Sports Medicine Research: In the Lab & In the Field: Strongest Indicator of Implementing a Return-to-Learn Protocol was Communication (Sports Med Res)
Monday, May 9, 2016

Strongest Indicator of Implementing a Return-to-Learn Protocol was Communication

Examining Academic Support After Concussion for the Adolescent Student-Athlete: Perspectives of the Athletic Trainer

Kasamatsu T., Cleary M., Bennett J., Howard K., Valovich McLeod T. J Athl Train. 2016.51(2):153-61

Take Home Message: Overall 84% of athletic trainers recommended a gradual return to learn, but only 44% of athletic trainers report having a return-to-learn policy.

Many medical professionals are implementing return-to-learn policies for athletes with a concussion. However, cognitive rest may be difficult for adolescents during the academic year. Additionally, since most athletes recover from a concussion within two weeks they do not qualify for individualized educational modification programs (i.e., Individualized education program, Section 504 plan). School nurses often facilitate these educational modification programs following an injury; however, little is known about the athletic trainers’ role in the return-to-learn process. Therefore, the authors implemented a web-based survey to athletic trainers working in secondary schools to examine the athletic trainers’ perspective on return to learn, cognitive rest, and communication with school professionals following a concussion. Overall, 1124 athletic trainers (29% response rate) completed the survey. This 5-section survey was part of a larger exploratory research study on concussion-management practices. Within this study the authors analyzed the 17-item section on return-to-learn policies and the 12-item demographic section. Overall, 84% of athletic trainers recommended a gradual return to learn, but only 44% reported having a return-to-learn policy. Following a concussion athletic trainers typically recommend complete (45%) or situational (36%) rest compared with partial (18%) or no cognitive rest (0.6%). Common academic accommodations were postponed due dates (83%), rest breaks (80%), and partial school attendance (78%). Of the athletic trainers that did not provide return-to-learn recommendations, the rationale for not making these recommendations was lack of school professionals’ understanding of concussion (30%), lack of school support (19%), lack of time to monitor (13%) or develop (10%), and that it is not their responsibility (8%). Nearly 74% of athletic trainers reported that they feel that they are the primary monitors of health, and 36% reported monitoring academic progression. The strongest predictor of the existence of a return-to-learn policy was the athletic trainer’s frequency of communication with teachers after an athlete’s concussion, where athletic trainers were 1.5 times more likely to have a return-to-learn policy if they communicated frequently with teachers compared to athletic trainers who seldom communicated with teachers.

The authors of this study highlight that though many athletic trainers put forth graduated return-to-learn strategies, less than half report actually having a return-to-learn policy. Nearly 74% of athletic trainers report that they are the primary monitor of heath, but only ~36% monitor academic progression. The frequency of athletic trainers monitoring academic progression following a concussion seems low; however counselors and school nurses are typically perceived to support this role. What is concerning is that 21% of athletic trainers report no one is currently monitoring academic progression of an athlete. Athletic trainers reported many barriers to implementing return-to-learn policies. Some of the recommendations such as missing school may be out of the athletic trainer’s scope and against school policy. This brings up a very important question. Who is in charge of the athlete’s academic progression following a concussion? Teachers are not trained in concussion management, and previous research depicts it may not solely be a physician’s responsibility to progress a student athlete academically. The authors of this study point out that schools would benefit from interdisciplinary training on the individualized roles between nurses, teachers, and athletic trainers in the return-to-learn process. It seems as though implementing a policy is likely to encourage communication, and that communication isn't predicting having a policy but rather showing that the policy is in place and being implemented efficiently and effectively. In the meantime, athletic trainers should increase communication with teachers, nurses, and other school professionals to start implementing an interdisciplinary approach for return-to-learn strategy.

Questions for Discussion: How can we facilitate better communication between athletic trainers and school professionals? Do you have a return-to-learn policy? If so, how do you carry out your policy?  

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

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Kasamatsu T, Cleary M, Bennett J, Howard K, & McLeod TV (2016). Examining Academic Support After Concussion for the Adolescent Student-Athlete: Perspectives of the Athletic Trainer. Journal of Athletic Training, 51 (2), 153-61 PMID: 26942658

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