Jessica Wallace

Psychosocial Aspects of Rehabilitation in Sports

When an athlete is injured, the primary focus of the sports medicine team is to treat the physical effects of the injury. However, many injured athletes experience negative psychological responses that should also be addressed throughout the rehabilitation process. Sports medicine professions should use psychosocial skills to help decrease the negative consequences of the injury, such as fear of reinjury, anxiety, depression, and adherence to rehabilitation. These psychosocial skills include goal setting, imagery, relaxation techniques, motivation, and self-talk. This article addresses the negative consequences of injury, psychosocial skills used to aid in the rehabilitation process, and clinical implications of the psychological aspects of rehabilitation in sport.

Knowledge of Concussion and Reporting Behaviors in High School Athletes With or Without Access to an Athletic Trainer

CONTEXT Increased sport participation and sport-related concussion incidence has led to an emphasis on having an appropriate medical professional available to high school athletes. The medical professional best suited to provide medical care to high school athletes is a certified athletic trainer (AT). Access to an AT may influence the reporting of sport-related concussion in the high school athletic population; however, little is known about how the presence of an AT affects concussion knowledge, prevention, and recognition. OBJECTIVE To evaluate knowledge of concussion and reporting behaviors in high school athletes who did or did not have access to an AT. DESIGN Cross-sectional study. SETTING Survey. PATIENTS OR OTHER PARTICIPANTS A total of 438 athletes with access to an AT and 277 without access to an AT. INTERVENTION(S) A validated knowledge-of-concussion survey consisting of 83 items addressing concussion history, concussion knowledge, scenario questions, signs and symptoms of a concussion, and reasons why an athlete would not report a concussion. The independent variable was access to an AT. MAIN OUTCOME MEASURE(S) We examined the proportion of athletes who correctly identified knowledge of concussion, signs and symptoms of concussion, and reasons why high school student-athletes would not disclose a potential concussive injury by access to an AT. Frequency statistics, χ2 tests, independent t tests, and linear regression were conducted to analyze the data. RESULTS The underreporting of concussion among high school athletes was 55%. Athletes with access to an AT had more knowledge of concussion than did athletes without such access (P ≤ .001). Chi-square tests did not demonstrate a significant relationship between AT access and a higher percentage reporting concussions. CONCLUSIONS High school athletes with access to an AT had more concussion knowledge, but they did not report suspected concussions to an authority figure more frequently than athletes without access to an AT.

Does a 20 minute cognitive task increase concussion symptoms in concussed athletes

Abstract Objective: The purpose of the present study was to examine if concussion symptoms worsened immediately (i.e. 20 minutes) following performance on a scomputerized neurocognitive test. Research design: Cross-sectional study; Level of evidence, 2. Methods and procedures: A total of 165 athletes with a concussion participated in the study. Participants completed the Immediate Post-concussion Assessment and Cognitive Test (ImPACT) and Post-concussion Symptom Scale (PCSS) at baseline, 3 and 10 days post-concussion. Participants completed a second PCSS following the ImPACT test at 3 and 10 days post-injury. Main outcomes and results: Athletes with a concussion exhibited greater symptoms post-neurocognitive test 3 days post-concussion on headache (p = 0.01), nausea (p = 0.03), dizziness (p = 0.03), sadness (p = 0.005), mentally foggy (p = 0.002) and visual problems (p = 0.007). Athletes with a concussion demonstrated increased symptoms on sadness (p = 0.00) and difficulty remembering (p = 0.03) at 10 days post-injury. Athletes also demonstrated neurocognitive impairments in verbal memory (p = 0.009) and slower reaction time (p = 0.01) 10 days post-concussion and visual memory (p = 0.000) and motor processing speed (p = 0.000) impairments at 3 days post-injury. Conclusion: The current study suggests that there may be an increase in concussion symptoms following a 20-minute cognitive task. Thus, it illustrates the need for clinicians to make sure they are symptom free with both physical and cognitive testing.

Concussion Knowledge and Reporting Behavior Differences Between High School Athletes at Urban and Suburban High Schools

BACKGROUND We determined differences in knowledge of concussion and reporting behaviors of high school athletes attending urban and suburban high schools, and whether a relationship exists between underreporting and access to an athletic trainer in urban schools. METHODS High school athletes (N = 715) from 14 high schools completed a validated knowledge of concussion survey consisting of 83 questions. The independent variable was school type (urban/suburban). We examined the proportion of athletes who correctly identified signs and symptoms of concussion, knowledge of concussion and reasons why high school athletes would not disclose a potential concussive injury across school classification. Data were analyzed using descriptive, non-parametric, and inferential statistics. RESULTS Athletes attending urban schools have less concussion knowledge than athletes attending suburban schools (p < .01). Athletes attending urban schools without an athletic trainer have less knowledge than urban athletes at schools with an athletic trainer (p < .01) There was no significant relationship between reporting percentage and school type (p = .73); however, significant relationships exist between AT access at urban schools and 10 reasons for not reporting. CONCLUSION Concussion education efforts cannot be homogeneous in all communities. Education interventions must reflect the needs of each community.

Use of the stepwise progression return-to-play protocol following concussion among practicing athletic trainers

Purpose The purpose of this study was to determine whether practicing athletic trainers (ATs) were using the stepwise progression to make return-to-play (RTP) decisions after concussion and to determine what factors influenced their decision to use the stepwise progression. Methods A total of 166 ATs (response rate = 16.6%) completed a 21-item questionnaire that evaluated participant demographics, methods of concussion management, and RTP decision-making using the stepwise progression. Descriptive statistics and a logistic regression were completed to analyze data. Results Factors such as education level (p = 0.05) and number of concussions treated (p = 0.05) predicted use of the stepwise progression, whereas sex (p = 0.17), employment setting (p = 0.17), state law (p = 0.86), and years practicing (p = 0.17) did not predict whether ATs were following the stepwise progression. Conclusion The majority of the ATs from this study are employing the stepwise progression to safely return athletes to play after sustaining a concussion. This demonstrates that ATs are providing a standard of care for concussed athletes across various athletic training settings; however, having a graduate degree and treating more concussions per year are predictors of whether an AT follows all steps of the stepwise progression.

Concussion Bingo: Taking an active learning approach to concussion education with vulnerable populations

Objective: The ability of athletes in underserved communities to recognise sport-related concussion (SRC) may be complicated by the lack of a qualified professional, such as an athletic trainer, present. An active learning educational activity (Concussion Bingo) was developed to assist in SRC identification. This study examined learning outcomes following the use of this activity by athletes in two US Title I (low socioeconomic status) high schools. Design: Cross-sectional study. Setting: High school sports. Methods: Participants (n = 102 athletes) completed 10-minute SRC knowledge of concussion surveys before and after participating in a Concussion Bingo activity. The 45-question survey assessed SRC knowledge through questions about SRC signs/symptoms, general injury information relating to loss of consciousness, the injured anatomical structure, complications of multiple SRCs and premature return to play. Participants had to mark key SRC terms on a Bingo card as they appeared throughout an SRC presentation including content from published consensus/position statements. Descriptive and parametric statistics were used to analyse the data. Results: Analysis of covariance revealed significant differences between pre- and post-Concussion Bingo scores. Athletes had the greatest knowledge increase of fogginess (n = 30, 29.5%), mood changes (n = 29, 28.5%), nausea (n = 27; 26.5%) and sleep problems (n = 27, 29.5%). On questions pertaining to the injury itself, athletes had the greatest increase on ‘you have to be hit in the head to get a concussion’ (n = 51, 50%), ‘what kind of an injury is a concussion’ (n = 31, 40.2%) and a concussion only occurs if you ‘black out’ (n = 24, 23.4%). Conclusion: Concussion Bingo increased Title I high school athletes’ knowledge of SRCs, suggesting that it may be an effective active learning tool for increasing SRC knowledge.

Assessment and Management of Sport-Related Concussion Teaching Trends in Athletic Training Programs

Context: Previous research suggests that health care providers, in general, are not adequately trained in sport-related concussion (SRC) recognition and management. However, it is unclear if athlet...

Racial disparities in concussion knowledge and awareness in american adolescent athletes

Objective To examine if concussion knowledge and awareness disparities exists between underserved African American (AA) adolescent athletes and Caucasian athletes; and, if disparities exist between AAs with and without access to a full-time athletic trainer (AT). Design Cross-sectional. Setting Participants from 14 US high schools (9 within underserved, AA communities and 5 within predominantly Caucasian communities) completed a one-time paper and pencil knowledge of concussion questionnaire. Participants 577 athletes (372 AA, 205 Caucasian). All participants completed concussion education mandated by the government; participants without documentation of completion were excluded. Intervention Race and AT access were the independent variables. Outcome measures Knowledge of concussion was examined using a validated instrument that included 35 questions. Participants were instructed to identify signs and symptoms of concussion, complications of multiple concussions, and answer questions pertaining to general concussion awareness among distractors. Total knowledge was calculated by summing the number of correct answers out of 35. Scores could range from 0 to 35. Scores closer to 35 represented greater knowledge. Data were analysed with frequency statistics and independent t-tests. Knowledge score was the dependent variable; p=0.05. Main results Caucasian adolescents have greater concussion knowledge than AA adolescents (t (2, 575)=5.47, p<0.001). AA adolescents with access to an AT have more knowledge than AAs lacking access to an AT (t (2, 370)=2.58, p=0.01). Conclusions Participation of AA adolescents in concussion-risk sports, such as football, is very high; therefore, education efforts in underserved communities must address the knowledge gap and disparity of care. Competing interests None.