Editing Concussion (section)

=== Return-to-school ===
The resumption of low-risk school activities should begin as soon as the student feels ready and has completed an initial period of cognitive rest of no more than 24–48 hours following the acute injury.<ref name="Zimmerman_2021">{{cite journal | vauthors = Zimmerman SD, Vernau BT, Meehan WP, Master CL | title = Sports-Related Concussions and the Pediatric Patient | journal = Clinics in Sports Medicine | volume = 40 | issue = 1 | pages = 147–158 | date = January 2021 | pmid = 33187605 | doi = 10.1016/j.csm.2020.08.010 | s2cid = 226947984 | doi-access = free }}</ref><ref name="DeMatteo_2020">{{cite journal | vauthors = DeMatteo C, Bednar ED, Randall S, Falla K | title = Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review | journal = BMJ Open Sport & Exercise Medicine | volume = 6 | issue = 1 | pages = e000667 | date = 2020 | pmid = 32153982 | pmc = 7047486 | doi = 10.1136/bmjsem-2019-000667 }}</ref> Long absences from school are not suggested, however; the return to school should be gradual and step-wise.<ref name="DeMatteo_2020" /> Prolonged complete mental or physical rest (beyond 24–48 hours after the accident that lead to the concussion) may worsen outcomes,<ref name="DeMatteo_2020" /> however, rushing back to full school work load before the person is ready, has also been associated with longer-lasting symptoms and an extended recovery time.<ref name="Purcell_2019">{{cite journal | vauthors = Purcell LK, Davis GA, Gioia GA | title = What factors must be considered in 'return to school' following concussion and what strategies or accommodations should be followed? A systematic review | journal = British Journal of Sports Medicine | volume = 53 | issue = 4 | pages = 250 | date = February 2019 | pmid = 29500251 | doi = 10.1136/bjsports-2017-097853 | s2cid = 3694730 | doi-access = free }}</ref> Students with a suspected concussion are required to see a doctor for an initial medical assessment and for suggestions on recovery, however, medical clearance is not required for a student to return to school.<ref name="Ontario Neurotrauma Foundation_2019" /> Since students may appear 'normal', continuing education of relevant school personnel may be needed to ensure appropriate accommodations are made such as part-days and extended deadlines.<ref name="Zimmerman_2021" /> Accommodations should be based on the monitoring of symptoms that are present during the return-to-school transition including headaches, dizziness, vision problems, memory loss, difficulty concentrating, and abnormal behavior.<ref name="Zimmerman_2021" /><ref name="Purcell_2019" /> Students must have completely resumed their school activities (without requiring concussion-related academic supports) before returning to full-contact or competitive sports.<ref name="Ontario Neurotrauma Foundation_2019" />