* The patient must complete the full Return to Learn protocol before the Return to Play protocol can be initiated. *The Speech-Language Pathologist will provide direction for advancing through the levels. *The goal is to progress through the levels while maintaining a sub-symptom threshold as much as possible. *Sub-symptom threshold – keeping cognitive activity below the level that triggers symptoms, such as headache, fatigue or other post-concussive symptoms

Stage Activity Objective
1. No activity Complete cognitive rest – no school, no homework, no reading, no texting, no video games, no computer work. Recovery.
2. Gradual reintroduction of cognitive activity Relax previous restrictions on activities, adding them back for short periods of time (5-15 minutes at a time). Gradual controlled increase in sub-symptom threshold cognitive activities.
3. Homework at home before school work at school Homework in longer increments (20-30 minutes at a time). Increase cognitive stamina by repetition of short periods of self-paced cognitive activities.
4. School re-entry Part day of school after tolerating 1-2 cumulative hours of homework at home. Re-entry into school with accommodations to permit controlled sub-symptom threshold increase in cognitive load.
5. Gradual reintegration into school Increase to full day of school. Accommodations decrease as cognitive stamina improves.
6. Resumption of full cognitive workload Introduce testing, catch up with essential work. Full return to school. May commence Return-to-Play protocol.

      Source: Master CL, Gioia GA, Leddy JJ, Grady MF. RETURN TO LEARN SPECIALISTS You can also learn more below:

 

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