological comorbidities. ResultsThe literature search retrieved 198 nonduplicate articles and a total of 13 articles were included in this review. Despite the adoption of several RTS and RTA protocols in clinical practice there is little evidence to determine their efficacy in the paediatric population.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review

DeMatteo

Bednar

Randall

et al. 2020

BMJ Open Sport Exerc Med

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“…SRC can induce changes in attention, cognitive processing speed, learning, short-term memory and executive function that make learning difficult 87. Return to learn is the process of transitioning back to the classroom following concussion using individualised academic adjustments87 88 (see table 4).…”

Section: Management Of Concussionmentioning

confidence: 99%

American Medical Society for Sports Medicine position statement on concussion in sport

et al. 2019

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Sport-related concussion (SRC) is a common injury in recreational and organised sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment and management of SRC. In addition to a growing need for knowledgeable healthcare professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC. The American Medical Society for Sports Medicine (AMSSM) formed a writing group to review the existing literature on SRC, update its previous position statement, and to address current evidence and knowledge gaps regarding SRC. The absence of definitive outcomes-based data is challenging and requires relying on the best available evidence integrated with clinical experience and patient values. This statement reviews the definition, pathophysiology and epidemiology of SRC, the diagnosis and management of both acute and persistent concussion symptoms, the short-term and long-term risks of SRC and repetitive head impact exposure, SRC prevention strategies, and potential future directions for SRC research. The AMSSM is committed to best clinical practices, evidence-based research and educational initiatives that positively impact the health and safety of athletes.

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Student concussion symptoms and tailored accommodations during use of a return to learn program in 13 public high schools

Philipson,

Avery,

Takagi‐Stewart

et al. 2024

PM&R

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BackgroundYouth concussion is common but there is a paucity of information on symptoms students report to school personnel and a gap in understanding what accommodations schools can provide.ObjectiveTo examine symptoms and provision of temporary accommodations in schools for students reporting concussion symptoms.DesignSecondary data analysis of a trial implementing an evidence‐based student‐centered return to learn (RTL) program.SettingThirteen public high schools during the 2021–2022 academic year.ParticipantsSixty‐two students diagnosed with concussion who reported symptoms to school personnel.InterventionsThe school‐based RTL program, which consists of up to four weekly check‐ins with an RTL champion who evaluates symptoms and recommends symptom‐tailored accommodations.Main Outcome MeasuresSymptom profile, accommodation type, and accommodation duration.ResultsA total of 46 (74.2%) students received accommodation for ≤2 weeks and 16 (25.8%) students received accommodation for 3 (21.0%) or 4 (4.8%) weeks. Sixty‐two students experienced an average of 11.2 unique symptoms during week 1. Compared to students whose symptoms resolved within the first 2 weeks, students who received accommodation for 3 or 4 weeks reported higher initial total symptom severity score (p = .02), and higher initial average severity per symptom (p = .01) at week 1. Physical symptoms were most common and received corresponding accommodations most often (75/90 reports: 83.3% of occurrences). In total, 674 (nearly 11 accommodations per student) weekly accommodations were offered.ConclusionsStudents with concussion report a large number and type of symptoms that necessitate symptom‐tailored academic accommodations. High school implementation of an evidence‐based RTL program may aid in identifying and addressing many RTL needs after concussion, including potential identification of students with concussion who will require longer‐term support.

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A review of the literature on pediatric concussions and return-to-learn (RTL): Implications for RTL policy, research, and practice.

Abstract: Given the inconsistencies in RTL literature, more rigorous research is needed to inform concussion policy and practice to assist with pediatric concussion management. (PsycINFO Database Record

Cited by 49 publications

References 68 publications

Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review

Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review

American Medical Society for Sports Medicine position statement on concussion in sport

Student concussion symptoms and tailored accommodations during use of a return to learn program in 13 public high schools

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