Concussion and School: The Critical Window for Cognitive Support

  • by

What are school accommodations for concussion management?

They are school support plans put in place for teachers, nurses, coaches, and other school faculty to provide academic support and relative cognitive rest to patients who have recently suffered a concussion.

Why are they necessary?

While some patients recover completely from a concussion in days to weeks, some students require additional time. Student’s symptoms include physical, neurocognitive and emotional components. School accommodations are necessary to limit cognitive symptom exacerbation and limit cognitive stimuli to the recovering brain.  These accommodations provide as much cognitive stimuli that the student can handle without going over their symptom threshold. They give children time to heal as well as reduce stress and ensure that their academic performance is not adversely affected by their concussion. They also help provide support so that the children do not feel punished by their inabilities to keep up in school. School accommodations to some degree are necessary with every concussion to prevent worsening symptoms, prolonged recovery course, and post concussive syndrome.

Who needs them?

School accommodations should be utilized for every concussion recovery plan.  They are particularly important in children with significant neurocognitive symptoms after a concussion, these include: fatigue, headaches, trouble remembering, trouble paying attention, fogginess and slowed processing speed.  Patients are followed very closely, typically with weekly follow-ups to make adjustments to their school accommodations as they gradually progress back to full workload at school.

How do we let teachers/schools know?

We provide a detailed Concussion Academic Support Plan that educates the recipients of the handout as to what a concussion is as well as signs and symptoms that require immediate medical attention following a concussion. The handout further indicates the signs and symptoms that the patient is experiencing at the time of his/her visit. The plan then further provides teachers and coaches with guidelines regarding school attendance, general academic supports, and physical activity at school.

Who are the people involved in putting together a school support plan?

Everyone including the patient, patient’s family, teachers, coaches, nurses, counselors, athletic trainers, and the medical provider.  Treating concussion takes a village approach to provide the best care.

What are the academic color “zones” and what do they mean?

After a patient is seen at the SPARCC concussion clinic they will be assigned a “color zone” which provides academic accommodations for the patient and provides teachers, counselors and the school nurse with guidelines of what the patient can handle during the school day. Generally, patients will be in the “red zone” for 2-3 days following the initial concussion, they will then progress to the “orange” and “yellow” zones usually for 1-2 weeks each. However, every child is different and may require shorter or longer periods in a specific zone. Once symptoms are resolved the student is moved to the “green” zone to help support a smooth transition back to full workload.

Color Zones

Red Zone

Total Rest

  • No chores
  • No homework
  • No activity
Orange Zone
  • Limited or partial class attendance
  • Limited class work: prioritize and excuse assignments
  • Avoid tests and quizzes
  • If symptomatic, send student to nurse
Yellow Zone
  • Occasional absences
  • Develop and schedule for completing assignments
  • Limit one test or quiz per day
  • Excuse past assignments
Green Zone
Return to normal academic expectations while accomodating previous workload
Blue Zone
Full attendence and normal workload


What is return-to-learn and how is it similar/different from return-to-play?

Both return to learn (academic accommodations) and return to play provide gradual return to school and physical activity respectively.  One major difference is that the return to learn plan is initiated immediately while the return to play protocol is not initiated until patients are completely symptom free for a full 24 hours. Patients can only return to sport competition when they do not require accommodations in the classroom and are in the “blue zone”.


Concussion Guidelines for Teachers

Concussion Guide for Families

Concussion Guide for Adults


By Romy Shane and Mo Mortazavi, MD