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J Child Neurol. 2016 Jan;31(1):93-108. doi: 10.1177/0883073814555604. Epub 2014 Dec 22.

Medical-School Partnership in Guiding Return to School Following Mild Traumatic Brain Injury in Youth.

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Division of Pediatric Neuropsychology, Children's National Health System, George Washington University School of Medicine, Rockville, MD, USA


Mild traumatic brain injury is recognized as a prevalent and significant risk concern for youth. Appropriate school return is particularly challenging. The medical and school systems must be prepared partners to support the school return of the student with mild traumatic brain injury. Medical providers must be trained in assessment and management skills with a focused understanding of school demands. Schools must develop policies and procedures to prepare staff to support a gradual return process with the necessary academic accommodations. Ongoing communication between the family, student, school, and medical provider is essential to supporting recovery. A systematic gradual return to school process is proposed including levels of recommended activity and criteria for advancement. Targets for intervention are described with associated strategies for supporting recovery. A 10-element Progressive Activities of Controlled Exertion (PACE) model for activity-exertion management is introduced to manage symptom exacerbation. A strong medical-school partnership will maximize outcomes for students with mild traumatic brain injury.


TBI; concussion; mild traumatic brain injury; pediatric; youth

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