Concussion policies exist in many schools, but support gaps remain
A new study suggests that many U.S. public schools remain underprepared to help students return to class after a concussion. While most schools reported having some form of concussion policy during the 2023–2024 school year, the study found major gaps in what those policies actually require, including whether staff are trained and whether students receive classroom accommodations during recovery.
The findings come from an analysis of data from the 2024 School Pulse Panel, a survey of nearly 1,700 U.S. public school principals. Researchers reported that 75% of schools said they had a concussion policy. But that headline figure masked a more uneven reality: about one in four schools reported having no concussion policy at all, and many of the schools that did have one were missing practical elements that can shape how well a student is supported after injury.
The study was reported in the Journal of School Nursing, and the researchers framed the issue as more than a paperwork problem. A concussion can affect concentration, memory, balance, mood, sleep, and headaches, all of which can complicate a student’s return to normal classroom demands. In that setting, a policy is only useful if school staff know what to do and if schools have a process for adjusting expectations while a student recovers.
Why the classroom matters after a concussion
Concussions are often discussed in the context of sports and return-to-play decisions, but the new findings focus on something less visible and just as important: return to learning. Students may look physically well enough to be back at school while still dealing with symptoms that make reading, screen time, testing, noise, or sustained concentration difficult.
That can create a mismatch between what schools expect and what students can realistically handle in the days or weeks after injury. Without accommodations, the school day itself can intensify symptoms or slow recovery. Researchers pointed to the need for structured support as students transition back into classes, rather than treating school attendance as a simple yes-or-no decision.
Lead researcher Kelly Sarmiento, director of outreach programs for the Brain Injury Association of America, said the current gaps put added pressure on school nurses. In practice, that can mean nurses are expected to educate other staff, coordinate care, and help ensure students receive the support they need, even when the broader school system has not built those responsibilities into policy or training.
The numbers behind the preparedness gap
The study’s figures show how incomplete many school policies remain. Among schools that reported having a concussion policy, only 58% said the policy included information on how to accommodate and support students in the classroom while they recover. That means a substantial share of schools with policies may still lack formal guidance on the central academic question of what happens after an injured student comes back to school.
The training picture was even thinner. Only 29% of schools with a concussion policy required staff training on concussions. In practical terms, that suggests many educators and school employees may be working in environments where a policy exists on paper but is not reinforced through regular instruction, implementation standards, or shared expectations.
The combined effect is significant. A school without a policy has no formal structure at all. A school with a policy but no training may struggle to apply it consistently. And a school with a policy that omits classroom accommodations may be missing the part of concussion management that students feel most directly once they return.
School nurses are carrying much of the burden
The researchers emphasized the central role of school nurses in concussion management. That role can include recognizing symptoms, helping families and educators communicate, monitoring recovery, and translating medical guidance into day-to-day classroom adjustments. But the study suggests nurses are often doing this in systems that have not fully distributed responsibility across the rest of the school staff.
That matters because concussion support is rarely a one-person job. Students may need teachers to modify workload, allow breaks, reduce screen exposure, postpone high-stakes testing, or adjust classroom participation requirements. Administrators may need to ensure those accommodations are applied consistently across multiple classes. Coaches, counselors, and other staff may also be involved depending on how the injury happened and how symptoms evolve.
When training is not required, that network can break down. Nurses may know what should happen, but classroom implementation may vary from teacher to teacher. Families may receive mixed messages. Students may return to a full academic load before symptoms have eased enough to support it.
Why schools may still be falling short
The study was not designed to determine exactly why schools remain underprepared, but senior researcher Dana Waltzman pointed to several possible explanations. These included limited staffing and resources, lack of access to school health professionals such as full-time nurses or athletic trainers, competing priorities, and difficulty implementing policies consistently across schools.
Those explanations fit a broader reality in public education. Even when schools agree that a problem matters, translating that agreement into staff time, training requirements, and coordinated policy can be difficult. Health support systems may also vary widely depending on school size, district resources, and whether a campus has dedicated medical personnel on site.
The result is a fragmented landscape. Some schools may have relatively mature concussion procedures with clear return-to-learn steps. Others may be relying on informal practices or case-by-case judgment. That inconsistency can leave student recovery dependent on where a child goes to school rather than on a common standard of care.
What the findings suggest for schools
The study does not prescribe a single national solution, but it points clearly toward a few operational priorities. First, schools that still lack a concussion policy may need a formal baseline process so that students are not navigating recovery without any institutional framework. Second, schools with policies may need to revise them to include explicit classroom accommodations, not just general statements about injury response.
Third, staff training appears to be a major weak point. A policy that only a nurse or administrator understands is unlikely to produce consistent support across a student’s school day. Teachers, support staff, and other personnel need enough training to recognize the educational effects of concussion and to respond in a coordinated way.
Those changes would not eliminate every challenge around student recovery, but they would move schools closer to treating concussion as both a health issue and an academic one. That distinction matters. A student can be medically stable enough to attend school while still needing a reduced workload, environmental adjustments, or temporary flexibility.
A warning sign hidden inside a majority number
The study’s most striking feature may be how easily its headline numbers could be misread. Saying that 75% of schools have a concussion policy sounds reassuring. But when only 58% of those schools include classroom support guidance and only 29% require staff training, the picture changes. A formal policy is not the same as a functioning support system.
That is the main value of the new research. It moves the conversation beyond whether schools acknowledge concussion at all and toward whether they are prepared to manage its practical consequences for students. On that question, the answer remains uneven. Many schools appear to have built at least part of the framework. Many others still have major gaps. For students returning to class with headaches, concentration problems, memory issues, or sleep disruption, those gaps are not abstract. They shape whether recovery at school is supported or left to chance.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
