General Procedures for a School Concussion Management Form (Return to School Plan)

Stages 3a to 4b of the Concussion Return to School Plan for Return to Learning (RTL) and stages 3 to 6 of the Concussion Return to School Plan for Return to Physical Activity (RTPA) focuses on a student’s progression through the school stages of the Return to Learning (RTL) plan and Return to Physical Activity (RTPA) plan. It has been designed to provide direction for, and documentation of the stages of the RTL and RTPA Plan.

The school part of the plan begins with:

• A parent/guardian and principal/designate meeting (for example, in-person, phone conference, video conference, email) to provide information on:
  • the school part of the RTL and RTPA plan;
  • the Collaborative Team members and their role (for example, parent/guardian, student, principal/designate, team lead, teacher(s), medical doctor or nurse practitioner and/or appropriate licensed healthcare provider).
• A student conference to determine the individualized RTL plan and to identify:
  • the RTL learning strategies and/or approaches required by the student based on the post-concussion symptoms;
  • the best way to provide opportunities for the permissible activities.

• Stages 3a to 4b of the Concussion Return to School Plan for Return to Learning (RTL) and Stages 3 to 6 of the Concussion Return to School Plan for Return to Physical Activity (RTPA) occur at school and where appropriate the RTPA part of the plan may occur at sport practices (for example, student is not enrolled in physical education).
• Inform parent/guardian/student of the importance to disclose a concussion diagnosis with any outside coach/sport organization(s) with which the student is involved or registered.
• Stages are not days – each stage must take a minimum of 24 hours and the length of time needed to complete each stage will vary based on the severity of the concussion and the student.
• Completion of the RTL and RTPA plans may take 1-4 weeks.
• A student moves forward to the next stage when activities at the current stage are tolerated and the student has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms.
• A student is tolerating an activity if their symptoms are not exacerbated (aggravated, intensified, made worse).
• While the RTL and RTPA stages are inter-related they are not interdependent. A student’s progress through the stages of RTL is independent from their progression through the RTPA stages. However, students must have completed Stage 4a and 4b of RTL and Stage 4 of RTPA and have obtained Medical Clearance prior to beginning Stage 5 of RTPA.
• Until a student has successfully completed all stages in the RTL plan they must not participate in the following physical activities where the risk of re-injury is possible:
  • full participation in the physical education curricular program;
  • intramural activities;
  • full participation in non-contact interschool activities; or
  • participation in practice for a contact sport.
• A student that has no symptoms when they return to school, must progress through all the RTL stages and RTPA stages and remain symptom free for a minimum of 24 hours in each stage prior to moving to the next stage.
• The plan does not replace medical advice.
• During all stages of RTL and in Stages 1-4 of RTPA:
  • if symptoms return or new symptoms appear, the student returns to previous stage for a minimum of 24 hours and only participates in activities that can be tolerated.
• During stages 5 and 6 of RTPA:
  • if symptoms return or new symptoms appear, the student must return to medical doctor/nurse practitioner to have the Medical Clearance re-assessed.
• During all stages of RTL and RTPA if symptoms worsen over time, follow school (collaborative team procedures) for contacting parents/guardians to inform them that the student needs a follow-up medical assessment.
• Progression through the plan is individual, timelines and activities may vary.
• Upon completion of the RTL and RTPA plans, this form is returned to the principal/designate for filing as per school board’s procedures.