Phase One: Complete Rest with no school/cognitive rest
Symptom Severity
Severe symptoms at rest that may include; headaches, dizziness, pressure in head and nausea, photosensitivity, auditory sensitivity, inability to focus, memory difficulties, feeling mentally foggy, fatigue, or mood changes.
Interventions
- No school (usually 2-4 days but may last more than one week depending on individual cases).
- Initial evaluation by primary care physician (Not ER physician).
- No PE or athletic participation (including practices and attending athletic events).
- Avoid activities that exacerbate symptoms including reading, video games, computer use, texting, television, and loud music.
- No tests, quizzes, or homework.
- Teachers may provide students with copies of class notes that are teacher or student generated.
Students may progress to Stage Two when
- They experience decreased sensitivity to light/noise.
- They experience decreased intensity and frequency of headaches and dizziness.
- They have the ability to do light reading for 10 minutes without increase in symptoms.
- They experience decreased feeling of fogginess or confusion
Phase Two: Part-Time School Attendance with Accommodations
Symptom Severity
Symptoms have decreased to manageable levels; symptoms may be exacerbated by certain mental activities that are complex or long in duration. Students may do cognitive activities but only for short periods of time (5-15 minutes) and need frequent breaks to rest.
Treatment
Re-introduction to school. Students should avoid tasks that trigger or worsen symptoms. In this phase students focus on making sure they can tolerate the school environment without worsening symptoms. The student should focus on sitting in class and listening to instructions (no note taking or reading). Once the student is able to tolerate this task they may try short intervals of cognitive work per class (5-15 minutes).
Interventions
- Part time school attendance (alternating half days with morning and afternoon classes) repeating as symptoms warrant.
- No PE or athletic participation (may attend practice or PE class without participation).
- Report daily to the School Nurse for concussion symptoms assessment checklist.
- Limit or eliminate screen time (computers and phones), reading or other visual stimuli depending on symptoms.
- Teacher will provide copies of class notes (teacher or student generated).
- Homework load based on symptoms with no due dates on homework assignments.
- Rest in the Health Office for breaks between academic classes as needed.
- Reduce weight of backpack.
- Leave class 5 minutes early to avoid noisy and crowded hallways.
Student may progress to Stage Three when
- School activity does not increase symptoms.
- Overall symptoms continue to decrease.
Phase Three: Full Day Attendance with Accommodations
Symptoms
Symptoms are decreased in number and severity. Student may have intervals when they are symptoms free. Symptoms may still be exacerbated by certain activities.
Treatment
As the student improves gradually increase demands on the brain by increasing the length of time and difficulty of academic requirements as long as it does not cause worsening of symptoms.
Interventions
- Report daily to the School Nurse for concussion symptoms assessment checklist.
- Prioritize assignments, tests, and projects.
- Limit student to one test per day with extra time to complete tests and allow for breaks depending on symptom severity.
- Gradually increase the amount of homework.
- Reported symptoms will be addressed by specific accommodations.
- No PE or athletic participation (may attend practice or PE class without participation).
- May continue with interventions listed in stage two if needed.
Student may progress to Stage Four when
- They are symptom free with cognitive and physical rest.
Stage Four: Full Day Attendance without Accommodations
Symptoms
Students may report no symptoms or may experience mild intermittent symptoms.
Treatment
Accommodations will be removed when student can participate fully in academic work at school and at home without triggering symptoms.
Interventions
- Report daily to School Nurse for concussion symptoms assessment checklist.
- For athletes Return to Play protocol will begin.
- Resume full academic responsibilities when symptoms have completely resolved as determined by primary care physician and provide a copy of physician report/orders to School Nurse. School Nurse will notify teachers.
- Create a plan for possible modifications and gradual completion of required make up work.
- Written clearance for full participation will be required from the primary care physician for return to PE participation.
Follow-up
- The School Nurse will conduct a follow up assessment with the student on week after returning to full time academic and athletic activity.
- The student is encouraged to meet with teachers to discuss progress, homework, and make up work.
- The student is encouraged to meet with School Nurse if they experience any recurring symptoms.