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Updated: Mar 21, 2026
A Neuroscientific Approach to the Examination of Concussions in Student-Athletes
Published on: December 8, 2014
Factors Associated With Return-to-Learn Duration After Concussion in US Service Academy Cadets and Midshipmen
Jeremy D Ross1, Michael J Aderman, Megan H Roach
1Author Affiliations: John A. Feagin Jr Sports Medicine Fellowship (Ross, Aderman, Malvasi, and Cameron), Keller Army Hospital, United States Military Academy, West Point, New York; Extremity Trauma and Amputation Center of Excellence (Roach), Defense Health Agency, Falls Church, Virginia and Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, North Carolina; United States Naval Academy (Susmarski), Annapolis, Maryland; United States Coast Guard Academy (Brodeur), New London, Connecticut; United States Air Force Academy (McGinty, Robb, and Jackson), USAFA, Colorado Springs, Colorado; University of Michigan Concussion Center (Broglio), Ann Arbor, Michigan; Medical College of Wisconsin (McCrea), Milwaukee, Wisconsin; Indiana University School of Medicine (McAllister), Indianapolis, Indiana; and Uniformed Services University of Health Sciences (Aderman, Pasquina, and Cameron), Bethesda, Maryland.
Objective:
Patterns of clinical recovery and factors that may influence return to activity after concussion have been well studied; however, data regarding return-to-learn (RTL) duration after concussion and factors that influence this period have not been adequately explored.
Hypothesis:
We have hypothesized that sport level, sex, concussion history, and initial symptom burden will be associated with RTL duration after concussion.
Setting:
The study was conducted at US military service academies.
Study Design:
This was a prospective cohort study.
Participants:
A total of 1509 service academy cadets (41% female, 20.2 ± 1.48 y, 174.9 ± 10.3 cm, 73.8 ± 14.0 kg) who sustained a concussion during the study period from December 2014 to March 2020 were included.
Main Measures:
The primary outcome of interest was time elapsed between an incident injury and self-reported return to normal academic performance. All participants provided baseline demographics, including sex (male, female), sport level (varsity, non-varsity), and concussion history (yes, no). Participants completed standardized concussion assessments at regular time points. Initial symptom burden was collected within 48 hours after injury, and self-reported RTL duration was collected during the unrestricted return-to-activity (URTA) evaluation.
Results:
On average, RTL duration was faster in men (8.1 ± 11.2 days) than in women (13.6 ± 20.3 days). Univariate models demonstrated that participants with an initial symptom burden ≤6 returned sooner than those endorsing 7-15 symptoms (HR = 0.73, 95% CI = 0.64-0.83, P ≤ .001) and ≥16 symptoms (HR = 0.56, 95% CI = 0.48-0.65, P ≤ .001). Sex (HR = 0.70, 95% CI = 0.62-0.77, P ≤ .001), and sport level (HR = 0.66, 95% CI = 0.59-0.73, P ≤ .001) also contributed to RTL duration in the univariate model. In the multivariable model, participants with an initial symptom burden ≤6 returned 25%-41% sooner than those endorsing 7-15 symptoms (HR = 0.75, 95% CI = 0.65-0.86, P ≤ .001) and ≥16 symptoms (HR = 0.59, 95% CI = 0.51-0.69, P ≤ .001). Sex (HR = 0.71, 95% CI = 0.64-0.80, P ≤ .001) and sport level (HR = 0.75, 95% CI = 0.67-0.85, P < .001) also contributed to RTL duration in the multivariable model.
Conclusions:
RTL duration for men, varsity athletes, and individuals with fewer initial symptoms after injury was significantly faster than for women, nonvarsity athletes, and individuals with a greater initial symptom burden.
