Return to Learn Stepwise Approach 

Step 1 – Cognitive Rest (Typically Same Day of Injury)   

Following your concussion, you may need cognitive and physical rest for the first 24 to 48 hours. Limit activities that make your symptoms worse. The following steps are critical to follow during the initial days after your injury.  

Activities that require high cognitive energy, such as class or laboratory attendance, homework, and “screen time” (i.e., phone, computer, and video game use), reading, driving, bright lights, and loud noises should be limited if your symptoms increase. If symptoms worsen, stop the activity or remove yourself from the environment that resulted in your increased symptom severity.  

An increase in symptom severity (e.g., increased dizziness) should not worry you, rather, it's your body’s way of saying it is not prepared to do that type of activity yet. Please review the red flag changes under the Frequently Asked Questions that should prompt emergency room visit.  

Activities of daily living (e.g., walking) are encouraged to the extent that they do not worsen symptoms.     

Step 2 – Begin Limited Cognitive Activity   

1. Begin cognitive activities such as homework, reading, or attending class for a maximum of 30 min followed by 15-minute rest periods. If your symptoms do not increase, cognitive activity can be increased to 45-minute periods followed by 15 minutes of rest in an environment that does not worsen your symptoms.   

2. Request modifications from your professors for classes or activities that result in worsening symptoms. For example, if your classes are cognitively challenging, have labs, or require excessive computer use your professor or instructor may be able to provide alternative activities for you.  If a class is unable to be modified, discuss alternative learning options with your professor/instructor. Please ensure you communicate what makes your symptoms worse to help your instructors/professors modify your classroom experience.    

3. Communicate with instructors/professors when you are experiencing symptoms and ask to leave class/take breaks to minimize concussion symptoms.    

4. You may ask your instructors/professors to delay quizzes or exams and/or request extended time for assignments.   

 If symptoms develop while/after participating in classroom activities, rest until symptoms subside in an environment that does not worsen your symptoms. When you can complete a partial day of classes without the onset of concussion symptoms, progress to Step 3.   

   Step 3– Increased Cognitive Activity (With Minimum Modifications)   

Return to all of your classes and take breaks as necessary. Begin to take quizzes or tests (consider asking for an oral or written test/quiz instead of computer if screens continue to cause symptoms).  You should begin to make up any missed academic work.  When you can attend all classes without the onset of concussion symptoms, progress to Step 4.   

   Step 4 – Full Cognitive Activity (No Modifications)   

Return to your classes as usual, fully participating and taking all quizzes or tests in the original format. Continue to work with professors and instructors to complete any missed work. If you experience a return of concussion-related symptoms, you should follow-up with a medical professional.  

 Return to Physical Activity:   

Light exercise including walking and activities of daily living may help you recover from your concussion and can be started during the first 48 hours from time of injury. Light exercise is exercise that raises your heart rate and is prescribed by your healthcare provider. You may experience a mild increase in your symptom severity (i.e., 2 points on a 10-point scale with 0 being no symptoms and 10 most severe). If your symptoms increase beyond 2 points, stop exercising and rest.  The Return to Sport table 2 below is an example provided by the Amsterdam 2022 concussion conference. Please reach out to a medical provider for an individualized plan.  

*NOTE* 

JMU Club Sports and ROTC participants: Follow-up with Athletic Trainers at UREC or at the University Health Center before progressing to practice, activity, or game play.