These rules are pretty quick because they are nice and easy to follow when they are available on your consensus guidelines. These are straight out of those guidelines.

• A return to school guidelines. It is the academic school first. Children and adolescents should not return to sport until they have successfully returned to school. That is full-time school, full-time workload, full-time homework, no problems. That is the return to school.
• Return to Work.  If you are more of an adult going to work and not a child, it is are you back at work, full-time work, full-time workload, normal eight days of the week, hours, no symptoms.

That is what you have got to be able to achieve before you can go and start playing sport again.

However, doing aerobic exercise, the buffalo concussion treadmill test, and prescribing the exercises, is absolutely appropriate. That is not sport. That is the therapy. We are using aerobic exercise as a therapy.

No return to play before clinically recovered. Meaning no symptoms. Then we work through each of the phases listed in the zones below. Symptoms at any stage. If you are getting your patients to do aerobic activity, let us just say stage two, and you are doing your buffalo concussion treadmill test aerobic activity, if that is aggravating their symptoms, you move back to stage one.

You got to do stage one without symptoms before you can move into stage two. Then they need to do stage two without symptoms.

This is the international consensus.

Remember, this is not done in isolation. When we look at the current return to sport,  some countries have increased the return to sport guidelines. You could have returned to the sport following that protocol in about eight days because you would have had a day off. You would have gone through those stages, and then what would have happened is at stage five, before you can go to full-contact practice, you had to have medical clearance. To be able to go back to full contact, you may need a medical clearance. Then once you have gone through that, then as long as you can pass through each of these stages without symptoms, the athlete can return to sport.

Some countries have already implemented these guidelines, which means the earliest you can be back is thirteen days. The idea of the seven-day, eight-day return to sport does not happen anymore in these countries. It is now a thirteen-day recovery. This is likely going to be the approach within the next concussion census update. 

Therefore, make sure you know your sport and reference the guidelines in place for that sport and keep yourself up-to-date with the latest statements. 

The STAGE is assigned based on the student’s most significant limitation in any one class. The definition is based on a combination of physical and cognitive attendance. The STAGE concept has been developed to support teachers in their recognition of the level of instructional modification that may be appropriate for a student based on their daily academic and social/physical evaluation within each class.

The student is assigned the lowest STAGE any one teacher or Concussion Specialist determines based on observation and evaluation.

A student may perform to pre‐concussion ability with no instructional modifications in place in one or more classes while struggling in a 3rd class, as each concussion will manifest differently in each student.

We are asking for the teachers, parents, guardians input, perhaps multiple times, while they go through the recovery process.  Please ask the student teachers to report any behaviour, personality, or cognitive changes from what you would normally observe in this student to the parent or via the survey which you can provide to the parent to give to the school.

Below is an example of a letter you can use for a student return to learn letter to a teacher. It is important to ensure the parent or guardian, as well as the student, understand the recommendations for this and follow up measures are put in place to monitor the progress.

Dear Teacher:

The above student reported a suspected concussion, please see the below information for the return to learn staging for this student.

ALERT: Symptoms of a concussion may take as long as 72 hours to manifest. In addition, symptoms may subside during times of rest only to resurface when the brain is stressed, either with physical activity or with cognitive activity. Given the complexity of recovery of the brain following a concussion and observation of the student in our clinic, the student is considered to currently be at STAGE _______.

INSERT THE INFORMATION ABOUT THE STAGE. 

The STAGE is assigned based on the student’s most significant limitation in any one class. The definition is based on a combination of physical and cognitive attendance. The STAGE concept has been developed to support teachers in their recognition of the level of instructional modification that may be appropriate for a student based on their daily academic and social/physical evaluation within each class.

The student is assigned the lowest STAGE any one teacher or Concussion Specialist determines based on observation and evaluation. A student may perform to pre‐concussion ability with no instructional modifications in place in one or more classes while struggling in a 3rd class, as each concussion will manifest differently in each student.

We will be asking for your input, perhaps multiple times, while they go through the recovery process. Please report any behaviour, personality, or cognitive changes from what you would normally observe in this student to the parent or via the survey provided.

INSERT THE FOLLOW-UP INFORMATION FOR ANY DETERIORATION OF STUDENTS CONDITION. 

Stage – 4

DEFINITION: Full class attendance (both mental and physical) with instructional strategies

INSTRUCTIONAL STRATEGIES:

 Student attends full class
 Instructional strategies in use Relevance of instructional strategies to be determined by the teacher as appropriate for each individual student’s needs

This student should be attending a full school day and be in attendance for and participating in the entire class period with minimal instructional strategies in place, including:

 Increasing amounts of classwork/testing, including summative assessments
 Actively working on completing missed assignments

These instructional strategies may be utilized to reduce any residual concussion symptoms and foster the most appropriate learning environment during the final stages of the student’s recovery. Please alert the counsellor and/or athletic training staff if the student is not able to maintain classroom attendance due to concussion symptoms.

DEFINITION: Full class without instructional strategies.

INSTRUCTIONAL STRATEGIES:
 No instructional strategies needed

This student should be participating fully in class at this time and is scheduled to begin a return to athletic participation/increased physical activity. Before we do, we are asking for any input or concern that you as the teacher might have about this student based on your classroom observation as they have progressed through the concussion recovery. Please alert the athletic training staff if the student continues to utilize any instructional strategies to minimize concussion symptom exacerbation. The student should be actively working on, or have completed any make-up work as appropriate.

1. Follow‐up 1 – 3 weeks post to return to unrestricted activity

2. Verification that student is performing at pre-concussion level cognitively in classroom

This student has recently recovered from a concussion and has returned to unrestricted cognitive and physical activity. We would like to verify that this student has returned to their pre‐concussion academic ability in your class. Please respond using the link below to confirm or comment on their recovery.