Background: Mild traumatic brain injury (mTBI) is a steadily growing public health concern. Young adults with mTBI find themselves having to navigate not only the physical, cognitive, and somatic aspects of their recovery, but also self-advocate for accommodations and services when they return to school. The skills required to be an effective student upon returning post-injury are paramount to continued success in returning to life. However, there is a gap in the literature in terms of evidence-based return to school (RTS) programs for those with mTBI.
Objective: The aim of the current study is to examine effectiveness of an outpatient RTS intervention on students’ executive function and post-concussive symptoms.
Methods: In this pre-post-trial, an RTS program was delivered to students attending post-secondary institutions with a diagnosis of a concussion. The group based RTS program consisted of 2 hour sessions delivered over 7 weeks. The program included sessions consistent with the Practice Standard Guidelines for Cognitive-Communication put forward by the College of Audiologists and Speech-Language Pathologists of Ontario. Participants were asked to complete questionnaires related to demographic factors and a formal battery of cognitive-communication assessments. Participants who completed the RTS Program were also sent a survey link, with questions about their injury and school status. Primary outcome measures included: Attention Processing Training (APT), Woodcock-Johnson III Test of Cognitive Abilities (WJ-III), and Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at baseline and post-treatment. Pre and post assessment scores were compared using paired samples t-tests.
Results: 38 students participated in the study.  According to survey results, the number of students who continued/enrolled in academic studies increased from 24 to 33 after attending the RTS program. Additionally, the number of students using learning supports increased from 17 (post injury-pre RTS program) to 29 (post RTS program). Overall satisfaction with the RTS program was high with 37 out of 38 participants stating they would recommend it to others looking to return to learning.  Significant improvements were seen in attention including complex sustained attention (p<.001), selective attention (p<.001) and alternating attention (p=.004) on the APT. Significant improvements were also found on decision speed (p<.001), pair cancellation (p=.027), rapid picture naming (p<.001), and reading fluency (p=.029) from the WJ-III. No significant improvement in the RPQ was reported.
Conclusions: Results from the study suggest improvement in the management of skills beyond simply academic performance and into improved cognitive symptoms in general. Future research should examine if improvements in cognitive-communication symptoms result in a significant change in learning strategies, information uptake, and academic achievement. Studies incorporating multidisciplinary management for learners including rehabilitation professionals and academic centers are warranted.

Evaluating a Post-Concussion Return to School Group Program for Secondary and Post-Secondary Students in Southwestern Ontario, Canada