Received Concussion Education Research Articles

Does the Association Between Concussion Measures and Social Context Factors Differ in Black and White Parents?

Middle school (MS) parents may benefit from education supporting timely concussion identification and care-seeking in their young children (aged approximately 10 to 15 years). However, such education may not consider individual needs and different social context factors, including lower socioeconomic status, disadvantaged social determinants of health, and different racial and ethnic backgrounds. To examine the relationship between social context factors and concussion knowledge, attitudes, and communication in MS parents and to explore the possible role of race and ethnicity (Black or White) as an effect measure modifier. Cross-sectional study. Online survey. A nationally representative sample of MS parents who completed an online survey (n = 1248). Parent outcomes were a history of concussion education, concussion symptom knowledge and attitudes, and communication with children about concussion. Main exposures were parental race and ethnicity (Black or White) and social context factors. Uni- and multivariable statistical analyses were performed to achieve the study aims. Black parents were more likely than White parents to have received concussion education (69.5% versus 60.5%, P = .009), although median concussion knowledge scores were higher for White parents than for Black parents (40 versus 37, P < .001). Few associations were found for social context factors with concussion knowledge, attitudes, and communication in Black and White parents separately. Among MS parents, race and ethnicity may not influence the association between social context factors and concussion-related knowledge, attitudes, or communication. However, differences were present by race and ethnicity regarding previous concussion education and other parental outcomes, concussion symptom knowledge in particular.

Current Concussion Knowledge, Beliefs, Education, and Management Practices Among Irish Post-Primary PE Teachers

ABSTRACT Purpose: Physical education (PE) teachers play an important role in concussion recognition and management in schools both in an academic and activity based setting. This study aimed to identify Irish post-primary PE teachers’ concussion knowledge, beliefs, education and management practices. Methods: An anonymous online survey, adapted to the Irish context from the validated BAKPAC-TEACH, was completed by 128 PE teachers (female = 74/123; 60.2%; male = 49/123; 39.8%, 36.1 ± 10.9 years), representing 4% of registered PE teachers in Ireland. Results: PE teachers reported 3.5 ± 4.7 students suffer with a sports-related concussion in their classroom annually and 43.9% previously had a student sustain a concussion during their PE class. Most received concussion education (58.6%), largely provided by sporting bodies. They frequently identified dizziness (93.0%) and headaches (92.2%) as concussion symptoms, but less commonly emotional (more emotional = 36.5%, nervous or anxious = 33.6%, sadness = 28.9%) or sleep (35.2%) symptoms. All PE teachers knew that a concussion requires immediate removal from a game/practice. PE teachers demonstrated less perceived knowledge and confidence relating to academic adjustments and return to learn criteria. Just 31.3% reported their school facilitates academic adjustments. Conclusion: Tailored concussion education addressing knowledge gaps highlighted in this study should be developed. A concussion policy and an academic support team in each school should be established and widely publicised to enhance the support of concussed students in returning to school.

Brain smart – Let's play safely: Evaluation of a concussion education program in schools

Objectives There are two objectives for this paper. First, to determine effects of a concussion education program in a local school board in terms of concussion-specific knowledge in children and confidence in identifying and managing concussion in adults. Second, to identify differences and similarities in concussion knowledge between children who participate in sports and those who do not and between children with a history of one or more concussions and those without. Design A cross sectional survey regarding concussion knowledge was distributed randomly to students and adults at both pre- and posteducation timepoints. A concussion education program was disseminated across the school board for students between the distribution survey timepoints. Following the education program, adults and students completed their respective post-test surveys. Chi-squared tests in SPSS determined the significance of between-group differences. Results All 17 adults (100.0%) who had received concussion education recently reported confidence in their knowledge of concussion management, compared to 35.7% adults who had not received education for over a year (p = 0.020). For students, all of whom completed the concussion education training between the pre- and post-tests, there were no significant differences in concussion knowledge scores between athletes and non-athletes (either in or outside of school) or between those with a history of concussion and those without. There were no significant changes in concussion knowledge between the pre- and post-tests, except for one question. Conclusion Concussion education programs increase confidence of concussion management protocols in adults involved in sport, but they require improvements to better support knowledge amelioration, particularly for target groups that are at high risk of sustaining another injury.

Association between concussion education and concussion knowledge, beliefs and behaviours among youth ice hockey parents and coaches: a cross-sectional study

ObjectivesTo examine the association between self-reported exposure to concussion education and knowledge, beliefs and self-reported behaviour among parents and coaches of youth ice hockey players.DesignCross-sectional.SettingCommunity ice hockey teams from Calgary...

Youth Soccer Parents' Attitudes and Perceptions About Concussions

PurposeParents are important figures in properly managing youth sport concussions. Although media attention has predominantly centered on concussions in contact/collision sports, evidence suggests that the concussion rate in soccer is comparable to those found in contact/collision sports. Given the high rate of concussions in youth soccer, this study aimed to examine parents of youth soccer athletes' attitudes and perceptions about concussions and associated factors. MethodsA cross-sectional study was conducted by surveying parents of youth soccer athletes from the five largest organized youth soccer programs across the U.S. The researchers developed a questionnaire after an extensive literature review and by modifying previously used instruments. ResultsOverall, 419 parents completed the survey. The vast majority (85%) agreed that a concussion is a serious injury, but only 27.9% believed that their child could suffer a concussion during the next season. Parents were most concerned about permanent brain damage when their child suffers a concussion. The vast majority (4.37 ± .89) perceived concussion reporting as an important injury prevention strategy. Greater appreciation and perceived risk about concussions was found particularly among parents who received concussion education and those who had witnessed or heard about a concussive incidence(s). ConclusionsFindings suggest that youth soccer parents have high appreciation and perceived risk about concussions. However, the need for more targeted education was noted, as improvements to better manage and reduce concussions can be made. Future research should continue examining youth sport parents' belief and understanding about concussions as well as factors affecting them.

High School Student-Athletes’ Awareness of Concussion Education May Differ by Age

Background:A tremendous amount of resources and education have been directed towards those involved in high school athletics to help recognize the signs and symptoms of a concussion and ensure removal from play of potentially concussed athletes. Concussion education policies have been broadly implemented across the country; however, the success of these educational methods at encouraging adolescents to disclose their symptoms has yet to be determined.Purpose:The purpose of this study was to (1) identify how many student-athletes recognized they had been provided concussion education and (2) document disclosure and non-disclosure patterns.Methods:An anonymous survey was distributed to student-athletes at four Connecticut high schools. The survey contained demographic questions (sex, age, primary sport, and prior history of concussion) along with a question asking if the individual had received formal concussion education. The survey then asked in which of six provided situations the athlete would disclose their symptoms and which of eight provided reasons would prevent the athlete from disclosing their symptoms. Respondents were grouped by education status (received or not) and the difference in response frequency was evaluated using Chi-Square tests.Results:A total of 872 athletes (average age 15.8±1.3 years, 410 Males, 462 Females) completed the survey (61.2% response rate). A total of 583 (66.9%) athletes reported having received concussion education. Athletes who reported that they had not received concussion education were significantly younger than athletes that reported that they had received concussion education (p=<0.001). Both the education and non-education groups identified an important game as the least likely situation to disclose symptoms, and practice as the most likely situation. The most common reason for non-disclosure was “Don’t want to miss game” in the education group and “Don’t think I have a concussion” in the non-education group. Significant differences in response rates between groups were found for ‘Don’t think I have a concussion’ (p=0.038) and ‘Others played with concussions’ (p=0.005).Conclusion:Current educational efforts may not be successfully educating younger student-athletes about the importance of recognizing and reporting concussion symptoms. Within our small cohort of Connecticut high schools, approximately 1/3 of individuals reported not receiving education, and more than half of student-athletes report that they would not disclose concussion symptoms during important games despite receiving education. Further work is required to re-evaluate the efficacy of current educational programs available to high school athletes, focusing on non-disclosure reasons reported by varying ages of student-athletes.Table 1.Status of Concussion Education and Disclosure and Non-Disclosure Patterns of High School Student Athletes Education (n=583) No Education (n=289) p-value Age (years)16.0 ± 1.315.5 ± 1.2 <0.001 Gender (Female)50.957.10.086History of Prior Concussion (yes)30.515.6 <0.001 Would tell in a… Practice79.178.5.857Important Game38.936.3.455Regular Game59.760.6.806Unimportant game77.773.6.155Early Season63.066.1.363Late in Season53.249.5.304 What is the reason you wouldn’t tell Don’t Think you have a concussion53.961.2 .038 Don’t want to let team down48.449.1.831Part of the Game12.516.6.100Not Serious Enough44.844.3.893Don’t want to miss game58.051.9.089Don’t want to disappoint parents13.214.9.500Don’t want to disappoint coach36.732.5.224Other played with concussions4.10.7 .005 All values reported as percentage (%), except for age and history of concussions.

Concussion disclosure in middle and high school youth: Who gets the message and are they trained to receive it?

Background Disclosure of concussion is vital for proper diagnosis and treatment. Youth have many stakeholders to whom they may disclose concussion, including parents, peers, coaches, and school personnel. We examined whom high school and middle school youth report concussion and the level of concussion education of the recipients of the disclosure. Methods Data were analyzed from 2362 students, 680 parents, and 150 school personnel who completed an online survey about concussion reporting, education, and training. Results Youth were most likely to disclose concussions to parents, particularly mothers, and their peer group. Middle school youth reported to teachers and school nurses at higher rates than high school youth. High school youth were more likely to disclose concussion to coaches and athletic trainers than middle school youth. While mothers were the most likely recipient of youths’ reporting, they were least likely to have received concussion education. Conclusions Recipients of youth concussion disclosure differs by school level. Parents are the most common recipients of disclosure. The role of school personnel and coaches changes as youth enter high school. Youth primarily report concussions to parents, yet parents receive the least amount of concussion training. These findings highlight the need for targeted concussion training for stakeholder groups as their role in disclosure may differ by school age.

Effects of Legislative Mandates, Education Type, and Education Provider on Concussion Education for Student Athletes

Most states in the United States have enacted legislation mandating concussion education for student-athletes; however, it is not clear if such legislation leads to all students receiving the mandated education or if this education is associated with greater awareness of concussion symptoms. This work investigates whether collegiate student-athletes report receiving legislatively-mandated concussion education, and whether this varies by gender and sport. This study also investigates what methods are being used to deliver education, who is providing the education, and if receiving education is associated with an increase in ability to name the various signs and symptoms of concussion. One hundred and fifty-seven collegiate athletes from a private Midwestern university completed anonymous surveys asking about participation in high school concussion education programs, the type of education received, and who provided it. Participants were also asked to name concussion symptoms. Despite legislative mandates, 20% of student-athletes reported not receiving concussion education in high school, with women more likely to report not receiving education relative to men. The percentage reporting not receiving legislatively-mandated concussion education did not decrease over the five year period since legislation went into effect. The most common education method reported was casual conversation, and the most common providers were athletic trainers and coaches. Athletes reporting education showed no difference in ability to name concussion signs and symptoms, compared to those who reported no education. The type of education provided and the role of the person providing the education was not associated with ability to name a cognitive or behavioral signs and symptom. Legislatively-mandated concussion education is either not being delivered to all student-athletes or is not being delivered in a manner that can be remembered and reported. Education as currently being delivered is not effective in increasing awareness of diverse cognitive and behavioral signs and symptoms of concussion.

Effect of contextual/procedure-based concussion education on community college student-athlete reporting of concussion

Various measures have been recommended to facilitate early identification of concussion including concussion education. Most commonly, concussion education is provided via lecture, video, and written materials. The extent to which these modes of concussion education result in greater self-reporting of concussion by student-athletes is unclear. This retrospective study compared student-athlete concussion reporting behaviors of participants who received traditional concussion education with those who also received a contextual/procedure-based learning approach. Sports medicine charts were reviewed for 2 groups: collegiate student-athletes (n = 301) who received concussion education in the fall semester of 2015 in a classroom setting that included lecture, hand-outs and viewing a video (Traditional Learning Group) and collegiate student-athletes (n = 271) who received traditional education in the fall 2016 semester and additionally received contextual/procedure-based learning approach (Contextual/Procedure-based Learning Group). Data was analyzed using a series of t-tests. Percent of concussions identified increased by 42% when comparing the fall 2015 Traditional Learning Group to the fall 2016 Contextual/Procedure-based Learning Group. Self-reporting of concussion by student-athletes increased 69% in the Contextual/Procedure-based Learning Group. Time to report concussion was significantly lower for participants in the Contextual/Procedure-based Learning Group, but this result was specific only to male student-athletes. This study indicates a contextual/procedural-based learning approach to concussion education may positively influence reporting and reduce time to report when compared to a more traditional lecture-based approach to concussion education.

Incidence of head injury and concussion among synchronized skaters: Rates, risks, and behaviors

Data regarding risk and rates for head injury and concussion specific to the sport of synchronized skating is absent from literature. This study differentiated team level-based rate and risk for head injury and concussion, identified behaviors to include education, baseline screening and protective equipment utilization, and the implementation of return to play protocols. An anonymous cross-sectional survey was implemented at the 2018 U.S. Synchronized Skating Championships. Participants were female members of a qualifying team, ages 13 and older, intermediate participation level and higher. The survey response rate was 42% (520/1,232). Among the survey respondents, 7% (36/520) reported head injury in the practice setting and 1% (4/520) in the competitive setting. Among respondents who reported head injury (n = 37), 68% (25/37) reported a team skill injury, with senior level reporting the highest 22% (13/75) rate. Among the sample population (n = 520), the odds of sustaining a head injury during a team skill was 2.13 times more likely than during individual skill (OR: 2.13, CI: 1.06, 4.30; p = 0.03). The odds of sustaining a head injury during practice was 9.59 times higher than in competition (OR: 9.59, CI: 3.30, 27.15; p &lt; 0.0001). Among the sample population, 36% (188/520) reported receiving concussion education during the past training year and 8% (44/520) reported hitting their head on the ice and returning to skating without seeking medical consultation. A χ2 analysis did not reveal a significant association between education and return to skating without medical consultation X2 (1, n = 520) = 0.391, p = 0.532. Baseline screening was reported among 25% (128/520) of the survey respondents. Only 0.06% (3/520) of the survey respondents reported utilizing protective headgear. Among those reporting concussion (n = 26), 92% reported receiving a return to sport/learn progression. Emphasis on concussion education and medical provider access should be targeted to team skill development in the practice setting.

Mandated High School Concussion Education and Collegiate Athletes' Understanding of Concussion.

Concussions in student-athletes are a serious problem. Most states have enacted legislation mandating concussion education for student-athletes, under the assumption that education leads to better self-reporting of concussions and improved knowledge of symptoms. (1) To determine the effect of state-based concussion legislation on the proportion of student-athletes receiving concussion education and to assess the moderation of this effect by gender and sport and (2) to assess the effect of concussion education on student-athletes' knowledge of concussion symptoms and likelihood of seeking treatment after a concussion. Cross-sectional study. Private university. A total of 249 National Association of Intercollegiate Athletics collegiate athletes attending St Xavier University; 160 were surveyed prelegislation and 89 were surveyed postlegislation. Participants completed an anonymous survey that assessed previous involvement in concussion-education programs, degree of self-reporting after a concussion, and ability to enumerate symptoms. The number of athletes who reported having received education increased after the implementation of concussion legislation; however, almost 25% still reported not having received education. Athletes who played football were more likely to report having received education than those who played volleyball. The student-athletes' ability to name a diversity of concussion symptoms or to report seeking medical attention after a concussion did not improve in the postlegislation period relative to the prelegislation period. Legislation has been passed in all 50 states to address concussions in student-athletes; however, improvements are still needed. Concussion education must be delivered in a uniform, effective manner to all student-athletes across sports and genders. Concussion education should emphasize the diversity of symptoms, especially cognitive and behavioral symptoms. We must develop and disseminate evidence-based educational programs that are clinically proven to be effective in improving athletes' knowledge and behaviors.

Racial Disparities in Concussion Knowledge and Symptom Recognition in American Adolescent Athletes.

The purpose of this study was to identify if knowledge of concussion differences exists between communities that service underserved, African-American athletes compared to white athletes, and to explore differences in concussion knowledge between African-American and white athletes with and without access to an athletic trainer. Five hundred seventy-seven adolescent athletes ranging in age from 13 to 18 from 14 schools in the USA completed a one-time pencil and paper survey instrument. Data were collected from September 2014 to April 2015. All athletes included in the study received concussion education implemented (i.e., Centers for Disease Control and Prevention (CDC) Heads UP documents) by state concussion law. Knowledge of concussion scores were determined by summing the total correct responses to the 35 questions. Race (white or African-American) and access to an athletic trainer were the independent variables explored. White high school athletes have increased concussion knowledge compared to African-American athletes (p<0.001). African-American athletes less frequently recognized all correct signs and symptoms of concussion compared to white athletes. African-American athletes with access to an athletic trainer have more knowledge than African-American athletes without access to an athletic trainer (p=0.003). White athletes had more concussion knowledge than African-American athletes; however, African-Americans that had access to an athletic trainer at their respective school were more likely to identify the signs and symptoms of concussion compared to African-Americans that did not have access to an athletic trainer. This further accentuates the health disparity that occurs in high school athletics, in regard to the presence of an athletic trainer and their influence on an athlete's health and safety.

Concussion education for student athletes: What kind? Who is providing it? Does it matter?

To determine the type of concussion training being received by student-athletes and who is providing it and to determine if there is a relationship between these factors and being able to name the diverse symptoms of concussions (physical, cognitive, behavioral). To assess how the reported rates of receiving concussion education vary by gender and sport played.

Content, Delivery, and Effectiveness of Concussion Education for US College Coaches.

The primary objective of this study was to examine the proportion of US college coaches who receive annual concussion education from their institution and to describe the content and delivery modalities of this education. This study also tested the hypothesis that coaches receiving concussion education from their institution will have greater knowledge about concussions independent of other individual and institutional characteristics. Cross-sectional online survey. US college sport. College coaches in National Collegiate Athletic Association Division I, II, and III (n = 1818). Self-reported receipt of education from institution, sex, sport coached, division of competition. Concussion identification and management knowledge. Two-thirds of coaches reported receiving informational materials about concussion from their institution. The content of the education most frequently referred to symptoms of a concussion and information about proper management of a concussion. Coaches who received educational materials from their institution were better able to identify symptoms and had more conservative responses to concussion management scenarios. Male coaches of male contact or collision teams less frequently endorsed safe or correct response as compared with female coaches of noncontact or collision teams. Not all US college coaches receive concussion education from their institution. Male Division I coaches of male contact/collision sport are a population for whom targeted educational outreach may be particularly valuable. Education for coaches, delivered by clinicians at many institutions, is an important component of ensuring that coaches are prepared to be informed partners in supporting concussion safety.

Underreporting of Concussions and Concussion-Like Symptoms in Female High School Athletes.

Underreporting of concussions and concussion-like symptoms in athletes continues to be a serious medical concern and research focus. Despite mounting worry, little evidence exists examining incidence of underreporting and documenting characteristics of head injury in female athletes participating in high school sports. This study examined the self-reporting behaviors of female high school athletes. Seventy-seven athletes participated, representing 14 high school sports. Nearly half of the athletes (31 participants) reported a suspected concussion, with 10 of the 31 athletes refraining from reporting symptoms to training staff after injury. Only 66% reported receiving concussion education. Concussion education appeared to have no relationship with diagnosed concussion rates in athletes, removing athletes from play, or follow-up medical care after injury. In conclusion, female high school athletes underreport signs and symptoms of concussions. Concussion education should occur at higher rates among female athletes to influence reporting behaviors.

Concussion reporting behaviours of community college student-athletes and limits of transferring concussion knowledge during the stress of competition.

Concussion education for student-athletes is mandated by several states and is becoming an integral component of concussion management programmes; however, little is known about student-athlete concussion knowledge and self-reporting of suspected concussion. This study explored to what extent collegiate student-athletes are knowledgeable on the topic of concussion, the relationship between having concussion knowledge and reporting behaviours, and factors contributing to not reporting when education has been provided.MethodMixed method explanatory design. The Rosenbaum Concussion Knowledge and Attitudes Survey was administered to 986 community college student-athletes from 6 sports. Follow-up qualitative interviews were conducted using purposive sampling.ResultsConcussion knowledge scores positively correlated with number of times concussion education was received, but were not associated with reporting of concussion. Of respondents with a history of concussion, 64% stated that they reported all of their concussions. The highest ranked reason given for not reporting concussion was, “I was into the game/practice and didn't realize I had a concussion at the time.” Qualitative analysis revealed physiologically related and attitudinal factors particular to competition that precluded participants’ identification and reporting of concussion.ConclusionsDespite receiving concussion education, student-athletes may not be cognizant of a possible concussion particularly during the stress of competition. Results indicate that alternate methods of providing concussion education that can affect knowledge transfer should be explored: providing education in the settings where student-athletes practice and compete, incorporating a kinaesthetic or procedural learning approach to concussion education, and addressing the social and attitudinal aspects of concussion reporting.

The Impact of Concussion Legislation on Education and Knowledge in Student Athletes

This research sought to assess if one state’s concussion legislation translated into an increase in high school athletes receiving concussion education. It also assessed whether concussion education mandated by the legislation resulted in athletes being better able to recognize the diverse symptoms of concussion and if athletes were more likely to seek treatment after experiencing a concussion.

Concussion Education for High School Football Players

This survey study compared high school football players’ knowledge and attitudes about concussion before and after receiving concussion education. There were no significant changes in the Concussion Attitude Index. Results revealed a statistically significant difference in the athletes’ scores for the Concussion Knowledge Index, t(244) = 8.49, p = .000, and Cohen’s d = 1.05. Concussion education can help football players learn signs, symptoms, and negative effects of mild brain injuries.

NCAA concussion education in ice hockey: an ineffective mandate

Background/aimDespite concussion education being increasingly mandated by states and sports leagues, there has been limited evaluation of what education is in fact effective. The National Collegiate Athletic Association (NCAA) currently...