Return to Learn after Mild Traumatic Brain Injury (mTBI): A Systematic Review and Meta-Analysis

Research Objectives: To assess mTBI effects on attendance, academic performance, perceived learning difficulty, and accommodations, as well as to identify contributing factors underlying academic outcomes following mTBI.

Design: Data Sources: Digital databases (e.g., MEDLINE, PsycINFO, CINAHL) and references identified from bibliographies of pertinent articles and books. Constraints placed on peer-reviewed journals and English Language.

Setting: N/A

Participants: N/A

Interventions: N/A

Main Outcome Measures: Study Selection: Studies include a target population of students with mild traumatic brain injury/concussion from elementary to college settings and have extractable RTL data as related to school attendance, academic performance, perceptions of academic difficulty, and accommodations were included.

Data Extraction: The Scottish Intercollegiate Guidelines Network (SIGN) was used to guide evidence quality assessment. 20% of articles were recoded to confirm data extraction and quality inter-rater reliability.

Results: Attendance is negatively affected by mTBI (r=−.30, 95% confidence interval [CI] [−.42, −.18], p<.01). Sleep symptoms, vestibular ocular-motor dysfunction, previous history of mTBI, history of migraines, or female group appeared to be risk factors for school absenteeism. The meta-analysis confirmed small but negative effects on academic performance (r=-.09, 95%CI [−.18, .006], p<.05). Multiple prior brain injuries and cognitive symptoms, including memory deficits, slow thinking, attention problems, were risk factors for poorer academic performance after mTBI. Meta-analysis yielded a moderate effect size for the relationship between symptomatology and academic concerns (r=.50, 95%CI[.33, .68], p<.001). Sleep difficulties, vision symptoms, hearing disturbance, and concentration difficulty increased the likelihood of having school problems. In contrast, time post-injury and preserved executive functioning were protective factors. Between 17% to 74% of students received academic support, especially recommendations for rest. Female athletes were more likely to receive accommodations than male students, but other contributing factors of accommodation referral were unclear from the literature.

Conclusions: Students tend to show reduced school attendance and performance as well as increased academic concerns after injury. The lack of studies limited investigation into the moderators of each academic outcome after mTBI.

Author(s) Disclosures: We do not have any financial or non-financial conflicts of interest to disclose.