Objective: To identify critical elements of return to learn (RTL) for students with concussion and examine the state of the peer-reviewed published literature through a scoping review. Methods: Three electronic databases were systematically searched, and reference lists screened for articles addressing components of RTL protocols and accommodations for students with concussion. In total, 100 articles met inclusion criteria, including 56 empirical studies and 44 expert articles. Results: Four key components to RTL protocols were identified: RTL teams, management approaches, outcome measurement, and accommodations. Both bodies of literature agree on the importance of RTL teams, but evidence for specific monitoring tools and management approaches is less robust. Accommodations have been better addressed by experts than empirical evaluation. Empirical studies are largely cross-sectional, and many are survey based. Just 24 include student perspectives. Publication of expert literature has declined in frequency, as empirical studies have become more common. Conclusion: This scoping review describes the current landscape of RTL and provides guidance toward expanding the empirical literature to systematically determine best practices to serve students with concussion.

Purpose: Examine concussion effects on academic outcomes, including student perspectives.Methods: This study included a systematic review and meta‐analysis examining post‐concussion school attendance, academic performance, perceptions of academic difficulty, and accommodations for students in elementary through college settings. The analysis considered pre‐ and post‐injury factors, along with injury factors that contribute to post‐concussion academic outcomes.Results: The systematic review showed that students with concussion miss more school days and perceive higher levels of academic difficulty, but results about academic performance varied. Meta‐analysis yielded small concussion effects on school absence and academic performance and moderate effects on perceptions of academic difficulty. Female sex, older age, history of migraine, prior concussions, severe or persistent symptoms, vestibular‐ocular motor, and cognitive disruptions are risk factors, but these moderators were not identified in the meta‐analysis due to lack of effect sizes.Implications for School Health Policy, Practice, and Equity: This study confirmed negative concussion effects on academic absences, performance, and perceptions of academic difficulty. Identified contributing factors will guide future practices to support students returning to learn after concussion.Conclusions: Negative impacts to academics from concussion may be amplified by complicating factors. Future investigations are needed to confirm risk factors and mitigating effects of early identification and post‐injury supports.

Purpose: Typical measures of recovery from concussion—such as symptom scales, neurocognitive testing, or exertion measures—may not capture individualized experiences of concussion. This report examines how college students with concussion interact with and consider their recovery. Method: Sixteen college students who sustained concussions while in college completed 40- to 75-min semistructured interviews. All were enrolling to become mentors in a peer mentoring program for students with concussion. Questions addressed experiences as a college student with concussion, life changes following concussion, and role of peers in recovery. Using phenomenological reduction, analysis focused on the phenomenon of recovery and motivation for participation in a mentoring program. Results: Two main themes were found: (a) What Recovery Looks Like and (b) Gaining Perspective, Learning to Cope and Adapting to Change . Thirteen participants denied the label of “recovered” even though all had been deemed recovered and discharged from medical care. Instead, two subthemes emerged within What Recovery Looks Like : Ongoing Recovery and Reconceptualizing Recovery . Perceptions of recovery were influenced by effort, capacity, and resilience. In the second theme, students described strategies, resources, and supports used to cope with their injuries; most commonly used was emotion-focused coping. Conclusions: College students with concussion consider recovery as an ongoing process rather than a dichotomized condition. Student experiences may not be reflected in commonly used symptom scales or objective assessments. Supplemental Material: https://doi.org/10.23641/asha.21084925

Purpose: This study examines school-based speech-language pathologists' (SLPs’) experience, knowledge, and confidence in supporting students as they return to the classroom following concussion, with a particular focus on knowledge of new management guidelines over the last decade.Method: Participants were 74 school-based SLPs who completed an electronic survey about their knowledge and experiences serving students with concussion. We examined participants' accuracy and confidence across knowledge questions using Kruskal–Wallis tests. We also conducted linear regression to explore the relationships between training, work experiences, knowledge, and confidence.Results: Nearly half of participants who are currently working with students with concussion reported having no clinical or training experiences related to concussion. Participants who had more concussion-related training or working experiences reported higher confidence. Participants were confident about general concussion knowledge but less confident about providing assessment and supporting students with concussion as they returned to school. Participants had the lowest confidence and accuracy for the most recent guidelines around rest and activity, as well as the differential impact of concussion on children as compared to adults.Conclusions: Many school-based SLPs have limited training around concussion management and are often not specifically consulted to work with students following concussion. Despite this, SLPs have good awareness of their knowledge about concussion, but show gaps in knowledge surrounding more recent evidence-based guidelines. Additional investigation is needed to determine better ways to move research into clinical practice and to increase the involvement of SLPs in school-based concussion teams.Supplemental Material: https://doi.org/10.23641/asha.20361969

Purpose: Listeners shift their listening strategies between lower level acoustic information and higher level semantic information to prioritize maximum speech intelligibility in challenging listening conditions. Although increasing task demands via acoustic degradation modulates lexical-semantic processing, the neural mechanisms underlying different listening strategies are unclear. The current study examined the extent to which encoding of lower level acoustic cues is modulated by task demand and associations with lexical-semantic processes. Method: Electroencephalography was acquired while participants listened to sentences in the presence of four-talker babble that contained either higher or lower probability final words. Task difficulty was modulated by time available to process responses. Cortical tracking of speech—neural correlates of acoustic temporal envelope processing—were estimated using temporal response functions. Results: Task difficulty did not affect cortical tracking of temporal envelope of speech under challenging listening conditions. Neural indices of lexical-semantic processing (N400 amplitudes) were larger with increased task difficulty. No correlations were observed between the cortical tracking of temporal envelope of speech and lexical-semantic processes, even after controlling for the effect of individualized signal-to-noise ratios. Conclusions: Cortical tracking of the temporal envelope of speech and semantic processing are differentially influenced by task difficulty. While increased task demands modulated higher level semantic processing, cortical tracking of the temporal envelope of speech may be influenced by task difficulty primarily when the demand is manipulated in terms of acoustic properties of the stimulus, consistent with an emerging perspective in speech perception.

Purpose: Speech-language pathologists provide important services to people recovering from mild traumatic brain injury (mTBI), also called concussion, although they may be underutilized in outpatient care. Because health care providers face challenges in selecting assessments to efficiently describe patient needs, the purpose of this study was to describe factors related to patients receiving speech-language pathology services after mTBI, as well as how assessments predict amount of services received. Method: In this retrospective chart review study, demographic factors, injury characteristics, and assessment scores were extracted from medical records of patients aged 14–65 years receiving services for recent (within 6 months) mTBI at an outpatient specialty clinic. The Post-Concussion Symptom Scale (PCSS), Montreal Cognitive Assessment, Standardized Assessment of Concussion, and a newly developed self-report measure of cognitive-communication function—the Cognitive-Communication Referral Indicator for Concussion (CCoRI-C)—were used as dependent variables to predict speech-language pathology service referral. For those referred, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Behavior Rating Inventory of Executive Function (BRIEF) scores were added as dependent variables predicting speech-language pathology dosage. Results: A total of 132 patient charts met inclusion and exclusion criteria. In addition to CCoRI-C and PCSS symptoms, receiving imaging, being injured in a motor vehicle crash, experiencing loss of consciousness, and being of female sex were related to speech-language pathology referrals. Of the 77 patients referred for speech-language pathology care, higher CCoRI-C, PCSS, BRIEF, RBANS total, and RBANS visuospatial scores were associated with recommended speech-language pathology dosage. Only the CCoRI-C, BRIEF–Adult Version (BRIEF-A) Behavioral Regulation, and BRIEF-A Metacognition were associated with actual number of speech-language pathology sessions attended. Conclusions: Cognitive-communication symptoms and executive function may be important to planning speech-language pathology rehabilitative episodes of care for people with mTBI. Future work should continue to evaluate how assessments augment demographic and injury characteristics in decision making for both referral to and use of speech-language pathology services after mTBI.