A Student Returns to PE After a Concussion
Ms. Nguyen teaches freshman physical education. A student, Priya, returns to class after a concussion sustained in a club soccer game three weeks ago. The physician's note says "may return to full physical education," but in class Priya says her head hurts after the five-minute warm-up jog, becomes dizzy during a 20-second plank and a forward-roll station, and mentions that she has been leaving world history class to rest in the nurse's office. Her grades in two classes have dropped. The athletic trainer is in the building only on Tuesdays and Thursdays; today is Monday. Priya's mother has not returned two calls from the school nurse. Priya asks Ms. Nguyen not to tell her mother that she is still having symptoms.
1. What should Ms. Nguyen do for Priya during today's class, and who must be involved? Explain the reasoning about roles and about return-to-learn versus return-to-play.
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She should stop the activity that provokes symptoms. Priya is reporting headache after a jog and dizziness with a plank and a forward roll; dizziness and headache with exertion are red flags after a concussion, and a forward roll involves head movement and inversion, which are among the last things to reintroduce.
The physician's note does not override observed symptoms. A clearance letter says the medical restriction has been lifted; it does not mean the student is currently symptom-free or that a straight-line return is safe. Nor is this a decision a physical education teacher makes alone. Today she should remove Priya from activity, seat her in a quiet supervised spot, notify the school nurse, leave a message for the athletic trainer and follow up Tuesday, document the symptoms and the time, and contact the parent or guardian the same day.
Return-to-learn precedes return-to-play. If Priya is leaving class to rest and her grades are slipping, she is not fully back to learning, and physical activity should be reduced rather than advanced. Massachusetts requires districts to maintain concussion policies and medical clearance before return to athletics; whether a PE class is covered depends on the district's written protocol, which Ms. Nguyen should read today rather than guess about.
2. How should activity be reintroduced for Priya, and what criteria should trigger stopping or stepping back?
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Reintroduction should be graded and stepwise, with at least 24 hours at each step and no progression if symptoms return. A standard sequence adapted to school:
- Symptom-limited rest and light daily activity.
- Light aerobic activity - 10–15 minutes of walking, no resistance work, no head movement.
- Moderate activity - jogging or stationary bike, no contact, no rapid direction changes.
- Non-contact sport drills and moderate resistance training.
- Full practice.
- Full game.
In class, Priya would start at step 2 - walking laps or the stationary bike while the class runs - and move to modified stations only when a step is tolerated. The stopping rules must be explicit and written down: stop for headache, dizziness, nausea, balance problems, fogginess, or light and noise sensitivity that appears or worsens. If symptoms return, she rests, and the next attempt occurs at the last tolerated step after 24 hours. Forward rolls, heading, diving, and any contact stay out until she has progressed through the steps.
The protocol belongs in her file and must be shared with every teacher and substitute who supervises her, not kept in Ms. Nguyen's memory.
3. What are Ms. Nguyen's obligations regarding confidentiality, documentation, and communication, and how should she handle Priya's request?
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Priya's request not to tell her mother cannot be honored. Ms. Nguyen is not a counselor with a confidentiality privilege, and the school needs a guardian involved in an unresolved health event that is also affecting academics. She should tell Priya honestly before making the call: "I have to call your mother because you're having symptoms - that's a health issue. I'll tell her what I saw and that the nurse is involved. I won't talk about this with your classmates." That respects Priya's privacy without promising secrecy.
Documentation should include the date and time, the activity, the symptoms observed and reported, what was done, and who was notified, plus the physician's note on file. Health information goes only to those who need it - nurse, athletic trainer, administrator, parent - and is never read aloud, posted, or discussed in the staff room.
If Priya is still playing club soccer, the coach should be alerted as well, because a school clearance does not automatically cover a club; that contact goes through the parent. Finally, she should ask the nurse whether a Section 504 plan is warranted if symptoms persist and continue to affect academics.