How should institutions of higher education support students’ return to the classroom after a concussion?

February 12, 2023


By Tina Chen

After spending years as an athletic trainer supporting student-athletes, Dr. Allyssa Memmini developed a passion for helping students return to their classrooms safely, with minimal disruption to their learning, while including professional insights from a multidisciplinary team. 

Concussion Center and Kinesiology alum (PhD ’22), Dr. Allyssa Memmini discussed her return to classroom protocol that supports post-secondary students after sustaining a concussion. During her first year as a graduate student instructor, she recalled one of her undergraduate students suffered a concussion during her first year of teaching. Due to the lack of resources supporting students beyond K-12 education settings, it was challenging for Dr. Memmini to gather medical documentation and student-support resources to guide the student, even though she was actively involved in concussion-related research. According to Memmini, now an assistant professor of Athletic Training at the University of New Mexico College of Education & Human Sciences, much of the return-to-learn research focuses on the younger populations. The unmet need of post-secondary students, regardless of their athletic history, drove her to develop a return-to-learn (RTL) protocol specifically for this population as part of her dissertation work.

Essentially, this guideline is a model to help students, their multi-disciplinary team (i.e., anyone who advocates for the student), and instructors develop an individualized plan for returning the student to the classroom after sustaining a concussion. This return-to-learn protocol, designed with post-secondary students in mind, was published recently in the Sports Medicine journal article “Achieving Consensus Through a Modified Delphi Technique to Create the Post-concussion Collegiate Return-to-Learn Protocol.” In addition to involving different stakeholders in the plan, Memmini advanced the return-to-learn guidelines to incorporate specific recommendations for university students.  

“This [guideline] is very similar to the return-to-sport progression in such that if a student reports increasing symptoms, they either need to communicate that to their instructor and figure out if they need additional academic support or return to a prior stage because they may be experiencing too much too soon,” explained Memmini.  

“We need to understand, through more qualitative work, some of the barriers university students face as they recover from concussion and how that might differ across race, the gender spectrum, LGTBQ students, and other underrepresented groups on campus.”

Allyssa Memmini, PhD, LAT, ATC

The first stage encourages students to undertake in-person activities with a light cognitive load, such as going to the cafeteria or socializing with friends. Memmini also recommends that students develop individualized guidelines specific to their coursework with their instructors and multi-disciplinary team.  

During the second stage, the students are encouraged to reengage in course-related activities and work with their instructors to discuss alternative options for coursework, quizzes, and tests.  

“We would prefer they engage in course-related activity as early as possible rather than have excused absences because those can build up over time and cause additional stress and anxiety, which we know can prolong some of those recoveries,” said Memmini.

By the third stage, Memmini recommends attending an entire class in their learning environment. She pointed out that additional recommendations could include alternative options for note-taking during class lectures or working with instructors on scaffolding the remainder of the course assignments.

Finally, students should be able to attend a whole week of class within their learning environment, whether in a remote or physical classroom. They should also be relying less on academic support and checking in with their multi-disciplinary team to see whether they are on track to complete the semester and if support is still warranted.

“What’s important in the fourth stage is that we encourage them (students) to seek medical care and to make it clear if they’re not recovering within two-to-four weeks, they may have some more lingering symptoms that may need to be addressed by a medical team and require further evaluation,” said Memmini.

She also knew it was essential to include information on how students could advocate for themselves“. When working with young adults, they are no longer supervised by a parent or legal guardian. So, it’s up to them to advocate for themselves,” said Memmini.

Before developing the protocol, Memmini conducted a qualitative study to help her understand some of the challenges students and faculty faced when a student was returning to the classroom after a concussion. She then used the four-step return to school progression from the 2016 Consensus statement on concussion in sports as her baseline, gathering input and recommendations from clinicians, academic staff, and concussion researchers on what should be included. She later published those research findings in the Journal of Head Trauma Rehabilitation article “Recommendations for Medical Discharge Documentation and Academic Supports for University Students Recovering From Concussion.”

Despite the comprehensive return-to-learn protocol, Memmini acknowledged the challenges, including the students’ discomfort with approaching instructors, especially in the higher education setting.

“We need to understand, through more qualitative work, some of the barriers and challenges our students face as they recover from concussion and how that might differ across race, the gender spectrum, LGTBQ students, and other underrepresented groups on campus,” she said.