1. Prince William County Public Schools​ Return to School (RTS) from a Concussion High School Instructional Staff Presentation ​ ​
Welcome to the Prince William County Public School’s staff concussion education training for high school staff.

2. Objectives At the completion of this training you will:
Understand and recognize signs & symptoms associated with a concussion.
Be familiar with the role of the instructional staff in support of a concussed student.
Be knowledgeable of Prince William County Public Schools concussion management process.
Understand how to implement proper medical treatment and referral guidelines for a person suspected of having a concussion.
Be aware of the tools available to provide academic support during recovery.
At the completion of this training you will:
Understand and recognize signs & symptoms associated with a concussion.
Be familiar with the role of the instructional staff in support of a concussed student.
Be knowledgeable of Prince William County Public Schools concussion management process.
Understand how to implement proper medical treatment and referral guidelines for a person suspected of having a concussion.
Be aware of the tools available to provide academic support during recovery.

3. Presentation Overview
Concussion Overview
Return to School Framework
Strategies and Techniques
School Concussion Management Team
Assignments, Grading and SOLs
This presentation overview is divided into five parts with each part addressing specific aspects of the overall return-to-learn protocol and process.
Concussion Overview
Return to School Framework
Strategies and Techniques
School Concussion Management Team
Assignments, Grading and SOLs

4. As of July 1, 2016
The State of Virginia passed legislation for Return to School protocol that provided six specific phases that provide guidance for schools and staff to follow that support student recovery from concussion. All staff shall use the protocol outlined in the Concussion Management Regulation 759 – 1. Utilizing the information in this presentation to implement a RTS process will enable a student to sustain progress in school and achieve recovery.
The State of Virginia passed legislation for Return to School protocol that provided six specific phases that provide guidance for schools and staff to follow that support student recovery from concussion.
All staff shall use the protocol outlined in the Concussion Management Regulation 759 – 1.
Utilizing the information in this presentation to implement a RTS process will enable a student to sustain progress in school and achieve recovery.

5. Part One Concussion Overview
Let’s begin with part one and discuss concussion; What it is; How a concussion affects a student as well as daily life at home and/or school.

6. PWCS Commitment to Recovery
“Our main goal is to ensure that PWCS students and student-athletes who sustain concussions are properly diagnosed, given adequate time to heal, and are comprehensively supported at home and school throughout the recovery of their injury.”

7. What is a Concussion?
A concussion is a brain injury that results in the rapid onset of short lived impairment of neurological function that resolve. This injury is caused either by a blow to the head, face or neck, or elsewhere on the body with an impulsive forces that is transmitted to the head, (i.e., a helmet to the head, being knocked to the ground).
Medically speaking, a concussion is a brain injury that results in the rapid onset of short lived impairment of neurological function that resolve.
This type of injury is caused either by a blow to the head, face or neck, or elsewhere on the body with an impulsive force that is transmitted to the head, (i.e., a helmet to the head, being knocked to the ground).  
The key to recovery from a concussion is both physical and mental rest, followed by a gradual progression back to activity, both in athletics and in the classroom.

8. How Does a Concussion Affect a Student?
This invisible injury disrupts the way the brain normally works by affecting mental stamina, as the brain must work longer and harder even to complete simple tasks.
Concussions also affect reaction time, short-term memory, working memory and cognitive processing speed.
Think of you brain like a cell phone, when you get a concussion your battery life goes down. It's harder to charge it back up to 100%, since a lot of the power goes to healing your brain. Trying to do normal activites causes the battery to drain more quickly. The student feels run down and post concussion symptoms get worse. Prioritize activities that are most important and plan to do those activities when the battery is at full charge. Let the student take breaks to recharge their battery. 

9. Facts about Concussions
Symptoms may last for as short as several minutes and last as long as several days, weeks, months, or even longer in some cases.
A concussion may or may not result in loss of consciousness (LOC).
A concussion is not only a physical injury to the brain, but can additionally cause a disturbance of normal brain activity/function. Since structural injury is not always present, standard imaging technology such as CT scans are not always reliable sources in determining the presence of a concussion. These symptoms can last from minutes to hours or even weeks, months or longer. A concussion may or may not result in loss of consciousness.

10. Effects on Daily Life at Home
Difficulty completing tasks
Reduced play/ activity
Behavior changes
Fatigue
Sleep
Following a head injury everyday functions can be effected. They may have difficulty completing tasks at home or in school, become irritable easily and may experience periods of excessive sadness.

11. Effects on Daily Life at School
These changes can have a significant impact on classroom learning and school work!
A+ student may become C- student
Inability to concentrate
Difficulty remembering direction
Difficulty completing assignments
Falls behind, fails tests, reduction in grades
Disorganized
Fatigue
Personality changes
Physical symptoms may interfere with the student’s ability to focus and concentrate, while cognitive symptoms may impact the ability of the
student to learn, memorize and process information, as well as keep track of assignments and tests. Struggles with
school work may worsen the frustration, nervousness and/or irritability that were originally caused by changes in brain
chemistry. Lastly, disturbances in sleep patterns often result in fatigue and drowsiness during the day, factors which
may compound all the other problems the student may experience.

12. Part Two Return-To-School Framework
In section two, we will look at the Return-To-School Protocol enacted by the State of Virginia and the Return-To-School Framework developed by Prince William County Public Schools..

13. Return-To-School Framework
Full School and Extra-Curricular Involvement
Phase Six
Which phase a student starts is dependent on the severity of the concussion
Full Day Attendance with Minimal Academic Adjustments
Phase Five
Half Day Attendance with Moderate Instructional Modifications
Phase Four
Half Day Attendance with Maximum Instructional Modifications
Phase Three
Prince William County Public Schools has implemented a Return to Learn program that enables a student to return to portions or all of their school related work with the decrease of symptoms. With collaborating information from the health care provider, teachers, administrators, and parents the student may enter one of the phases shown in this slide to remain as current as possible with the academic needs of the student. As long as the student is able to continue recovery and not experience an increase in symptoms, the student can move to through each phase until recovery is complete.
A key component of understanding this phase program is that a student maybe in a phase for an undetermined amount of time. It could be from one day to many days.
Every student’s ability to reach full recovery is different and will vary in the length of time it takes.
Phase Two
No School Rest with Light Cognitive Mental Activity and Limited Physical Activity.
Phase One
No School – Cognitive and Physical Rest

14. Return-To-School Framework
Phase 1: No School
Symptoms may prevent the student from full or partial participation in school. Physical symptoms tend to be the most prominent and interfere with even basic tasks.
Recommendation:
The student should rest the brain and body as much as possible.
Symptoms may prevent the student from full or partial participation in school. Physical symptoms tend to be the most prominent and interfere with even basic tasks.
It is recommended during Phase One the student rest the brain and body.
Here are a few strategies that can be used during Phase One of Return-To-School:
No school and no physical activity. As stated……Resting is important.
Limit and/or restrict student activities which could aggravate symptoms.
Strategies
No school;
No activities that aggravate symptoms, such as television, video games, computer use, texting or loud music;
No physical activity.

15. Return-To-School Framework
Phase 2: Half-day Attendance - Academic Adjustments
Symptoms have decreased to manageable levels but may be aggravated by certain mental activities that are complex, difficult and/or have a long duration
Recommendation:
Avoid tasks that produce, worsen or increase symptoms. Avoid symptom triggers
Strategies:
Part-day school attendance, with focus on the core subjects;
Symptoms reported by student addressed with specific academic adjustments;
Eliminate busy work or items not essential to learning priority material;
No physical activity.
In Phase Two a student may attendance school a half day and there maybe a need for making adjustments to class schedule. Symptoms have decreased to manageable levels but may be aggravated by certain mental activities that are complex, difficult and/or have a long duration
It is important during Phase Two to carefully monitor a concussed student’s recovery. The challenge is to avoid tasks that may worsen symptoms or even increase symptoms.
Try using some of these strategies with a student in Phase Two:
Limiting physical activity.
Making academic adjustments in order that a student is able to work on core subjects by eliminating “busy” work and/or prioritizing learning materials.

16. Return-To-School Framework
Phase 3: Half day Attendance - Academic Adjustment
Symptoms have decreased in both number and severity. These symptoms may still be aggravated by certain activities. However short time spans with known symptom triggers do not have drastic effects on symptom levels.
Recommendation:
As the student improves, gradually increase the brain’s activity by increasing the amount of work, length of time spent on the work, and the type or difficulty of work.
Strategies:
Continue to prioritize in-class learning material; minimize workload and promote best effort on important tasks;
Gradually increase amount of homework.
Symptoms have decreased in both number and severity. These symptoms may still be aggravated by certain activities. However short time spans with known symptom triggers do not have drastic effects on symptom levels.
As the student improves, gradually increase the brain’s activity by increasing the amount of work, length of time spent on the work, and the type or difficulty of work.
Student may still attend school on a half day basis during Phase Three. Continue to prioritize in-class learning material; minimize workload and promote best effort on important tasks;
Gradually increase amount of homework.
Continue to watch for re-occurrence of symptoms.

17. Return-To-School Framework
Phase 4: Half day Attendance - Academic Adjustment
Symptoms have decreased in both number and severity. These symptoms may still be aggravated by certain activities. However, longer time spans with known symptom triggers do not have drastic effects on symptom levels.
Recommendation:
As the student improves, gradually increase the brain’s activity by increasing the amount of work, length of time spent on the work, and the type or difficulty of work.
Strategies:
Continue to prioritize in-class learning material; minimize workload and promote best effort on important tasks;
Gradually increase amount of homework.
In Phase Four, symptoms have decreased in both number and severity but can be aggravated by certain triggers.
Even though a student may be attending school for half-day, the amount of work, length of time spent on the work, and the type or difficulty of work can be increased.
Continue to prioritize in-class learning material; minimize workload and promote best effort on important tasks;
Gradually increase amount of homework.

18. Return-To-School Framework
Phase 5: Full-day Attendance - Minimal Academic Adjustments In Phase 5, the student may not have any symptoms or may experience mild intermittent symptoms.
Recommendation:
Gradual removal of academic adjustments through monitoring the student’s RTL progression.
If the student is symptom free, they may begin the RETURN TO PLAY Progression
During Phase Five, the student attends school on a full time basis. The student may not have any symptoms or may experience mild intermittent symptoms.
There is a gradual removal of academic adjustments through monitoring the student’s Return-To-School progression during Phase Five.
If the student is symptom free, they may begin the RETURN TO PLAY Progression
Continue to prioritize in-class learning material; minimize workload and promote best effort on important tasks;
Gradually increase amount of homework.
Strategies:
Continue to prioritize in-class learning material; minimize workload and promote best effort on important tasks;
Gradually increase amount of homework.

19. Return-To-School Framework
Phase 6: Full School Including Extracurricular Involvement
In Phase 6, student returns to full school activities and may be already in the RETURN TO PLAY Progression.
Recommendation:
No accommodations are needed.
Strategies:
Before returning to gym class, the student should complete the gradual return-to-play progression as indicated by the healthcare professional at the school.
A student during Phase Six, returns to full school activities and may be already in the RETURN TO PLAY Progression.
Student are able to handle a full academic schedule and no further accommodations are needed.
Before returning to gym class, the student should complete the gradual return-to-play progression as indicated by the healthcare professional at the school.

20. Part Three Strategies & Techniques
In Part three we look at how a teacher can help a student who is recovering from a concussion and has return to school. We will look at how to balance a student’s workload, prioritizing work; and how school activities beyond the core subjects and outside the classroom affect the student.

21. Facts about Concussions
A student who has suffered a concussion increases the risk of re-injury and may prolong the recovery period by returning to activities where: 
 There is an increased risk of concussion (such as PE) or; 
 Increased cognitive demands in the classroom.
A student who has suffered a concussion increases the risk of re-injury and may prolong the recovery period by returning to activities where: 
 There is an increased risk of concussion (such as PE) or; 
 Increased cognitive demands in the classroom.

22. How can a Teacher Help?
Every concussion is different, and each student may need different assistance;
Type and severity of symptoms should be used as a guide to identify the course of action to be taken;
Understand common symptom triggers; 
Reading 
Computer use 
Prolonged concentration 
Triggers are variable and will differ from student to student.
In general, a full “return to school” may be completed in five phases. Because The purpose of each phase is to identify what
the student can do without increasing symptoms (as increasing symptoms may delay recovery) and avoiding the
“triggers” that do worsen symptoms. Examples of common school-related symptom triggers are reading, screen time, computer use
for classwork, and prolonged concentration, although triggers are variable and will differ from student to student.
The task of looking up at the board and down to write notes is very difficult for a concussed student.

23. How Do I Know How Much is Too Much for the Student?
The emphasis on the return-to-school framework is allowing the student to participate and learn without worsening symptoms (which may delay healing).
As the student improves, the teachers should modify school work to gradually increase demands on the brain. This may be accomplished by:
Increasing the amount of work;
Increasing the length of time spent on the work;
Altering the type of work;
Increasing the difficulty of work.
If symptoms do not worsen, demands may continue to be gradually increased.
If symptoms do worsen, the activity should be discontinued and the student allowed to rest.
The emphasis on the return-to-school framework is allowing the student to participate and learn without worsening symptoms (which may delay healing).
As the student improves, the teachers should modify school work to gradually increase demands on the brain. This may be accomplished by:
Increasing the amount of work;
Increasing the length of time spent on the work;
Altering the type of work;
Increasing the difficulty of work.
If symptoms do not worsen, demands may continue to be gradually increased.
If symptoms do worsen, the activity should be discontinued and the student allowed to rest.

24. How Do I Determine Which Symptoms Will Affect the Student in the Classroom?
At the initial contact with the student after injury, an in-depth conversation should occur that will help the educator target major barriers to learning and achievement.
To identify where the student may struggle, it is recommended that the educator ask specific, open-ended questions focusing on concussion symptoms which have the most impact on student learning.
How is your _____________ today? (Insert a symptom, such as headache, dizziness, nausea, tiredness, etc.)
Are you having trouble focusing or concentrating?
What are you having the most trouble with in class?
Are lights and/or noise worsening your symptoms?
What things do you seem to forget?
Questions should be made course specific. For example, a math teacher could ask if remembering formulas has been difficult. An English teacher could ask if reading has any effect on headache or other physical symptoms. A music teacher could ask if the noise in the room has an effect on headache or other physical symptoms.
Once the initial and most significant problems are identified, modifications and adjustments can be made that address each issue so that the student may continue coursework, but not overload the healing brain. The student should be encouraged to report any changes in symptoms or issues so further alterations may be made. Continuous communication with the student is important.

25. Why is it Important to Prioritize Work?
It is very easy for a student who is behind in academic work to become stressed, frustrated and emotional.
Selection of the classes a student will attend for a half-day allows a student to avoid possible “catch up” requirements that may increase student stress.
In combination with the chemical changes taking place in the brain, making up schoolwork may seem downright impossible and lead to undue emotional distress that can worsen overall symptoms. Educators therefore must decide what is essential and what is not.

26. What About School Activities Beyond the Core Subjects
Consider levels of participation in the following activities, if symptoms are worse with participation:
Band/choir;
Activities requiring physical activity;
Movies in school;
Computer use in classes like keyboarding, drafting, animation and film;
Cafeteria, dining halls and busy hallways;
Driving or loud bus rides;
Dances, pep rallies and assemblies;
Classes with excessive noise, such as woodworking, auto mechanics, etc.;
After school sponsored events.
A student’s participation in this list of activities is going to be based on the current level of symptoms. One of the ways to assist in the recovery is for the Concussion management Team to provide guidance in the students return to the school life that offers a variety of activities. Participation in some of these school activities will need to be a consideration by the team.

27. What are the Symptom-Specific Academic Adjustments Can I Make?
Cognitive Exertion (Thinking) and the added stimulation of the schools environment can significantly increase symptoms, even when the student has begun to recover.
Not allowing for complete steady recuperation from symptoms will lengthen the recovery period.
For further assistance see the tool provided.
(Appendix A)Return-to-Learning Instructional Strategies
Cognitive Exertion (Thinking) and the added stimulation of the schools environment can significantly increase symptoms, even when the student has begun to recover.
Not allowing for complete steady recuperation from symptoms will lengthen the recovery period.

28. Example Scenario
One of your students gets hit in the head during participation in physical education; he informed the physical education teacher and was seen by his pediatrician later in the day. The pediatrician recommends both cognitive and physical rest until most symptoms go away. The student returns to school two days after the incident but he remains complaining of light and noise sensitivity.
As a teacher, what adjustments can you provide for the student?
Remove him from the noisy gym and send him to a classroom or library.
Coordinate with other teachers and sent the student to another class to catch up on missed work.
Reccommend e.ar plugs

29. What If the Student has Problems with Sensitivity to Light and/or Noise?
You Can…….
Move the student away from windows or dim the lights in the room.
Allow the student to wear sunglasses and/or a hat.
Allow the student to avoid assemblies and allow students to avoid busy hallways, by leaving early.
Encourage the student to avoid school events where there may be loud noises and/or bright lights.
What If the Student has Problems with Sensitivity to Light and/or Noise?
Here are some ways you can help:
Move the student away from windows or dim the lights in the room.
Allow the student to wear sunglasses and/or a hat.
Allow the student to avoid assemblies and allow students to avoid busy hallways, by leaving early.
Encourage the student to avoid school events where there may be loud noises and/or bright lights.

30. What if the Student Seems to be Easily Distracted?
You Can…..
Break down assignments into small, manageable chunks that can be completed in a half hour or less. Then provide a break before moving onto the next task.
Issue short and concise written instructions or have the student write instructions down in a step-by-step sequence.
Allow the student to take tests in a separate, quiet room.
Move the student’s seat to the front of the room so that he or she may be better observed and less easily distracted.
Use color coding and/or highlighting to emphasize important information.
What if the Student Seems to be Easily Distracted?
Try the following…..
Break down assignments into small, manageable chunks that can be completed in a half hour or less. Then provide a break before moving onto the next task.
Issue short and concise written instructions or have the student write instructions down in a step-by-step sequence.
Allow the student to take tests in a separate, quiet room.
Move the student’s seat to the front of the room so that he or she may be better observed and less easily distracted.
Use color coding and/or highlighting to emphasize important information.

31. What if the Student Complains of Memory Problems?
You Can…
Provide class notes to the student or allow the use of a tape recorder for lectures.
Allow the use of fact sheets on tests to reduce the demand on memory.
Use multiple-choice and open-book tests (rather than short answer or essay) to minimize demand on memory.
Help the student devise ways to rehearse information (mnemonic devices, association, etc.)
What if the Student Complains of Memory Problems?
You Can…
Provide class notes to the student or allow the use of a tape recorder for lectures.
Allow the use of fact sheets on tests to reduce the demand on memory.
Use multiple-choice and open-book tests (rather than short answer or essay) to minimize demand on memory.
Help the student devise ways to rehearse information (mnemonic devices, association, etc.)

32. How do I Know When a Student’s Symptoms are Worsening?
Carefully observe students for:
Greater irritability
Increased problems paying attention or concentrating
Less ability to cope with emotions than normal
Increased difficulty learning or remembering new information
Increased forgetfulness
Inappropriate or impulsive behaviors during class
Repeating themselves
Worsening of physical symptoms (Headaches, vomiting, etc.)
Some students may continue to have difficulties even when these management techniques are used. 
If symptoms worsen, share information with parents, school nurse and athletic trainer.
If symptoms worsen, share information with parents, school nurse & athletic trainer and members of the Concussion Management Team.
You Can…
Provide class notes to the student or allow the use of a tape recorder for lectures.
Allow the use of fact sheets on tests to reduce the demand on memory.
Use multiple-choice and open-book tests (rather than short answer or essay) to minimize demand on memory.
Help the student devise ways to rehearse information (mnemonic devices, association, etc.)

33. Part Four School Concussion Management Team
It is very important to have lines of communication available to assist the student’s recovery from a concussion. In part Four we will look at creating the school concussion management team.

34. Who Can Help Me Manage a Student with a Concussion?
Academic concussion management should be a collaborative approach.
A concussion management team is recommended in each school to ensure continuity of care and support
The concussion management team may include:
A consistent message and good communication are key
If you are unsure how information is communicated about concussed students in your school, speak with your administrators.
Student’s Physician
Athletic Trainer
Guidance Counselor
Teachers
School Psychologist
School Nurse
Parents
Coaches
Academic concussion management should be a collaborative approach.
A concussion management team is recommended in each school to ensure continuity of care and support
Varying or mixed messages may cause the student unnecessary distress, so communication within the team is vital.
A consistent message and good communication are key
If you are unsure how information is communicated about concussed students in your school, speak with your administrators.

35. Communication as a Team
Development of Concussion Management Teams (CMTs) and a working chain of communication is our future goal.
This initiative will allow for smooth transitioning of students suffering from concussion back to the classrooms.
Concussion teams within the school will share common roles and responsibilities to assist other team members and the concussed student.
PWCS has identified the need for school based Concussion Management Teams as a way to monitor smooth transitioning of students suffering from concussion back to the classrooms.
These teams should be in place as support for the student and the parents in a process that has many uncertainties. Working together to support recovery and academic progress will help to reduce the potential anxiety that a student may experience.

36. Communication is a MUST!
Concussed Student
Parents
Primary Care Physician
Nurse
School Administrator
Counselor
Teachers
Athletic Trainer
All suspected concussions need to be reported to the school nurse and/or athletic trainer.
From there the entire academic team will be notified via one central
Communication regarding progress should be sent via the one chain to limit errors
Communication is the key to recovery. Parents will monitor their student’s progress at home and keep an open line of communication with school and academic team personnel. In elementary schools, all suspected concussions need to be reported to the school nurse. Remember concussions may occur during regular school hours, after school in a school sponsored activity.
Guidance counselors, school psychologist & teachers are able to identify any academic and behavioral changes in the classroom and relay that information to the athletic trainer and school nurse. School administrators are there to support the athlete and their parents throughout recovery process, in addition to implementing accommodations as needed in the classroom.

37. Sample Concussion Management Team
STUDENT/ATHLETE
PARENTS/GUARDIANS
AT-HOME CONCUSSION TEAM
SCHOOL ADMINISTRATOR
TEACHER
SCHOOL COUNSELOR
PHYSICAL EDUCATION TEACHER
SCHOOL PSYCHOLOGIST
SCHOOL CONCUSSION TEAM
NURSE
ATHLETIC TRAINER (AT)
PRIVATE MEDICAL PROVIDER
MEDICAL CONCUSSION TEAM
COACH
SCHOOL ATHLETIC DIRECTOR (AD)
TEAMMATES
ATHLETIC CONCUSSION TEAM
This chart is another way to look at the composition of a school’s concussion management team. Depending on the school, the Concussion Management Team can be composed of several sub teams.

38. Concussion Management Team Roles
This chart depicts a school’s Communication Management Team composition and a brief explanation of each members role.

39. Sample Concussion Flow Chart
This is a sample flow chart showing the interrelationships that may exist when addressing a student.

40. Part Five Assignments, Grading and SOL Testing
In Part Five we will look at documenting assignments; creating a concussion score code in the PowerTeacher Gradebook; how to handle missing assignments and how to report grades associated with a concussed student.

41. Documenting Assignments
In support of PWCS Regulation 759-1, Concussion Management and Education, the following process will be used to document assignments missed by students who have sustained a concussion and are receiving instructional modifications through Return to School.  
Assignments missed due to a student’s concussion will be assigned a Concussion score; this score code must be manually created.
The following process will be used to document assignments missed by students who have sustained a concussion and are receiving instructional modifications through Return to School.  
Assignments missed due to a student’s concussion will be assigned a Concussion score; this score code must be manually created.

42. How To Create a Concussion Score Code
From PowerTeacher Gradebook, select Tools à Preferences.
Select the Score Codes tab.
Click the Add button to add a new Score Code.
From PowerTeacher Gradebook, select Tools à Preferences.
Select the Score Codes tab.
Click the Add button to add a new Score Code.

43. How To Create Concussion Score Code
On the Create a New Score Code. Complete the following fields:
Code – Enter: CONCUS
Description – Enter: Concussion
Exempt – Be sure to deselect this checkbox
Percent – Enter Zero (0)
Numeric – select Custom  Value – Enter Zero (0)
Click OK
On the Create a New Score Code. Complete the following fields:
Code – Enter: CONCUS
Description – Enter: Concussion
Exempt – Be sure to deselect this checkbox
Percent – Enter Zero (0)
Numeric – select Custom  Value – Enter Zero (0)
Click OK

44. How To Handle Assignments
When a student misses an assignment due to a concussion, the student’s score for the assignment should be CONCUS.
Once the student completes the assignment, the grade must be changed to the score the student received on the assignment. Until the assignments are made-up and the new scores entered, the student’s final grade will be impacted by the missed assignments.
Assignments that will not be made-up should be marked as “Exempt”; the Exempt score code has no impact on the student’s final grade.
When a student misses an assignment due to a concussion, the student’s score for the assignment should be CONCUS.
Once the student completes the assignment, the grade must be changed to the score the student received on the assignment. Until the assignments are made-up and the new scores entered, the student’s final grade will be impacted by the missed assignments.
Assignments that will not be made-up should be marked as “Exempt”; the Exempt score code has no impact on the student’s final grade.

45. How To Create Concussion Score Code
Sample:
Using GradeBook to document assignment for a student with a concussion.
The is example of a Gradebook using the CONCUS code.

46. Reporting Grades Associated With Concussion
If at the end of the grade reporting period the student has made up little to no work, the student should be assigned a final grade of Incomplete (I).
Once the assignments have been made-up and the scores have been updated for those assignments, the student’s score for that grade reporting period must be recalculated by going to Tools à Recalculate Final Scores.
Follow your school’s grade change process for updating the student’s grade in SMS.
If at the end of the grade reporting period the student has made up little to no work, the student should be assigned a final grade
of Incomplete (I).
Once the assignments have been made-up and the scores have been updated for those assignments, the student’s score for that grade reporting period must be recalculated by going to Tools à Recalculate Final Scores.
Follow your school’s grade change process for updating the student’s grade in SMS.

47. Concussed Student With Academic Adjustments and SOL/AP Testing
Can the student take the SOL test?
YES
Student can take the SOL online, no adjustment is needed.
Student needs to have pencil/paper test. NO
Student is not cleared for online or pencil/paper SOL testing. 
Student can take the test when symptoms have resolved during summer school or December.
When it comes to answering the question whether a concussed student can take SOL tests, the correct answer is IT DEPENDS. A student who has suffered a concussion but has completed the Return To Learn process can take SOL tests with or without adjustments. If the student is cleared to take SOL tests will need to have a doctor’s note in order to use pencil/paper test. If the student has not completed the Return To Learn process, the student will not be able to take the SOL test at this time.
Note:
A doctors note must be provided for SOL test accommodations. Please have your doctor provide a note to the testing coordinator with the adjustments listed in red.

48. Sample SOL/AP Testing Letter
Hello Parents, 
Your son or daughter is currently receiving academic adjustments  for a concussion they sustained. SOL/AP testing will begin shortly and we need to determine if the test can be taken, if adjustments are needed or they are not permitted to take the test at this time. Please take a look at the attached flow chart to determine what your child may need. Share the information with your doctor and if adjustments are needed have the doctor provide a note indicating one of the specific statements in red lettering. If you feel that no adjustments are needed, please reply with your child's name letting us know they will take the SOL/AP tests online with no adjustments. 
Kind Regards, 
This is a sample form that could be used to notify parents of a concussed student about SOL/AP testing options.

49. Physical Instructional Strategies Cognitive Instructional Strategies
Resource Material
Physical Instructional Strategies
Cognitive Instructional Strategies
Emotional Instructional Strategies
Return-to-School Chart
These resources are available in pdf format on the PWCS Athletic web page.
These following resources for instructional strategies will be made available in pdf format on the PWCS Athletic web page.
Physical Instructional Strategies
Cognitive Instructional Strategies
Emotional Instructional Strategies
Return-to-School Chart

50. RTS Physical Instructional Strategies
Return-To-Learn Physical Instructional Strategies focus on the following symptoms:
Mental Fatigue/Headaches
Dizzy/Vestibular Problems/Balance
Noise Sensitivity
Light Sensitivity
Neck Pain

51. RTS Cognitive Instructional Strategies
Return-To-Learn Cognitive Instructional Strategies focus on the following symptoms:
Easily Distracted
Difficulty with New Learning
Difficulty with Attention/Concentration
Feeling Mentally Foggy
Slow Processing Speed
Difficulty Remembering/Memory

52. RTS Emotional Instructional Strategies
Return-To-Learn Emotional Instructional Strategies focus on the following symptoms:
Sad, Angry, Frustrated, emotional
Peer Relationship Difficulties

53. Return-to-School Chart
PROGRESSION STAGES
OBJECTIVE OF EACH STAGE
Symptom free?
Circle Yes or No
1. Home Bound (No School) – Total Rest
Zero activity. Parental interventions.
Avoid cognitive over-exertion by limiting mental activity. Temporary stimulus below usual threshold.
YES NO
2. School – Part Time
(Maximum Adjustments)
School work limited to only those areas that are essential for student academics (Core Subjects)
Part-time allows students to rest overnight and gauge load of information.
YES NO
3. School –Full Time
(Moderate Adjustments)
Less accommodations and small increase in academic goals.
4. School – Full Time
(Minimum Adjustments)
Return to full day activities with moderate to minimal accommodations for more intense assignments. (i.e. tests, quizzes, and projects)
5. School – Full Time
(No Adjustments)
Pre-Injury academic performance (norm)
The progression stages shown in this chart are used by medical providers for return to physical activity. The progression stages are very similar to the PWCS Return-To-Learn steps.
Once symptom free on each stage then the student is checked off and is progress onto the next phase.