Not just for student-athletes anymore. Why an official Return-to-Learn (RTL) protocol is necessary for all college students

By Melissa Sodko. This article was initially published in our Concussion Update newsletter; please consider subscribing.

Developing and implementing an age-appropriate concussion return-to-learn (RTL) program for college students is an under-studied area in research. Through interviews with students and academic stakeholders, a study identified that, while college students felt supported by their instructors, academic faculty lacked the information on appropriate academic supports and pathways to facilitate an RTL process for the student. For example, all academic stakeholders (faculty and staff) were unaware of RTL guidelines and had not received concussion training. We highlight the study's recommendations for creating and implementing an undergraduate RTL protocol. This mixed methods study, conducted by Allyssa Memmini et al. through the Michigan Concussion Center, was published in The Journal of Head Trauma Rehabilitation.

The study had several components. Memmini et al. interviewed students and academic stakeholders about their experience with RTL and concussion. In a separate part of the study, researchers did a literature review of research on undergraduate RTL processes and organized a panel of 22 individuals in 15 healthcare systems. These panelists studied the literature review, then followed a Delphi procedure to develop a consensus on recommendations for undergraduate RTL processes.

Researchers interviewed students and academic stakeholders between July 2020 and April 2021. Student participation included 21 undergraduates (57% female with a mean age of 21), currently enrolled or recently graduated, who sustained a concussion within the past three years as a university student and did not participate in varsity athletics. Most (90%) sought treatment through university health services or an ER and met with their instructors during their injury. Notably, 67% (14 students) indicated a healthcare professional provided documentation with suggestions for academic support; only one student was provided an RTL protocol.

Several themes evolved from the student interviews. Students reported the following: 

1. Emotionally supportive interactions with academic stakeholders

2. A lack of specific academic guidance and resources from professors following a concussion

3. A need for additional concussion education with clear RTL guidelines

4. A need for awareness of the seriousness of the injury and continuation of the de-stigmatizing of concussions

The research team interviewed academic stakeholders–7 participants, 73% female with a mean age of 47. These stakeholders were employed as faculty or staff and had experience assisting undergraduate students with academic support following a concussion. All 7 participants indicated they did not receive formal concussion training and were unaware of RTL guidelines to support students post-concussion. Many did refer students to areas within the university, post-concussion–Office of Undergrad Student Affairs, Counseling and Psychological Services, and Services for Students with Disability.

The following themes evolved from stakeholder interviews:

1. Stakeholders indicated that advocating for their students after a head injury was necessary.

2. Post-concussion academic guidelines were not standardized across campus.

3. Stakeholders report that students' medical discharge documentation often lacks the guidelines they need to assist students.

4. Because of this, stakeholders prefer to collaborate directly with students to address their academic needs.

5. There is a need for clear RTL guidelines.

Based on a consensus, the Delphi panel developed "post-concussion policy recommendations, including the following: 

1. Clinicians should improve medical discharge documentation that helps faculty/staff and students understand the injury and the impact on cognition, specific RTL suggestions for the student, and counseling on behavioral strategies to help improve recovery.

2. Institutions should create an undergraduate RTL protocol.

3. The development of the RTL protocol and its implementation may include the following stakeholders: academic faculty, disability services, clinicians, and peer-to-peer academic support (or any other student advocate).

Of note, limitations to the study include a narrow study population (white, non-Hispanic, female) which likely does not represent the broader campus community, and participation of academic stakeholders included only non-tenured track faculty. Despite these limitations and with the understanding that concussions present with individualized symptoms, it is essential for universities to consider incorporating consistent RTL guidelines for students in need of additional academic support.