The Concussion Return to School Plan was developed in partnership with Parachute and is based on the most recent research and recommendations of the expert scientific community on concussion, that is, The Canadian Guidelines on Concussion in Sport, July 2017 and the Berlin Consensus Statement on Concussion in Sport, October 2016.

Should a student be diagnosed with a concussion, the student will be expected to follow a Return to School Plan which includes their Return to Learning (RTL) plan and Return to Physical Activity (RTPA) plan. The RTL and RTPA plans are inter-related, however, they are not interdependent. A student’s progress through the stages of RTL is independent from their progression through the RTPA stages.

There are two parts to a student’s RTL and RTPA Plan. The first part is the Home Return to School Plan (RTL – Initial Rest to Stage 2, RTPA – Initial Rest to Stage 2b) and the second part is the School Return to School Plan (RTL – Stage 3a to 4b, RTPA – Stage 3 to Stage 6).

Return to Learning (RTL)

Stage 3a

• The student begins with an initial time at school of 2 hours.
• The individual RTS Plan is developed by Collaborative Team following the student conference and assessment of the student’s individual needs determining possible strategies and/or approaches for student learning.
  • Activities permitted if tolerated by student:
    • Activities from previous stage
    • School work for up to 2 hours per day in smaller chunks (completed at school) working up to a 1/2 day of cognitive activity
    • Adaptation of learning strategies and/or approaches
  • Activities that are not permitted at this stage:
    • Tests/exams
    • Homework
    • Music class
    • Assemblies
    • Field trips
• School Responsibility:
  • The student has demonstrated they can tolerate up to a half day of cognitive activity.
  • A School Concussion Management Form (Return to School Plan) is sent home to parent/guardian.
• Home Responsibility:
  • The student has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms.
  • The student has exhibited or reported a return of symptoms, or new symptoms, and must return to the previous stage for a minimum of 24 hours.
  • The student has exhibited or reported a worsening of symptoms and must return to medical doctor or nurse practitioner.
  • The School Concussion Management Form (Return to School Plan) is sent back to school.

Stage 3b

• The student continues attending school half time with gradual increase in school attendance time, increased school work and a decrease in the adaptation of learning strategies and/or approaches.
  • Activities permitted if tolerated by student:
    • Activities from previous stage
    • School work for 4-5 hours per day, in smaller chunks (for example, 2-4 days of school/week)
    • Homework – up to 30 minutes per day
    • Decrease adaptation of learning strategies and/or approaches
    • Classroom testing with accommodations.
  • Activities that are not permitted at this stage:
    • Standardized tests/exams
• School Responsibility:
  • The student has demonstrated they can tolerate up to 4-5 hours of the cognitive activities listed in Stage 3b.
  • The School Concussion Management Form (Return to School Plan) is sent home to parent/guardian.
• Home Responsibility:
  • The student has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms.
  • The student has exhibited or reported a return of symptoms, or new symptoms, and must return to the previous stage for a minimum of 24 hours.
  • The student has exhibited or reported a worsening of symptoms and must return to medical doctor or nurse practitioner.
  • The School Concussion Management Form (Return to School Plan) is sent back to school.

Stage 4a

• Full day school, minimal adaptation of learning strategies and/or approaches
• Nearly normal workload.
  • Activities permitted if tolerated by student:
    • Activities from previous stage
    • Nearly normal cognitive activities
    • Routine school work as tolerated
    • Minimal adaptation of learning strategies and/or approaches
    • Start to eliminate adaptation of learning strategies and/or approaches
    • Increase homework to 60 minutes per day
    • Limit routine testing to one test per day with accommodations (for example, supports – such as more time)
  • Activities that are not permitted at this stage:
    • Standardized tests/exams
• School Responsibility:
  • The student has demonstrated they can tolerate a full day of school and a nearly normal workload with minimal adaptation of learning strategies and/or approaches.
  • The School Concussion Management Form (Return to School Plan) is sent home to parent/guardian.
• Home Responsibility:
  • The student has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms.
  • The student has exhibited or reported a return of symptoms, or new symptoms, and must return to the previous stage for a minimum of 24 hours.
  • The student has exhibited or reported a worsening of symptoms and must return to medical doctor or nurse practitioner.
  • The School Concussion Management Form (Return to School Plan) is sent back to school.

Stage 4b

• At school: full day, without adaptation of learning strategies and/or approaches
  • Activities permitted if tolerated by Student:
    • Normal cognitive activities
    • Routine school work
    • Full curriculum load (attend all classes, all homework, tests)
    • Standardized tests/exams
    • Full extracurricular involvement (non-sport/non-physical activity, for example, debating club, drama club, chess club)
• School Responsibility:
  • The student has demonstrated they can tolerate a full day of school without adaptation of learning strategies and/or approaches
  • The School Concussion Management Form (Return to School Plan) is sent home to parent/guardian.
• Home Responsibility:
  • The student has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms.
  • The student has exhibited or reported a return of symptoms, or new symptoms, and must return to the previous stage for a minimum of 24 hours.
  • The student has exhibited or reported a worsening of symptoms and must return to medical doctor or nurse practitioner.

Return to Physical Activity (RTPA)

Stage 3

• Simple locomotor activities/sport-specific exercise to add movement.
  • Activities permitted if tolerated by student:
    • Activities from previous stage (20-30 minutes walking/stationary cycling/elliptical/recreational dancing at a moderate pace)
    • Simple individual drills (for example, running/throwing drills, skating drills in hockey, shooting drills in basketball) in predictable and controlled environments with no risk of re-injury
    • Restricted recess activities (for example, walking)
  • Activities that are not permitted at this stage:
    • Full participation in physical education or Daily Physical Activity
    • Participation in intramurals
    • Full participation in interschool practices
    • Interschool competitions
    • Resistance or weight training
    • Body contact or head impact activities (for example, heading a soccer ball)
    • Jarring motions (for example, high speed stops, hitting a baseball with a bat)
• School Responsibility:
  • The student has demonstrated they can tolerate simple individual drills/sport-specific drills as listed in permitted activities.
  • A School Concussion Management Form (Return to School Plan) is sent home to parent/guardian.
• Home Responsibility:
  • The student has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms.
  • The student has exhibited or reported a return of symptoms, or new symptoms, and must return to the previous stage for a minimum of 24 hours.
  • The student has exhibited or reported a worsening of symptoms and must return to medical doctor or nurse practitioner.
  • The School Concussion Management Form (Return to School Plan) is sent back to school.

Stage 4

• Progressively increase physical activity. Non-contact training drills to add coordination and increased thinking.
  • Activities permitted if tolerated by student:
    • Activities from previous stage
    • More complex training drills (for example, passing drills in soccer and hockey)
    • Physical activity with no body contact (for example, dance, badminton)
    • Participation in practices for non-contact interschool sports (no contact)
    • Progressive resistance training may be started
    • Recess – physical activity running/games with no body contact
    • Daily Physical Activity
    • Activities that are not permitted at this stage:
    • Full participation in physical education
    • Participation in intramurals
    • Body contact or head impact activities (for example, heading a soccer ball)
    • Participation in interschool contact sport practices, or interschool games/competitions (non-contact and contact)
• School Responsibility:
  • The student has completed the activities in RTPA Stage 4 as applicable.
  • The School Concussion Management Form (Return to School Plan) is sent home to parent/guardian.
  • A Concussion Medical Clearance Form is sent home to parent/guardian.
• Home Responsibility:
  • The student has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms.
  • The student has exhibited or reported a return of symptoms, or new symptoms, and must return to the previous stage for a minimum of 24 hours.
  • The student has exhibited or reported a worsening of symptoms and must return to medical doctor or nurse practitioner.
  • The School Concussion Management Form (Return to School Plan) is sent back to school.
• Before progressing to Stage 5, the student must:
  • have completed Stage 4a and 4b (full day at school without adaptation of learning strategies and/or approaches);
  • have completed Stage 4 and be symptom-free; and
  • obtain a signed medical clearance from a medical doctor or nurse practitioner.
• Please Note: Premature return to contact sports (full practice and game play) may cause a significant setback in recovery.

Stage 5

• Following medical clearance, full participation in all non-contact physical activities (that is, non-intentional body contact) and full contact training/practice in contact sports.
  • Activities permitted if tolerated by student:
    • Physical Education
    • Intramural programs
    • Full contact training/practice in contact interschool sports
  • Activities that are not permitted at this stage:
    • Competition (for example, games, meets, events) that involves body contact
• School Responsibility:
  • The student has successfully completed the applicable physical activities in Stage 5.
  • The School Concussion Management Form (Return to School Plan) is sent home to parent/guardian.
• Home Responsibility:
  • The student has not exhibited or reported a return of symptoms or new symptoms.
  • The student has exhibited or reported a return of symptoms or new symptoms and must return to medical doctor or nurse practitioner for Medical Clearance reassessment.
  • The School Concussion Management Form (Return to School Plan) is sent back to school.

Stage 6

• Unrestricted return to contact sports. Full participation in contact sports games/competitions
• School Responsibility:
  • The student has successfully completed full participation in contact sports.
  • The School Concussion Management Form (Return to School Plan) is sent home to parent/guardian.
• Home Responsibility:
  • The student has not exhibited or reported a return of symptoms or new symptoms.
  • The student has exhibited or reported a return of symptoms or new symptoms and must return to medical doctor or nurse practitioner for Medical Clearance reassessment.
  • The School Concussion Management Form (Return to School Plan) is sent back to school for documentation purposes.