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U.S.

Air Force Academy
Return-to-Learn Protocol
(Supplement to USAFA Concussion Care Plan)

Return-to-learn is a parallel concept to return-to-play. Whereas return-to-play focuses on the
return to physical activity post-concussion, return-to-learn focuses on the return to cognitive
activity and full academic participation. Return-to-learn guidelines assume that both physical
and cognitive activities require the utilization of brain energy. After a cadet incurs a concussion,
the cadet experiences a “brain energy crisis” in which brain energy is not available for physical
or cognitive exertion. Thus, this protocol exists to allow the cadet to heal during this energy
crisis and prevent premature return to academic activities.

It is important to watch for the following characteristics in a concussed cadet:
 Increased problems with attention and/or concentration
 Difficulty with remembering or learning new information
 Longer time needed to complete tasks
 Inappropriate or impulsive behavior
 Greater irritability and/or emotionality
 Decreased ability to cope with stress
 Difficulty or distress in a stimulating environment

Physical symptoms such as:
 Headache
 Nausea
 Dizziness
 Fatigue

These are all symptoms of a concussion and an increased intensity or onset of new symptoms
may demonstrate a need for slower return-to-learn and additional medical attention. Presence
of these symptoms for longer than three weeks signals a need for further medical attention. If
you witness a cadet demonstrating these symptoms please escort them to the Cadet Clinic.

For more information refer to the Concussion Fact Sheet for U.S. Air Force Academy Cadets
handout in this protocol.

Protocol Management
After the diagnosis of a concussion, the cadet’s academic advisor and air officer commanding
(AOC) will manage his/her return-to-learn. These personnel will work with the cadet and
his/her instructors, professors, as well as medical staff in order to develop a customized plan.
As the cadet moves through the return-to-learn stages, the academic advisor and AOC will
provide updates on his/her progress. Personnel in the Cadet Clinic will assign the return-to-
learn stages and will maintain and disseminate an accurate Form-18. It is imperative that AOCs
and academic advisors provide feedback to medical personnel on their concussed cadet’s
academic progress.

Returning to the classroom does not mean the cadet is symptom-free. The gradual return to full
academics (i.e. caught up with syllabi in all classes) should be modified individually for each
cadet based on symptoms and course content. Return-to-learn is completed in several stages
and symptoms are monitored at each stage. Certain activities may trigger new symptoms or
worsen existing ones. In this case, the cadet may need to be reevaluated by medical personnel.
Cadets with a concussion are seen at least once per week in the Concussion Clinic.

Concussion and mild traumatic brain injury are covered under the Americans with Disabilities
Act Amendments Act (ADAAA). Any action taken in this process must remain compliant with the
ADAAA law.
Return-to-Learn Stages

The role of the AOC and academic advisor is to oversee their concussed cadet’s academic
recovery and communicate that information to medical personnel who will assign the return-
to-learn stages. The duration of each stage should be specific to each individual cadet and is
based on the symptoms experienced by the cadet. Regardless of stage, the AOC and academic
advisor will jointly manage return-to-learn. During stages 1 and 2, the cadet will be on bed rest
so these stages will be primarily managed by the AOC. When the cadet is ready to return to
class (i.e., progress to stage 3) the AOC will handover primary management responsibilities to
the cadet’s academic advisor.

Stage 1- Cognitive Rest (typically same day of injury)
Avoid:
 Classroom attendance
 Formation
 Briefings
 Homework
 “Screen time” (i.e. phone, computer, video game use)
 Reading
 Loud noise and bright lights
o E.g., meals should be provided in their dorm in order to avoid Mitchell Hall

Due to the energy crisis that occurs after a concussion, cognitive rest allows the brain to heal
more quickly. While the cadet is still experiencing symptoms without stressors or activity, they
should remain at the cognitive rest stage.

When the cadet is asymptomatic at rest, they will progress to the next stage.

Stage 2- Trial of Cognitive Activity (return to homework)
 Attempt cognitive activity such as homework or reading for 30 minutes
 Gradually increase time increments
 Allow for approximately 15 minutes of rest in between each activity
 If the cadet develops symptoms after participating in activities, they should rest until
symptoms subside

Once the cadet can complete approximately an hour of cognitive activity without the onset of
concussion symptoms, they will progress to the next stage.

Stage 3- Return to Class (with maximum modifications)
 Return to a partial day of classes
 Avoid specific classes or activities that lead to the onset of symptoms
o E.g., particularly challenging classes, labs, and excessive computer use
 The cadet should not participate in physical education classes
 The cadet should communicate to their academic advisor, professors, and instructors
when they are experiencing symptoms and ask to leave class or modify classes in order
to minimize the experience of concussion symptoms
 The cadet should not take quizzes or GRs, as a quiz or GR taken while concussed will not
accurately represent their ability and knowledge
 The cadet can begin to make up work (e.g., reading assignments) missed when they
were not in class
 The cadet can begin to attend morning accountability formation, briefings, and meals in
Mitchell Hall unless they provoke concussion symptoms

Once the cadet can complete a partial day of classes without the onset of concussion
symptoms, they will progress to the next stage.

Stage 4- Return to Class (with minimum modifications)
 The cadet returns to a full day of classes but should take breaks when necessary
 The cadet can begin to take quizzes and GRs, although they should be provided an
opportunity to take an adapted form in order to prevent triggering symptoms (e.g., oral
exam instead of written, paper instead of computer, etc.)
 Single class exceptions for a particular class that provokes symptoms may be necessary

Once a cadet can attend classes without the onset of concussion symptoms, they will progress
to the next stage.

Stage 5- Full Class Attendance (no modifications)
 The cadet returns to classes as usual, fully participating and taking all quizzes and GRs in
the original format
 The cadet will continue to work with professors and instructors in order to ensure that
any missed work is made up and they are caught up to the syllabus
 The expectation is that the cadet is attending all formations and briefings

Continue to monitor for concussion symptoms, even after the cadet has reached stage 5. Any
return of symptoms should be referred to a medical professional.

Symptoms Persisting Longer Than Three Weeks

For most cadets, concussion symptoms will subside and a full return to class with no
modifications will occur within three weeks. For those cadets who continue to experience
symptoms past the three-week period, there are differing ways to make academic adjustments
and accommodations. The cadet may need a change in schedule (e.g. drop a class); special
arrangements may be required to allow for extended absences, quizzes and GRs, term papers,
and projects.
Potential Accommodations for Professors/Instructors to Consider

General Academic Accommodations:
 Modify or cancel an assignment(s)
 Short in-class breaks
 Extended time on assignments or quizzes/GRs
 Quieter/dimmer exam room
 Ability to record lectures or provide note takers
 Alternative forms of quizzes and GR’s e.g., oral instead of written, paper instead of
computer
 Excused absences
 Schedule change
 Drop a class that induces concussion symptoms