Sample Return to School Strategies and/or Approaches for Cognitive and Emotional/Behavioural Difficulties

| Post-Concussion Symptoms | Impact on Student’s Learning | Potential Strategies and/or Approaches | | ------------ | ------------ | ------------ | | Headache and fatigue | Difficulty concentrating, paying attention, or multitasking |

• Ensure instructions are clear (for example, simplify directions, have the student repeat directions back to the teacher)
• Allow the student to have frequent breaks or return to school gradually (for example, 1-2 hours, half-days, late starts)
• Keep distractions to a minimum (for example, move the student away from bright lights or noisy areas)
• Limit materials on the student’s desk or in their work area to avoid distractions
• Provide alternative assessment opportunities (for example, give tests orally, allow the student to dictate responses to tests or assignments, provide access to technology)

• Provide a daily organizer and prioritize tasks
• Provide visual aids/cues and/or advance organizers (for example, visual cueing, non-verbal signs)
• Divide larger assignments/assessments into smaller tasks
• Provide the student with a copy of class notes
• Provide access to technology
• Repeat instructions
• Provide alternative methods for the student to demonstrate mastery

• Coordinate assignments and projects among all teachers
• Use a planner/organizer to manage and record daily/weekly homework and assignments
• Reduce and/or prioritize homework, assignments, and projects
• Extend deadlines or break down tasks
• Facilitate the use of a peer note taker
• Provide alternate assignments and/or tests
• Check frequently for comprehension
• Consider limiting tests to one per day and student may need extra time or a quiet environment

Adapted from Davis GA, Purcell LK. The evaluation and management of acute concussion differs in young children. Br J Sports Med. Published Online First 23 April 2013 doi:10.1136/bjsports-2012-092132

| Post-Concussion Symptoms | Impact on Student’s Learning | Potential Strategies and/or Approaches | | ------------ | ------------ | ------------ | | Anxiety |

• Decreased attention/concentration
• Overexertion to avoid falling behind

• Inform the student of any changes in the daily timetable/schedule
• Adjust the student’s timetable/schedule as needed to avoid fatigue (for example, 1-2 hours/periods, half-days, full-days)
• Build in more frequent breaks during the school day
• Provide the student with preparation time to respond to questions

• Inappropriate or impulsive behaviour during class

• Encourage teachers to use consistent strategies and approaches
• Acknowledge and empathize with the student’s frustration, anger, or emotional outburst, if and as they occur
• Reinforce positive behaviour
• Provide structure and consistency on a daily basis
• Prepare the student for change and transitions
• Set reasonable expectations
• Anticipate and remove the student from a problem situation (without characterizing it as punishment)

• Difficulties working in classroom environment (for example, lights, noise)

• Arrange strategic seating (for example, move the student away from window or talkative peers, proximity to the teacher or peer support, quiet setting)
• Where possible provide access to special lighting (for example, task lighting, darker room)
• Minimize background noise
• Provide alternative settings (for example, alternative work space, study carrel)
• Avoid noisy crowded environments such as assemblies and hallways during high traffic times
• Allow the student to eat lunch in a quiet area with a few friends
• Where possible provide ear plugs/headphones, sunglasses

• Withdrawal from participation in school activities or friends

• Build time into class/school day for socialization with peers
• Partner student with a “buddy” for assignments or activities

Adapted from Davis GA, Purcell LK. The evaluation and management of acute concussion differs in young children. Br J Sports Med. Published Online First 23 April 2013 doi:10.1136/bjsports-2012-092132

Please Note: “Compared to older students, elementary school children are more likely to complain of physical problems or misbehave in response to cognitive overload, fatigue, and other concussion symptoms.” (Concussion in the Classroom. (n.d.). Upstate University Hospital Concussion Management Program. Retrieved from http://www.upstate.edu/pmr/healthcare/programs/concussion/pdf/classroom.pdf)