Concussion Return to School Plan for Return to Physical Activity

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 required to follow a Return to School Plan which includes a Return to Learning (RTL) plan and Return to Physical Activity (RTPA) plan. There are two parts to a student’s RTPA plan. The first part, Initial Rest to Stage 2, occurs at home and the second part, Stage 3 to 6, occurs at school.

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.

Each stage must last a minimum of 24 hours.

Initial Rest

  • 24 – 48 hours of relative physical rest
    • Activities permitted if tolerated by student:
      • Limited movement that does not increase heart rate or break a sweat
      • Moving to various locations in the home
      • Daily hygiene activities
    • Activities that are not permitted at this stage:
      • Physical exertion (increases breathing and heart rate and sweating)
      • Stair climbing other than to move locations throughout the home
      • Sports/sporting activity
  • The student moves to Stage 1 when symptoms start to improve or after resting 2 days maximum (whichever occurs first).

Stage 1

  • Light physical activities (as per activities permitted) that do not provoke symptoms.
  • Movements that can be done with little effort (do not increase breathing and/or heart rate or break a sweat).
    • Activities permitted if tolerated by student:
      • Daily household tasks (for example, bed-making, dishes, feeding pets, meal preparation)
      • Slow walking for short time
    • Activities that are not permitted at this stage:
      • Physical exertion (increases breathing and heart rate and sweating)
      • Sports/sporting activity
      • Stair climbing, other than to move locations throughout the home
  • The student moves to Stage 2a when:
    • The student tolerates light physical activities (completes both activities from Stage 1) and has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms.
    • The student has completed a minimum of 24 hours at Stage 1.
  • However:
    • The student must return to the previous stage for a minimum of 24 hours when they have exhibited or reported a return of symptoms, or new symptoms.
    • The student must return to a medical doctor or nurse practitioner when they have exhibited or reported a worsening of symptoms.

Stage 2a

  • Daily activities that do not provoke symptoms.
  • Add additional movements that do not increase breathing and/or heart rate or break a sweat.
    • Activities permitted if tolerated by student:
      • Activities from previous stage
      • Light physical activity (for example, use of stairs)
      • 10-15 minutes slow walking 1-2x per day inside and outside (weather permitting)
    • Activities that are not permitted at this stage:
      • Physical exertion (increases breathing and/or heart rate and sweating)
      • Sports
  • The student moves to Stage 2b when:
    • The student tolerates daily physical activities (completes activities permitted in Stage 2a) and has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms.
    • The student has completed a minimum of 24 hours at Stage 2a.
  • However:
    • The student must return to the previous stage for a minimum of 24 hours when they have exhibited or reported a return of symptoms, or new symptoms.
    • The student must return to a medical doctor or nurse practitioner when they have exhibited or reported a worsening of symptoms.

Stage 2b

  • Light aerobic activity
    • Activities permitted if tolerated by student:
      • Activities from previous stage
      • 20-30 minutes walking/stationary cycling/recreational (that is, at a pace that causes some increase in breathing/heart rate but not enough to prevent a student from carrying on a conversation comfortably)
    • Activities that are not permitted at this stage:
      • Resistance or weight training
      • Physical activities with others
      • Physical activities using equipment
  • The student moves to Stage 3 when:
    • The student tolerates light aerobic activities (completes activities permitted from Stage 2b) and has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms
    • The student has completed a minimum of 24 hours at Stage 2b.
  • However:
    • The student must return to the previous stage for a minimum of 24 hours when they have exhibited or reported a return of symptoms, or new symptoms.
    • The student must return to a medical doctor or nurse practitioner when they have exhibited or reported a worsening of symptoms.

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:
  • 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 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 of the RTL Plan (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.