Study: Some coaches lack concussion awareness

Many Idaho high school football coaches are unfamiliar with the signs and symptoms of concussion and are inexperienced in managing instances of mild concussion, concludes a study by Caroline Faure, Ed.D., Idaho State University assistant professor in the Department of Sports Science and Physical Education.

Faure conducted a study to determine if Idaho high school football coaches were acting consistently with regard to experts’ recommendations when it came to managing concussion and determining when a player suffering from a concussion should return to play.

“Overall, coaches are not following experts’ recommendations,” Faure said. “This is especially true at the smaller athletic classifications. Coaches at the larger schools, at the 4A and 5A levels, seem more prepared to deal with concussion incidence, most likely because of the presence of athletic trainers at those schools.”

Faure mailed survey questionnaires about concussion to all 128 Idaho high school head football coaches and received replies from 77 (60%) of them. She completed additional follow-up interviews with a randomly selected sample of coaches, which allowed her to detail the coaches’ perceptions and methods. Her study “An Examination of the General Understanding of Idaho High School Football Coaches Relative to Concussion” is a completed Doctor of Education research dissertation, but it has not yet been submitted to a journal for peer review. It has been published on the University of Oregon Kinesiology Publications online database.

She noted that in Idaho fewer than 20 percent of schools have designated athletic trainers so at 80 percent of the schools coaches are the ones who most-often make decisions about concussion management.

Faure also said her study showed that very little training has been made available to Idaho's high school coaches, although those coaches have expressed much interest in learning about concussion. The study also documented that only 50 percent of coaches who filled out surveys said they knew how to properly fit a football helmet, even though a properly fitting football helmet is one of the best ways to prevent football-related concussions.

Faure emphasized that she not being critical of coaches, but she believes better education of coaches and athletic administrators is necessary in order to manage concussion appropriately when it does happen. She points to national statistics that show one in six high school football players will sustain a concussion at some point in their prep playing career.

“We’re not providing coaches with ample opportunities for training and education about this topic,” Faure said. “Coaches want to do the right thing, but they often don’t know

what that is because they’re relying on old information that's incorrect or inconsistent with what we know today.”

Concussion can have devastating effects on young athletes, especially, if treated incorrectly.

“Research has shown concussions sustained by high school-aged athletes take much longer to fully heal than those suffered by college-aged and older athletes because of the delicate nature of their maturing brain,” Faure said. “Functional MRI tests have shown quite clearly that a college-aged athlete who has suffered a ‘bell-ringer’ type of concussion will take about three to five days to fully heal. But with high school kids, the period necessary for the brain to fully heal will take about two weeks.”

Faure also warns that all concussions are dangerous, whether an athlete has been knocked unconscious or if he/she has suffered a milder “bell ringer.”  Until recently, Faure said many medical professionals have been leery about calling these “bell ringers” concussions. Now, she says, research shows cases of mild concussion often become the most deadly because the symptoms tend to be ignored or overlooked and players return to play too soon.  In recent years several high school football players across the nation – and even a couple here in Idaho –  have suffered catastrophic  head injuries while playing football, likely as a result of “second-impact syndrome” (SIS). Faure said this condition results after an athlete with a concussion that hasn’t fully healed returns to play too soon and then receives a second concussive blow. SIS causes rapid swelling in the brain and can potentially lead to the brain literally exploding inside the skull. Most often, SIS develops after two cases of mild concussion and is most always associated with children under the age of 19.

Athletes who sustain single or multiple concussions can also suffer from long-term effects. Post-concussion syndrome can include a wide variety of symptoms ranging from headaches to confused thinking to exhibiting a lack of ambition. The symptoms can last for weeks, months or even years. In some cases, learning disabilities also arise.

Faure said that the consensus among experts is that evidenced-based concussion assessment tools should be used to recognize and treat concussions. These tools include symptoms scale checklists and the use of baseline neurocognitive testing software. These tools can help coaches and athletic trainers manage concussion more objectively. Additional medical services may also be needed.

Without proper training and knowledge, coaches, especially those without athletic trainers and who are charged with a variety of duties, are left with anecdotal information on how to recognize and treat concussions. Faure said some coaches may still use extremely subjective information when managing concussion by asking a player if they are ready to go back into a game or by asking players if they still are suffering from head pain.“Coaches shouldn’t be basing whether a player can get back into the game again on subjective responses from players,” Faure said. “Kids want to play and they know what answers to give if it means getting back in the game. These kids just don't understand the long term consequences involved when they lie about their symptoms. That's why their coaches need to know how to make their decisions more objectively.  They need to know the consequences of returning kids to play too soon."

For more information on sports-related concussion and neurocognitive testing, visit http://www.impacttest.com.