Athletic Trainers’ Perceived Challenges Toward Comprehensive Concussion Management in the Secondary School Setting

Abstract

Available financial and personnel resources often dictate the specifics of concussion policies and procedures in the secondary school setting. The purpose of this qualitative study was to explore athletic trainers' perceived challenges toward comprehensive concussion management in the secondary school setting. The findings indicate several challenges exist toward concussion management in the secondary school, including facility, personnel, and community resources, education levels of various stakeholders, and general perceptions of concussion and athletic trainers. It is important to identify challenges athletic trainers may face in order to develop strategies to align current concussion management procedures with current best practices.Keywords: concussion education, traumatic brain injury, return-to-play, multidisciplinary collaborationIn the United States, between 1.1-1.9 million sport-related concussions occur annually among adolescents under the age of 18, and approximately 2,800-5,000 of these concussion cases result in hospitalization. 1 Therefore, proper assessment and management of this public health concern is crucial. Current best practice guidelines suggest concussion assessment should include a multidimensional evaluation (i.e., cognition, symptoms, balance assessment, oculomotor function) both pre-and postinjury. 2,3 While the most current consensus recommendations suggest the use of baseline testing is inconclusive, 2 benefits of baseline testing not only include an opportunity to educate student-athletes about the risks associated with concussion and the importance of reporting concussion symptoms, 4 but also provide clinicians with individualized patient data that can be used for direct comparison during postinjury concussion management. 5 However, although the utility and frequency of baseline testing for student-athletes that are still maturing and developing has been argued, 6-8 researchers have reported that baseline assessment scores improve as an adolescent matures. [8][9][10][11] Therefore, if baseline testing is considered for adolescent studentathletes, it is recommended that the student-athlete complete baseline testing for a second time prior to tenth grade, 9 if not on an annual basis.Following a concussion, a multifaceted approach, similar to baseline testing, is recommended for the diagnosis and management of a concussed student-athlete. 2,3 To effectively monitor the concussed student-athlete and manage all aspects of the studentathlete's health-related quality of life, a multidisciplinary concussion management team is recommended. 12 Outside medical professionals (e.g., primary care physician, concussion specialist) and school-affiliated health care personnel (e.g., athletic trainer, school nurse) should evaluate, monitor, and track symptoms, while school personnel should monitor and track academic and emotional changes of the concussed student-athlete. In the home environment, family members should monitor symptoms, including sleep-related symptoms, as well as impose prescribed...

Lived Experiences of Adolescent Athletes Following Sport-Related Concussion

“…However, this may have been due to a lack of communication or understanding among the student-athlete and/or members of the concussion management team. 57 Regardless, it highlights one area where improved communication and postinjury education may be required to ensure that the patient, family, and medical and school personnel are on the same page.…”

School Nurses’ Perceived Challenges With Concussion Management Procedures in the Secondary School Setting

“…Our findings indicate that while concussion education has made significant strides in the last few years, improvements are still needed. Efforts should be focused on educating student–athletes, parents, school staff, and personnel, particularly in areas with less access to community resources ( Welch Bacon, Cohen, Kay, Tierney, & Valovich McLeod, 2018 ). In a recent study, Welch Bacon et al.…”

“…Efforts should be focused on educating student–athletes, parents, school staff, and personnel, particularly in areas with less access to community resources ( Welch Bacon, Cohen, Kay, Tierney, & Valovich McLeod, 2018 ). In a recent study, Welch Bacon et al. (2018) found that athletic trainers reported similar challenges with a lack of education from coaches and parents, which hindered their ability to properly manage concussions at the secondary school level.…”

“…A large focus on concussion education should also be directed toward those in the medical community, specifically in regard to standardization of care ( Feddermann-Demont, Straumann, & Dvorak, 2014 ; Valovich McLeod, Houston, & Welch, 2015 ). Previous research suggests that not all pediatric providers are using the guidelines and statements put forth by national organizations, such as the National Athletic Trainers’ Association and the American Academy of Neurology, to guide their practice and management of concussion ( Welch Bacon et al., 2018 ). If consistent recommendations are not provided by community providers, it may lead to confusion for student–athletes, parents, and other members of the concussion management team.…”

“…If consistent recommendations are not provided by community providers, it may lead to confusion for student–athletes, parents, and other members of the concussion management team. In addition, it may also lead to negative outcomes associated with returning to play prior to full recovery ( Welch Bacon et al., 2018 ). Welch Bacon et al.…”