What You Don't Know CAN Hurt You: A Survey of High School Football Players' Knowledge about Sports-Related Concussion

Abstract

Objective: To understand what high school (HS) football players know about concussion, related symptoms, and consequences of playing when symptoms are present.

Design: Confidential survey distributed to 13 football teams in the Los Angeles area. Setting and Participants: 305 complete surveys were returned by players.

Main Outcome Measurements: Descriptive findings address (1) frequency of head injury with or without loss of consciousness (LOC); (2) who decides whether or not athletes return to play; (3) whether or not players receive education about concussion; and (4) what players know about signs/symptoms of concussion and safe return to play.

Results: >58% of players reported hitting their head during a game/practice with <1% losing consciousness. More than 60% of players reported the coach as the primary person determining whether or not the athlete can return to play during practice/games. Most players (66.4%) had no knowledge about existing guidelines for returning to play after a hit to the head. About half the respondents believed its okay to play with a headache from a previous hit, indicating confusion among players about the signs and symptoms of concussion and their meaning, and placing them at risk for second-impact syndrome.

Conclusions: High school football players have limited knowledge about concussion, associated symptoms, and steps to take if they sustain a concussion. Athletes who sustain concussions may require services from a speech-language pathologist (SLP) because of residual cognitive-communication impairments. Educational programs chartered by an SLP, and supported by administration, are needed to arm athletes and their parents with knowledge in this area to minimize the risks and prevent more serious injuries.

Key Words: concussion, loss of consciousness (LOC), symptom, mild traumatic brain injury, traumatic brain injury (TBI), and speech-language pathologist (SLP)

Introduction

The roles and responsibilities of the school-based speech-language pathologist have evolved over many years. The American Speech-Language-Hearing Association (ASHA, 2000) describes the profession of "speech therapy" as originally created for the sole purpose of treating children with articulation, fluency, and voice disorders. Over the years, changes in society, policy, and the profession as a whole, have contributed to expansion of the role of the speech-language pathologist (ASHA, 2000). For instance, society has become more linguistically and culturally diverse, and, as a result, so too has the population that speech-language pathologists (SLPs) serve. Changes in policy, such as the implementation of the Individuals with Disabilities Education Act (IDEA; 2004), expanded the populations that qualify for services to include autism and traumatic brain injury (TBI). Furthermore, research in the field of speech pathology has identified a greater breadth of knowledge and skill areas, such as the identification and treatment of cognitive-communication disorders, in which SLPs are capable of providing services (ASHA, 2000). The populations served and the associated impairments diagnosed and treated are not the only aspects that have evolved. The SLP's responsibilities have also expanded. In recent years, one "responsibility" that has received heightened attention is that of prevention. Preventing some speech-language impairments may seem more difficult than others. For example, SLPs may question whether or not they can really "prevent" a phonological disorder or "prevent" autism. SLPs may not be able to prevent them; however, they can educate parents and teachers to look for the early signs of associated impairments and teach them to seek assistance early to minimize the impact of their effect. Can SLPs truly prevent aphasia? Here again, the answer lies in educating the public about the risk factors and warning signs of stroke and other pathophysiologies that may cause aphasia. ASHA has indicated that with regards to prevention, the scope of practice for the school-based speech language pathologist "encompasses providing information on general health and maintenance [and] environmental hazard" (p. 14) and "serves an important role on the education team in addressing prevention of communication disorders" (p.14). One area of prevention in which SLPs may readily make an impact, particularly those working at the high school level, relates to the topic of sports-related concussion.