The University of Michigan Concussion Center Return-to-Learn Protocol Following Concussion
The University of Michigan (U-M) Concussion Center Return-to-Learn (RTL) Protocol is a suggested progression to assist students returning back to the classroom after concussion. The protocol includes university-specific recommendations for students and instructors to consider as they gradually reintroduce course-related activities to support the transition back to class. We strongly recommend students provide this protocol to their instructor(s), academic counselors, and/or anyone else involved in their post-concussion care.
Students/instructors may decide to use, or modify, some of the recommendations based on the demands of the coursework, learning environments (e.g., lectures, labs, etc.), and/or how the student’s recovery is progressing. Concussion recovery is different for every student, and it is possible for some students to progress quicker than others. Therefore, students may advance, or slow down, at certain phases of the protocol depending on how they are feeling.
The University of Michigan Return-to-Learn Protocol
Step 1
Strategy:
Light cognitive activities that do not increase symptoms.
Goal:
Reintroduce activities of daily living.
RTL Recommendations:
- Notify your instructor(s) of potential absences as you may need intermittent cognitive and physical rest for up to 72 h.
- Seek additional medical care if you cannot tolerate short periods of light cognitive activities (reading, writing, etc.) or if symptoms worsen (e.g., increasing headache, repetitive vomiting, slurred speech, loss of consciousness).
- Gradually return to in-person social interactions (e.g., meeting with friends, talking on the phone, visiting face to face, cooking, going to the cafeteria).
- Check in with multidisciplinary team (academic counselor, physician, instructor, or any other student-advocate) to develop academic adjustments/accommodations specific to your coursework.
Step 2
Strategy:
Reintroduce course-related activities and part-time return to learning environment(s).
Goal:
Increase cognitive tolerance of course-related work at home.
RTL Recommendations:
- Give yourself additional time to complete out-of-class assignments and/or other coursework.
- Slowly reintegrate technology when completing coursework (e.g., turning down screen brightness, using blue light filters, and/or consider taking breaks when using computers/cell phones/tablets).
- Return to class with the possibility of breaks during class and/or attending partial classes.
- Discuss with your instructor(s) about adjusting quizzes/tests/assignments either by excusing certain coursework or delaying due dates or offering alternative options for quizzes/tests/assignments.
- Check in with multidisciplinary team (academic counselor, physician, instructor, or any other student-advocate) to review and/or revise your academic adjustments/accommodations.
- If symptoms worsen (e.g., increased headaches, sensitivity to noise or light, etc.), return to Phase 1 or collaborate with your instructor(s) on how to further modify the activities outlined in Phase 2 to tolerate your symptoms.
Step 3
Strategy:
Attend a full class in learning environment(s).
Goal:
Increase cognitive & symptom tolerance in-class
Recommendations:
- Attend a full lecture/laboratory course with academic supports (beyond rest breaks), if needed.
- Build in breaks between courses if your schedule permits.
- Discuss with your instructor(s) about modifying or prioritizing quizzes/tests/assignments rather than extending due dates (i.e., may include, but is not limited to, scaffolding assignments to avoid workload build-up).
- Meet with your instructor(s) to discuss permitting a notetaker, providing audio recordings of the lecture or hard copy print-outs of lectures/notes, allowing sunglasses/blue light glasses, turning off computer screens during hybrid learning, or other adjustments/accommodations that may decrease your symptoms during class.
- Discuss with your instructor(s) about implementing academic adjustments/accommodations for “high stakes” assignments or exams such as additional time, distraction-free testing environments, or postponing until you are no longer symptomatic.
- Check in with multidisciplinary team (academic counselor, physician, instructor, or any other student-advocate) to review and/or revise your academic adjustments/accommodations.
- If symptoms worsen (e.g., increased headaches, sensitivity to noise or light, etc.), return to Phase 2 or collaborate with your instructor(s) on how to further modify the activities outlined in Phase 3 to tolerate your symptoms.
Step 4
Strategy:
Attend a full week in learning environment(s).
Goal:
Gradually decrease use of academic supports while RTL.
Recommendations:
- Begin to wean away from academic adjustments until you can successfully attend a full week of class without academic supports.
- Check in with multidisciplinary team (academic counselor, physician, instructor, or any other student-advocate) to discuss recovery and/or continued use of academic supports.
- If symptoms worsen (e.g., increased headaches, sensitivity to noise or light, etc.), return to Phase 3 or collaborate with your instructor(s) on how to further modify the activities outlined in Phase 4 to tolerate your symptoms.
- Seek medical care from a licensed healthcare provider trained in assessment and management of concussion (e.g., physician, athletic trainer, etc.) if you are not progressing through this protocol within 2–4 weeks, or if you have persistent symptoms during cognitive activities such as reading, completing coursework, or taking exams.
Adapted from: Memmini et al, Sports Medicine, 2022. Additional details available here: https://link.springer.com/article/10.1007/s40279-022-01788-8
For more information, please visit the University of Michigan Concussion Center website at https://concussion.umich.edu/.