Appendix K: CHART 2: Diagnosed Concussion - Stages and Responsibilities
*continued from CHART 1: Identifying a Suspected Concussion – Steps and Responsibilities
Student
CONCUSSION DIAGNOSED
Appendix K: CHART 2: Diagnosed Concussion - Stages and Responsibilities
*continued from CHART 1: Identifying a Suspected Concussion – Steps and Responsibilities
Student
CONCUSSION DIAGNOSED
Principal/Designate
informs appropriate school staff of the diagnosis and meets with parent/guardian to provide and explain the Return to School Plan (RTS), which includes:
· Return to Learning (RTL) · Return to Physical Activity (RTPA)
HOME
Parent/Guardian
reports to principal/designate that student has completed:
· Stage 2 Return to Learning (RTL) · Stage 2b Return to Physical Activity (RTPA)
SCHOOL
meets with parent/guardian to:
· provide and explain the purpose of the School Concussion Management Form · explain the Collaborative Team approach and their role on the team
Student
returns to school and conferences with a school member of the Collaborative Team
Return to Learning – Stage 3a
Student attends school (2 hours) with adaptations of learning strategies or approaches.
Return to Learning – Stage 3b
Student attends school (half time) with moderate workload.
Return to Learning – Stage 4a
Student attends full day school with adaptations of learning strategies or approaches.
At the completion of each stage, student progress is documented with results shared between school and home with the parent/ guardian confirming completion of each stage by returning a School Concussion Management Form with a signature.
Return to Physical Activity –Stage 3
Student may participate in simple locomotor activities/sport-specific exercise (for movement).
Return to Physical Activity – Stage 4
Student may participate in increased physical activity, non-contact training drills (for coordination and increased thinking).
Return to Learning – Stage 4b
Student attends full day school without adaptations of learning strategies or approaches.
RTL COMPLETECollaborative Team Lead/Designate
reports to parent/guardian completion of Stage 4b RTL and Stage 4 RTPA and provides a Medical Concussion Clearance Form.
Parent/Guardianprovides principal with signed a Medical Concussion Clearance Form.
At each stage, the student is monitored for the return of symptoms, new symptoms, or worsening symptoms.
If the student exhibits or reports a return of symptoms or new symptoms , they must return to the previous stage for a minimum of 24 hours.
If during any stage the student exhibits or reports worsening symptoms , they must return to a medical doctor/nurse practitioner.
Return to Physical Activity – Stage 5
Student may return to participation in physical activities, including physical education, intramurals, non-contact interschool sports, and full contact training/practice in contact sports.
Return to Physical Activity – Stage 6
Student may return to full participation in physical activity.