and athletic activity, but also from the cognitive demands of academic work. For example, students who return to school after a concussion may need to: Take rest breaks as needed Spend fewer hours at school Be given more time to take tests or complete assignments Receive help with schoolwork, and/or Reduce time spent on the computer, reading, or writing (CDC: Heads up to Schools, Know your Concussion ABCs, A Fact Sheet for School Nurses)MDPH has worked with the Department of Elementary and Secondary Educationto provide guidance to schools regarding academic accommodation options. A link to this guidance can be found in the Additional Resources section. A graduated return to play (extracurricular athletic activity) plan should involve a stepwise process from complete rest, to light exercise, to aerobic exercise, to no-contact training drills, and finally full-contact practice and game play. The written graduated reentry plan should be kept in the student’s medical recordin the school health nurse office and also the athletic department office. Examples of both return to academics and return to play protocols can be found in the Sample Policies that follow. To comply with the regulations, this section of the school’s policies must address:which school personnel will be involved in the development of graduated reentry plans, how parents/guardians will be involved, who will monitor progress, and where the written plan will be kept. There is substantial flexibility that may be incorporated into school/school district policies and procedures for graduated re-entry based upon local needs and resources. This is demonstrated in the sample policies below. 35
Graduated Reentry Plan Sample 1: (Adapted from Marshfield Public Schools)________ School requires that all students returning to school and athletics after a concussion have a written plan for reentry. School staff, such as teachers, school nurses, counselors, administrators, speech-language pathologists, coaches and others should work together to develop and implement this plan in coordination with the student, their parent/guardian and the primary care provider. Graduated return to academic plans are based on the stages of recovery framework that takes a student from rest to gradual return to full participation in academic activities. Stages of Recovery: (Based on the work of Dr. Janet Kent at South Shore Hospital; see )The stages of recovery are a framework designed through a collaborative effort by local health care professionals. The purpose of this framework is to create common language that will help guide students, families, school personnel and health professionals through the recuperation process. Placement in stages is based on assessment of the student’s medical condition by a licensed medical professional and accompanied by written orders.