Preliminary Evidence-Based Recommendations for Return to Learn: a novel pilot study tracking concussion recovery in college students

Abstract

Objective Investigate the potential factors influencing resolution of chief concussion symptoms in a longitudinal design. Second, assess subjects' perception of their concussion recovery and what types of activities and accommodations appeared beneficial. Background Athletes re-entering the academic setting after a concussion is commonly referred as return-to-learn (RTL), which has appeared secondary to the abundantly researched return-to-play protocols implemented ubiquitously. Importantly, every concussed collegiate, adolescent, and pediatric athlete is first and foremost a student-athlete, with “student” holding the emphasis. To date, very few studies have examined the RTL aspect of concussion recovery, and the effects premature classroom attendance may cause. Design/Methods Nine concussed, college aged (18-26 years), full-time students were monitored longitudinally throughout their recovery from diagnosis to full symptom-free academic participation. Symptom severity for five prevalent symptoms were recorded 4 times per day, along with a daily phone call to report participant's diet, duration of screen-time usage and music listened to, physical activity participation, and types of classes attended. Results Response rates to text messages and phone calls yielded a mean 92% and 93% respectively across the nine subjects. Additionally, five variables were significantly associated with symptom resolution (music, sleep, physical activity, water, and time) (p = 0.0004 to p = 0.036). Lastly, subjects reported math and computer-oriented courses as the most difficult (33% and 44% respectively). Additional time on assignments/exams and reducing screen brightness were the most beneficial accommodations (66% and 56% respectively). Conclusions Our findings introduce a novel and robust approach to monitoring concussed students throughout their recovery. Furthermore, this methodology is the first to produce holistic evidence-based results concerning reintegrating students to the classroom. Lastly, it appears that dietary and social behaviors can indeed influence symptom resolution.