What are the four steps of the return-to-school strategy?

1. Activities of daily living and relative rest (first 24 to 48 hours). Typical home activities (preparing meals, social interactions, light walking) that do not cause more than mild and brief worsening of symptoms, with minimal screen time. After a maximum of 24 to 48 hours, move to step 2.
2. School activities with encouragement to return to school (as tolerated). Homework, reading or other light cognitive activities at school or home; take breaks and adapt activities if symptoms worsen more than mildly and briefly; gradually resume screen time.
3. Part-time or full days at school with accommodations (as needed). Gradually reintroduce schoolwork, build tolerance to the classroom over time (part-time days with breaks and other accommodations may be needed), then gradually reduce accommodations and increase workload.
4. Return to school full-time. Full days and academic activities without concussion-related accommodations.

Also from the guideline:

• Students do not need to be symptom-free to return to school, and a complete absence from school of more than one week is not recommended.
• Medical clearance is not required to return to school, except for full participation in school-based sport and physical activity (including physical education class), which follows the Return-to-Sport Strategy.
• The strategy is a recommendation and does not replace medical advice.

Source: Parachute, Canadian Guideline on Concussion in Sport, 2nd edition (Table 1): https://parachute.ca/wp-content/uploads/2019/06/Concussion-Guideline-2024.pdf