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

Kasamatsu T., Cleary M., Bennett J.,
Howard K., Valovich McLeod T. J Athl Train. 2016.

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

Many medical professionals are
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?  

Jane McDevitt, PhD
by: Jeff Driban


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