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Abstract Background Concussions are a public health concern. Underdiagnosis and mismanagement negatively impact patients, risking in persistent symptoms and permanent disability. Objective This scoping review consolidates the heterogeneous and inconsistent concussion research and identifies key areas for medical education curriculum design to focus on for effective knowledge acquisition and bolstering competency in family physician residency. We analyze the literature on concussion education spanning various healthcare disciplines in North America. Methods PRISMA-Sc was followed and MEDLINE and EMBASE Classic + EMBASE in the OvidSP search platform were used to find terms for brain concussion AND medical education OR specific education until 2021. Results There are significant knowledge gaps about concussions, increased clinical exposure is required for competency which bolster physical examination skills and streamlined concussion guidelines are required for family medicine specialists that filter undifferentiated symptoms25% of participants improved adherence to concussion guidelines after an educational intervention and knowledge increased after concussion workshop and clinics. Conclusions Multifaceted teaching improves concussion diagnosis and management. More research is needed to examine concussion competency and, more importantly, whether these interventions improve patient outcomes.

Concussions from sport and recreational activities can negatively impact academic performance in adolescents. This study aims to use reflexive thematic analysis to understand the knowledge, management, and education of concussion among Irish postprimary educators. A cross‐sectional study that involved semistructured interviews with 18 secondary school teachers was conducted. Interviews were recorded and transcribed in preparation for a reflexive thematic analysis process according to research conducted by Braun and Clarke. A total of 664 data items were coded which led to the development of 5 themes (i.e., teacher's background experience, consequences of concussion, concussion in school, educating educators, and existing standards) and 22 subthemes. The implementation of concussion education initiatives for improving student safety, injury management, and recovery through mandatory teacher‐continued professional development should be explored. Teachers' knowledge of concussion is influenced by personal experiences, with safer attitudes observed in those who have witnessed or experienced concussions. The role of the Year Head in concussion management should be explored with a focus on communication pathways and dissemination of materials. Protocols for medical emergencies and academic adjustments for concussed students should be made readily available to secondary school teachers. Practitioner points: There is an immediate need for structured concussion education and concussion recognition protocols in the Irish secondary school system.Concussion education in the Irish secondary schools system requires coordinating within each individual school to disseminate concussion management policies.Secondary school teachers have a broad knowledge of concussion with a better understanding toward concussion if they have experienced a concussion themselves. [ABSTRACT FROM AUTHOR]

Background: Concussions are a public health concern. Underdiagnosis and mismanagement negatively impact patients, risking in persistent symptoms and permanent disability. Objective: This scoping review consolidates the heterogeneous and inconsistent concussion research and identifies key areas for medical education curriculum design to focus on for effective knowledge acquisition and bolstering competency in family physician residency. We analyze the literature on concussion education spanning various healthcare disciplines in North America. Methods: PRISMA-Sc was followed and MEDLINE and EMBASE Classic + EMBASE in the OvidSP search platform were used to find terms for brain concussion AND medical education OR specific education until 2021. Results: There are significant knowledge gaps about concussions, increased clinical exposure is required for competency which bolster physical examination skills and streamlined concussion guidelines are required for family medicine specialists that filter undifferentiated symptoms25% of participants improved adherence to concussion guidelines after an educational intervention and knowledge increased after concussion workshop and clinics. Conclusions: Multifaceted teaching improves concussion diagnosis and management. More research is needed to examine concussion competency and, more importantly, whether these interventions improve patient outcomes. [ABSTRACT FROM AUTHOR]

Concussion education for athletes is essential for informed decision making to aid recovery. Education about concussion symptoms, treatment, and protocols can improve symptom recognition, reporting behaviors, protocol compliance, and overall health outcomes. This pilot study aimed to understand current concussion knowledge, attitudes, and beliefs among female club soccer players aged 12–18 years. Findings identified gaps in concussion education and knowledge among these athletes. Continued concussion education efforts are needed to increase concussion knowledge and players' confidence, focusing on creative education practices. [ABSTRACT FROM AUTHOR]

Coaches play an important role in concussion safety, and their views on concussion influence those of their athletes and the athletes' reporting behaviors. In this 2021 survey of youth, we examined how often coaches provide concussion safety information to their athletes and the association between coaches' provision of concussion information to athletes and the presence of athletic trainers (ATs) at a team's games and practices. More than 4 in 10 youth who played sports reported that their coaches did not provide any sort of concussion education or information to them in the past 12 months. Among those youth who always or sometimes had ATs at practices or games, 76.3% received some type of coach education on concussion in the past 12 months, compared with 31.9% of those who rarely or never had ATs at practices or games (P <.0001). Increasing access to ATs and adapting current concussion training and educational materials for coaches to increase coach-athlete communication may be beneficial. [ABSTRACT FROM AUTHOR]

Concussion awareness became a priority for the Northern Sydney Local Health District as the increase in children, teenagers, and young adults with concussion, had an effect on emergency department (ED) presentations, follow-up, schooling and sports-related activities. Education in some of the local schools from the Neuroscience Clinical Nurse Consultant had been occurring, but the need far outweighed the in-person approach. Therefore, it was decided that the development of an educational concussion video for schools was required. AIM: To produce a 5-minute educational video for use in schools in the PDHPE Program / Sport sessions, that could then be broken down into shorter 1-minute versions for social media bursts. METHOD: A focus group was established and the process of devising and parenting this video took approximately 11months. It is pitched at a 12-year-old and combines animation and realistic scenes. OUTCOME: The video can be found at - https://vimeo.com/674645370 It has been sent to and accessed by schools within the Northern Sydney Local Health District and has been integrated into the NSW Education Department teacher training as a tool for teachers and students. It has been accessed throughout NSW, other Australian states and accepted for use in the New Zealand schooling system. [ABSTRACT FROM AUTHOR]

With growing concerns surrounding exposure to head impacts in youth tackle football, players and parents must understand the exposure level when assenting and consenting to participate. To determine whether youth football players and parents could estimate on-field head-impact frequency, severity, and location. Prospective cohort study. Football field. We administered a 10-question head-impact estimation tool to parents (n = 23; mean age = 36.5 years [95% CI = 31.7, 37.3 years]) and players (n = 16 boys; mean age = 11.1 years [95% CI = 10.3, 11.8 years]). Player on-field head-impact exposure was captured using the Triax SIM-G system. We determined the accuracy between player and parent estimates relative to on-field head-impact exposures using κ and weighted κ values. Youth tackle football players and parents did not accurately estimate on-field head-impact frequency (κ range = −0.09 to 0.40), severity (κ range = −0.05 to 0.34), or location (κ range = −0.30 to 0.13). Players and parents overestimated head-impact frequency in practices but underestimated the frequency in games. Both groups overestimated head-impact severity, particularly in games. Most players and parents underestimated the number of head impacts to the top of the head, particularly during practices. Underestimations of head-impact frequency in games and to the top of the head suggest that informed consent processes aimed at educating players and parents should be improved. Overestimations of head-impact frequency in practices and severity may explain declining rates of youth tackle football participation. [ABSTRACT FROM AUTHOR]

Objective: To explore patterns of postconcussion care at a level 1 trauma center. Design: Retrospective cohort study. Setting: U.S. level 1 trauma center and local satellite units. Participants: Patients of any age with a concussion diagnosis that reported to level 1 trauma center and local satellite units between 2016 and 2018 (N=2417). Intervention: Not applicable. Main Outcome Measures: Age, sex, point of entry, rehabilitation referrals, and pre-existing comorbidity diagnosis. Results: Patient age (mean [SD]) significantly differed among points of entry, from youngest to oldest: 26.0 (14.0) years in sports medicine, 29.3 (23.0) years in the emergency department, 34.6 (23.6) years at primary care providers, and 46.0 (19.7) years at specialty care departments. Sex also significantly differed among points of entry; emergency departments reported more men (55.6%), whereas the other points of entry reported more women (59.3%-65.6%). Patients were more likely to receive a referral from sports medicine (odds ratio [OR]unadjusted=75.05, P

There are limited data connecting personality and behavioral tendencies and traits related to concussion care-seeking/disclosure behaviors and minimal research exists surrounding the relationship between risky behaviors, sensation-seeking, and concussion- related outcomes. This study examined the association between sensation-seeking and a student-athlete's concussion-related knowledge, attitudes, perceived social norms, and concussion care-seeking/disclosure behaviors (intention to disclose concussion symptoms, perceived control over symptom disclosure, self-removal from play due to concussion symptoms, continued play with concussion symptoms, and disclosure of all concussions at the time of injury). The current study utilized a retrospective cohort of collegiate student-athletes at a single National Collegiate Athletic Association Division I institution. Separate multivariable linear regression models estimating mean differences (MD) and 95% Confidence Intervals (CI) estimated the association between sensation-seeking and concussion knowledge, concussion attitudes, and perceived social norms. Separate multivariable binomial regression models estimating adjusted prevalence ratios (PR) and 95%CI estimated the association between sensation- seeking and intention to disclose concussion symptoms, perceived control over symptom disclosure, self-removal from play due to concussion symptoms, continued play with concussion symptoms, and disclosure of all concussions at the time of injury. All models were adjusted for sex, sport participation, and concussion history. Higher sensation-seeking was significantly associated with less favorable concussion attitudes (adjusted MD = - 1.93; 95%CI = -3.04,-0.83), less favorable perceived social norms surrounding concussion (adjusted MD = -1.39; 95%CI = -2.06,- 0.72), and continuing to play while experiencing concussion symptoms (adjusted PR = 1.50; 95%CI = 1.10, 2.06). Studentathletes with increased sensation-seeking could be at risk for failing to disclose a concussion, decreasing athlete safety and resulting in less optimal care post-injury. Results will inform future theory-based concussion education programs which consider behavioral tendencies and traits as well as sport culture to promote concussion care-seeking/disclosure and individualized interventions based on risky behavior engagement. [ABSTRACT FROM AUTHOR]

Objective: To compare concussion knowledge between US born and internationally born collegiate student-athletes. Furthermore, to investigate whether length of time in the United States impacted concussion knowledge. Design: Survey. Setting: Preparticipation physicals at a midwestern NAIA college. Participants: Three hundred one collegiate student-athletes. Interventions: Demographic questionnaire and the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS). Main Outcome Measures: t test was used to determine whether a difference in Concussion Knowledge Index (CKI) scores exists between US born and internationally born student-athletes. A one-way analysis of variance was used to determine significance for length of time in the United States. Results: A statistically significant difference was found for CKI scores between US born (19.22 ± 2.38) and internationally born student-athletes (18.01 ± 2.57) (t = 3.895, P = 0.000). Analysis of variance demonstrated statistically significant difference for CKI scores (F 2,300 = 13.883, P = 0.001). Post hoc analysis found significant differences in CKI scores between US born (19.22 ± 2.38) and internationally born student-athletes in the United States less than 2 years (17.31 ± 2.52) (P = 0.000), and between internationally born student-athletes in the United States 2 or more years (19.15 ± 2.25) and internationally born student-athletes in the United States less than 2 years (17.31 ± 2.52) (P = 0.002). Conclusion: Among this sample, being born in the United States and length of time in the United States contribute to student-athletes' concussion knowledge. Clinical Relevance: Standardized guidelines are needed to assist health care professionals in properly educating student-athletes about concussions as the recognition and management of concussions can be affected by a student-athlete's knowledge. [ABSTRACT FROM AUTHOR]

Recent research has found substantial gaps in knowledge surrounding concussion assessment and management in various groups of Canadian healthcare professionals, including medical students, physiotherapists, chiropractic students, and family medicine physicians. The purpose of this project was to explore concussion knowledge in a sample of athletic therapy students and to use these findings to make practical pedagogical recommendations to improve concussion education. A sequential explanatory mixed-methods approach (initial questionnaire, student interviews, clinical educator interviews) was used to investigate the research question. The findings showed a large gap between theoretical knowledge and practical abilities to assess and manage concussions. Additionally, students felt less prepared to assist throughout the entire continuum of concussion care (from initial recognition to return-to-play). Based on these findings, educators should consider innovative pedagogical strategies that focus on true competence development in concussion assessment and management while bridging the gap between foundational theory and practical application/skill development. [ABSTRACT FROM AUTHOR]

Recent research has found substantial gaps in knowledge surrounding concussion assessment and management in various groups of Canadian healthcare professionals, including medical students, physiotherapists, chiropractic students, and family medicine physicians. The purpose of this project was to explore concussion knowledge in a sample of athletic therapy students and to use these findings to make practical pedagogical recommendations to improve concussion education. A sequential explanatory mixed-methods approach (initial questionnaire, student interviews, clinical educator interviews) was used to investigate the research question. The findings showed a large gap between theoretical knowledge and practical abilities to assess and manage concussions. Additionally, students felt less prepared to assist throughout the entire continuum of concussion care (from initial recognition to return-to-play). Based on these findings, educators should consider innovative pedagogical strategies that focus on true competence development in concussion assessment and management while bridging the gap between foundational theory and practical application/skill development.

Context: Concussion education and prevention programs require reliable and valid instruments to evaluate the theory, mechanisms, and outcome of these interventions Objective: To assess the psychometric properties of measures evaluating concussion education and prevention programsDesign: Descriptive epidemiological Setting: 10 NCAA-member universities Patients or Other Participants: 841 student-athletes in an RCT control group testing an ecological, peer-led concussion education program Main Outcome Measures: Instruments adapted for assessing concussion knowledge and Theory of Planned Behavior/Theory of Reasoned Action (TPB/TRA) cognitive mediators of reporting behavior (attitudes, subjective norms, perceived control, and intentions to report concussion). Participants completed measures at baseline, after one hour, and after one month Results: Internal consistency and test-retest reliability were moderate for both the concussion knowledge and cognitive mediator measures. TPB/TRA was supported subscale intercorrelation and item factor analysis in the cognitive mediator scale. Factor analysis of the concussion knowledge measure revealed subscales for physical/cognitive, psychological/affective, and non-symptoms. The intermediate TPB/TRA mediators of attitudes, norms, and perceived control predicted greater intention-to-report, which predicted increased likelihood of reporting concussion one month later.Conclusions: Measures of concussion knowledge and cognitive mediators of reporting adapted from the literature show adequate psychometric properties and support TPB/TRA application for concussion reporting behaviors. [ABSTRACT FROM AUTHOR]

To examine whether a "letter to my future self" analyzed using structural topic modeling (STM) represents a useful technique in revealing how participants integrate educational content into planned future behaviors. 453 club-sports athletes in a concussion-education randomized control study wrote two-paragraph letters describing what they hoped to remember after viewing one of three randomly assigned educational interventions. A six-topic solution revealed three topics related to the content of the education and three topics related to the participant behavioral takeaways. The content-related topics reflected the educational content viewed. The behavioral takeaway topics indicated that the Consequence-based education was more likely to generate the Concussion Seriousness[CS:23%] topic while Traditional(24%) and Consequence-based(20%) interventions were more likely to generate the Responsibility for Brain Health[BH] topic. Traditional(21%) and Revised-symptom(17%) interventions were more likely to generate the Awareness and Action topics. Unstructured user-generated data in the form of a "letter to my future self" analyzed using structural topic modeling provides a novel evaluation of the present and likely future impact of educational interventions. Patient educators can enhance the effectiveness of education through the application of these methods to the evaluation of and innovation in programs. • A "letter to their future self" reveals content and behavioral intentions produced by the education. • Structured topic modeling (STM) offers insights into the effectiveness of patient education. • STM offers qualitative insights with quantitative ease. • This method has the potential to inspire innovation in health education. • A template for the application of the method is offered. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to identify the concussion-related training and education needs of Gaelic Athletic Association (GAA) coaches in Ireland, as well as the preferred method of concussion education delivery. Methods: We used a self-report questionnaire to collect data from a convenience sample of 108 GAA coaches in Ireland. Data were captured on (1) informational needs and desires, (2) preferred methods of delivery, and (3) concussion practices and procedures. Questionnaires were completed electronically from June 3rd–September 29th, 2015. Results: Coaches indicated that they were most interested in receiving information about the (1) signs and symptoms of concussion, (2) assessment of concussion, and (3) return-to-play guidelines. Over two-thirds of participants indicated that in-person training would be the most effective mode of delivery of concussion education for this population. Additionally, only 10% coaches reported that before the start of the season they talked to their athletes about concussion management and safety, and this was more common among coaches who reported being formally educated about concussion. Conclusion: Our findings reveal a disconnect between the concussion education needs and the education that is currently provided to GAA coaches, in terms of content and delivery modality. Our results suggest a need for a multifaceted approach to concussion education, tailored to the needs and learning preferences of the target population.

Context: Concussion-symptom education remains the primary approach used by athletic trainers to address underreporting of possible sport-related concussions. Social marketing represents an untapped approach to promote concussion reporting by communicating the benefits or consequences of reporting or not reporting, respectively. Objective: To apply expectancy value theory and identify how marketing the possible consequences of concealing concussion symptoms influenced young adults' concussionreporting beliefs to increase the likelihood of reporting. Design: Randomized controlled clinical trial. Setting: Laboratory. Patients or Other Participants: A total of 468 competitive collegiate club sport athletes at a large US university who engaged in 1 of 46 sports with various levels of concussion risk. Intervention(s): Participants were randomly assigned by team to 1 of 3 conditions. The treatment condition was a socialmarketing program focused on the possible consequences of the reporting decision. The control condition was traditional concussion-symptom education based on the National Collegiate Athletic Association's publication, "Concussion: A Fact Sheet for Student-Athletes." An additional condition mirrored the traditional symptom education but included a less clinical delivery. Main Outcome Measure(s): Positive and negative beliefs regarding concussion reporting were assessed. We applied expectancy value theory, which posits that changing beliefs in the short term will produce greater reporting intentions in the long term. Results: Club sport athletes exposed to consequencebased social marketing showed higher levels of positive reporting beliefs and lower levels of negative reporting beliefs than athletes exposed to traditional or revised symptom education. We observed no differences between the traditional and revised symptom-education programs. Exposure to consequence- based marketing decreased negative beliefs about reporting (B =-0.165, P = .01) and increased positive beliefs about reporting (B = 0.165, P=.01). Conclusions: Social marketing offers athletic trainers another strategic tool for motivating athletes to report concussion symptoms by translating scientific findings into marketable statements and then communicating the benefits of reporting or the negative consequences of concealing concussion symptoms. [ABSTRACT FROM AUTHOR]

Background: Sports- and recreation-related concussions are a common injury among children. Sports officials (SOs) and athletic trainers (ATs) are integral to setting the stage for safe play and managing concussions when they occur, and significant numbers of both groups have completed the Centers for Disease Control and Prevention's HEADS UP online concussion training course. However, the utility of the course for these audiences has not been assessed. We hypothesized that sports officials' and athletic trainers' concussion-related knowledge, attitudes, and behavioral intentions will improve from pre- and post-test after completing CDC's HEADS UP online concussion training course. Method: Respondents' concussion-related knowledge, attitudes, and behavioral intentions were assessed both before and after taking the training course. Differences between pre- and post-test scores were calculated based on the Wilcoxon Signed Rank Test Z-score or McNemar's test. Effect sizes were interpreted. Results: The SOs and ATs who participated in the HEADS UP online training had a high level of concussion knowledge before taking the course: 90% or more of respondents could identify the correct response for at least seven of the 13 knowledge questions in the pre-test. Still, the course was effective at improving the respondents' knowledge about return-to-play protocols and concussion reporting. Further, SOs and ATs demonstrated improvement in their concussion-related attitudes and behavioral intentions between the pre- and post-test. Conclusion: SOs' and ATs' concussion knowledge, attitudes, and behavioral intentions improved immediately following completion of the CDC HEADS UP online training. Future research could also focus on the long-term retention of this type of training. Practical Applications: This study provides insight into how to better focus concussion-related educational programs to fit SOs' and ATs' needs. [ABSTRACT FROM AUTHOR]

Background: For 15 years, the US Centers for Disease Control and Prevention's (CDC) HEADS UP education campaign has focused on increasing awareness of concussion among children to reduce adverse outcomes from this injury. Objective: To keep pace with the rapid expansion in media coverage, research, state laws and education efforts on concussion, the CDC embarked on a comprehensive evaluation effort to assess the campaign's brand. Method: The CDC conducted a multi-step process to evaluate HEADS UP. This included surveying partner organisations and focus groups targeting key audiences. Results: The analysis demonstrated that most (70%) partner organisations have used the materials for 4 years or longer, and more than half (51%) found the materials very useful or extremely useful. Focus groups with the campaign's target audiences yielded insights and opportunities to refresh the CDC HEADS UP brand. The need for more compelling images, prevention facts and use of eye-catching colours was signalled by all the campaign's target audiences. Updates focused on the use of data visualisation, more emotionally compelling images and more engaging colours. The CDC also created a new tagline to focus on concussion prevention that encourages children and young people to think about protecting their brains from concussion so that they can have a safer future. Conclusion: This paper describes the process used to update the branding of an educational health promotion campaign in order to meet the needs of key audiences. Findings can help others working to keep their educational campaigns relevant and aligned with expanding and changing public health problems. [ABSTRACT FROM AUTHOR]

Although a base level of knowledge is needed to recognize a concussion, knowledge-focused concussion educational materials ignore multifaceted barriers to concussion reporting. We compared student-athlete concussion reporting intentions and behaviors prior to and 1 year after exposure to an intervention or control treatment. We randomly assigned 891 collegiate student-athletes from three universities (Divisions I, II, III) to either the control group (National College Athletic Association [NCAA] Concussion Fact Sheet) or intervention group (theory-based, data-driven, multimedia, simulated concussion reporting module). A final sample of 520 student-athletes (control = 253, intervention = 267, expired eligibility = 189, left university = 182) completed intentions and behaviors surveys immediately prior to and 1 year after the educational intervention, and a second survey to assess the intervention effect. We compared intentions using 2 x 2 mixed model analyses of variance (ANOVAs). Behaviors and educational intervention effect were assessed using logistic regression models (α = 0.05). The intervention group had significantly improved concussion reporting intentions at 1-year follow-up relative to the control group (p = 0.009), but had similar odds for behaviors. The intervention group had 2.42 times greater odds of rating the module as "very effective," rather than "not effective" relative to the control group (95% confidence interval [CI]: 1.10,5.33). Relative to the control group, the intervention group had significantly greater odds of responding that the concussion education "greatly improved" rather than "did not improve" their knowledge (odds ratio [OR]: 2.49, 95% CI:1.25,4.96), attitudes (OR: 2.22, 95% CI: 1.23,4.03), self-efficacy (OR: 1.95,95% CI: 1.05,3.60), and intentions (OR: 1.86,95% CI: 1.03,3.35). The intervention was more effective at targeting elements of the overall sport culture in a way that substantively improved concussion reporting. We recommend use of this intervention in combination with other evidence-based educational materials. [ABSTRACT FROM AUTHOR]

This study reports on the use of ten knowledge competencies related to the behavioral management of concussion in schools. Trainings using these competencies as learning objectives were delivered to school personnel. This aims of the use of competencies in this way are to streamline the education of key stakeholders, to establish clear roles and responsibilities for constituents and equip individuals working with students following a concussion with the relevant knowledge to optimize outcomes. The majority of participants, primarily speech language pathologists working as related service providers in the schools where the trainings occurred, judged the use of the competencies to be informative and useful to their practice both immediately following the training and at a 5-month follow-up. The greatest gains in knowledge were noted by those participants self-reporting the least amount of knowledge pre-training. Participants also ranked the perceived value and relative importance of each of the ten competencies.

Social network analysis (SNA) is a uniquely situated methodology to examine the social connections between players on a team, and how team structure may be related to self-reported team cohesion and perceived support for reporting concussion symptoms. Team belonging was positively associated with number of friend.ship ties (degree, r = .23, p < .05), intermediate ties between teammates (betweenness; r = .21, p < .05), and support from both teammates (r =.21, p < .05) and important others (r = .21, p < .05) for reporting concussion symptoms. Additionally, an SNA-derived measure of social influence, eigenvector centrality, was associated with football identity (r = .34, p <.01), and less support from important others (r = -.24, p < .05) regarding symptom reporting. Discussion focuses on why consideration of social influence dynamics may help improve concussion-related education efforts. [ABSTRACT FROM AUTHOR]

Sport-related concussion (SRC) is a growing health concern, particularly in younger, at-risk athletic populations. These injuries commonly present with a wide range of clinical signs (i.e., poor coordination, behavioral, mood changes) and symptoms (i.e., headache, dizziness, difficulty concentrating), along with neurocognitive and vestibular/ocular impairments. This review of SRCs in youth athletes focuses on individuals 5-18 years of age and includes an overview of concussion (i.e., definition, signs/symptoms, epidemiology), as well as concussion education and awareness. This is followed by a review of SRC assessment and management strategies, along with common recovery, return-to-play, and treatment approaches. Finally, suggestions are made for future research and recommendations pertaining to SRC in youth athletes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Context: Currently, significant attention is focused on improving care for patients with concussions through legislative mandates that include educational interventions. Few researchers have examined young athletes' concussion knowledge and the factors that may influence their knowledge. Objective: To use the socioecological model to examine demographic, parental, and personal factors associated with youth athletes' knowledge of concussion. Our ultimate goal is to inform the planning and implementation of youth sport concussion-related interventions. Design: Cross-sectional survey. Setting: Gymnasium and classroom. Patients or Other Participants: North Carolina and Arizona youth athletes (n = 225; age = 8 to 15 years) active in football, boys' or girls' soccer, boys' or girls' ice hockey, or boys' or girls' lacrosse in 2012-2013. Main Outcome Measure(s): Participants completed a validated, self-administered survey. The intention and belief measures were guided by the theory of planned behavior. Perceptions of concussion and intention to seek care were examined using descriptive statistics. Athletes' concussion knowledge was modeled using linear regressions and generalized estimating equations, with child demographic and personal factors and parental knowledge and attitudes about concussion as predictors. Results: Geography, sport, parental attitudes toward concussion, and athlete age were associated with athlete knowledge in the univariable analyses (P < .10). In the multivariable model, geographic location (North Carolina versus Arizona, mean difference [MD] = 2.2, 95% confidence interval [CI] = 1.1, 3.2), sport (girls' soccer versus girls' lacrosse, MD = 2.2, 95% CI = 0.7, 3.6), more favorable parental attitudes toward concussion (MD = 1.2 for a 2-standard deviation shift; 95% CI = 0.3, 2.1), and older age (>12 years, MD = 1.6; 95% CI = 0.5, 2.6) were associated with better knowledge about concussion. Conclusions: Geographic location, sport, parental attitudes about concussion, and athlete's age influenced athletes' concussion-related perceptions, indicating the need to address multiple levels of the socioecological model when targeting youth sport interventions. Parental interventions that translate to an improved culture of youth sport by improving youth athletes' perceptions and experiences are key areas for future work. [ABSTRACT FROM AUTHOR]

Context: Concussions remain misunderstood, underreported, and undiagnosed. Although most concussion symptoms resolve within 2 weeks, some patients experience persistent symptoms that adversely affect physical, emotional, social, or cognitive functioning or a combination of these. Minimal evidence delineating the effect of concussions on recently retired collegiate athletes currently exists. Objective: To examine the lived experiences of retired collegiate athletes with a history of 1 or more concussions to discern individual concussion histories, knowledge and perceptions of concussions, and postconcussion quality of life. Design: Qualitative study. Setting: Telephone interviews. Patients or Other Participants: Former National Collegiate Athletic Association Division I athletes (n=14) with a history of 1 or more concussions and retired from 1 to 5 years. Data Collection and Analysis: Fourteen semistructured telephone interviews (8 men and 6 women) were audiotaped. Interviews were transcribed and inductively analyzed by 3 athletic trainers with 34 combined years of professional experience. Themes were negotiated through consensual review. Participant checks were completed to ensure trustworthiness of the findings. Results: Participants sustained their first concussion during adolescence and often experienced difficulties transitioning back into the postconcussion academic environment. Judgments of injury severity were clearly evident in participants' knowledge and perceptions of concussions. Participants experienced an array of emotional, physical, cognitive, and social challenges during the immediate postconcussion period but did not feel their concussion history decreased their current quality of life. Conclusions: Adolescent exposure to concussions is of concern due to the risk imposed on the developing brain and the potential for adverse outcomes later in life. Although a graduated return to play is heavily emphasized in concussion management, researchers need to investigate barriers inhibiting the implementation of return-to-learn protocols. Concussion education should aim to modify indifferent attitudes toward concussive injuries. Additionally, investigators should continue to assess how a history of concussion affects quality of life in recently retired collegiate athletes. [ABSTRACT FROM AUTHOR]

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 athletic training educators are instructing athletic training students on evidence-based SRC assessment and management protocols. Objective: To examine and identify which SRC resources and management tools are being used to teach and prepare athletic training students to clinically evaluate and manage SRCs. Design: Cross-sectional study. Setting: Single Web-based survey. Patients or Other Participants: One hundred two athletic training educators. Main Outcome Measure(s): Survey questions collected education level, years of experience as an athletic trainer, sex, role within the athletic training program, and the type of athletic training program at their institution. Participants were asked which position statement or consensus statement was used to teach SRC and, finally, which SRC management tools were taught to students in regard to SRC evaluation, management, and return to play. Results: Respondents have been certified athletic trainers for an average of 17.9 ± 6.5 years and accumulated a mean of 9.9 ± 6.8 years of clinical experience before transitioning into educational roles. Among the respondents to the survey, 99% of educators are using the National Athletic Trainers' Association position statement to teach SRC. The clinical examination (100%) was the most widely taught evaluation tool among respondents. Out of all the respondents, over 80% of educators are teaching clinical use and application of the Sport Concussion Assessment Tool 3, Balance Error Scoring System, and computerized neurocognitive testing; however, only 71% are teaching the stepwise progression, and less than 30% are teaching newer tools documented in SRC literature. Conclusions: Educators are following recommended practices of teaching a multifaceted approach to SRC evaluation and management. However, instruction is lacking on the use of a stepwise return-to-play progression and newer SRC management tools that assess vestibular and ocular-motor impairment. [ABSTRACT FROM AUTHOR]

Although experts have noted that adolescent athletes should be educated about concussions to improve their safety, there is no agreement on the most effective strategy to disseminate concussion education. The purpose of this study was to develop, implement and assess a concussion education programme. More precisely, four interactive oral presentations were delivered to high school student-athletes (N = 35,Mage = 15.94,SD = 0.34) in a large urban centre. Participants completed a questionnaire at three time-points during the season to measure changes in their knowledge (CK) and attitudes (CA) of concussions, and focus group interviews were conducted following the concussion education programme. Questionnaire data revealed participants’ post-intervention CK scores were higher than their pre-intervention scores. During the focus groups, the student-athletes said they acquired CK about the role of protective equipment and symptom variability, and in terms of CA, they intended to avoid dangerous in-game collisions in the future. Our study was the first to create and deliver a concussion education intervention across multiple time-points, and to use mixed-methods in its assessment. These findings may be of interest to researchers, practitioners and stakeholders in sport who are invested in making the sport environment safer through concussion education and awareness. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Researchers have investigated different types of concussion education programs within various populations with mixed results. To date, no research has been published using the Concussion Goggles™ educational program Objective: To compare secondary school student-athletes’ knowledge about concussions before and after attending a concussion education program using the Concussion Goggles™. Design: Pre- posttest. Setting: Public secondary school. Patients or Other Participants: 41 secondary school students (14 girls soccer players, 14 boys basketball players, and 13 girls basketball players) with a mean age of 15.37 ± 1.22 years. Intervention(s): Participants completed the Concussion Goggles™ concussion educational program consisting of PowerPoint slides with 3 activities and short video segments within the presentation. Participants completed a test developed by the manufacturers of the Concussion Goggles™ educational program prior to and following the intervention to measure change in concussion knowledge. Main Outcome Measure(s): A 3-way mixed factorial analysis of variance (sport x grade level x gender) for repeated measures was utilized to determine statistical significance. Results: A statistically significant difference between the overall pretest (9.37 ± 1.20) and posttest (9.63 ± 1.04) scores was not found (p = 0.28). Repeated measures analysis did not indicate significant interaction effects for test score x grade (p = 0.18), test score x sport (p = 0.63), nor test score x grade x sport (p = 0.96). Conclusion: The Concussion Goggle™ education program did not affect participant knowledge of concussions in the posttest. In its current form, the Concussion Goggle™ program may not be an effective concussion education program.

Research has shown that exposure to a concussion definition (CD) increases self-reported concussion history (SRCH) immediately, however, no research has been performed that examines the effects of exposure to a CD on SRCH over time. Collegiate recreational student-athletes (RSAs) have limited access to monitoring and supervision by medical staff. As such, recognition of concussion symptoms and need for medical management oftentimes falls upon the RSA. The purpose of this study was to assess the effect of a novel questionnaire on the SRCH of RSAs. A two-part questionnaire was sent to RSAs participating is sports with a greater than average risk of concussion at a university in Arizona. Data from 171 RSAs were analyzed to assess the change in RSAs' suspected concussion estimates pre- and post-exposure to a CD and concussion symptom worksheet, as well as over the short-term (2.5 months). Approximately one-third of RSAs reported an increase in suspected concussion estimates immediately following exposure to the questionnaire, but the change was not maintained over the short-term. The results suggest that a single exposure to a CD is ineffective at increasing short-term SRCH estimates. [ABSTRACT FROM AUTHOR]

Objective: The goals of this study are to evaluate the effectiveness of the curriculum for youth athletes and determine long-term retention in those who have previously participated. Design: Prospective cohort study. Setting: Middle schools. Participants: 887 male and female sixth- through eighth-grade Physical Education students, ranging from ages 11 to 16 entered and 858 students finished the HSYS Program. Subjects (n = 29) were excluded if they did not complete their pre-workshop or post-workshop test. Interventions: The program is designed to be a 35–45 min workshop. Main Outcome Measures: Tests were administered before and after workshop participation to evaluate knowledge of concussion and response to head injury. Results: The aggregated pre-workshop and post-workshop mean test scores for participants from all five middle schools were 68% ± 2% and 85% ± 3%, respectively, which demonstrated significant improvement in test scores after participation in the HSYS Program (paired t-test, p

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. [ABSTRACT FROM AUTHOR]

Research has shown that exposure to a concussion definition (CD) increases self-reported concussion history (SRCH) immediately, however, no research has been performed that examines the effects of exposure to a CD on SRCH over time. Collegiate recreational student-athletes (RSAs) have limited access to monitoring and supervision by medical staff. As such, recognition of concussion symptoms and need for medical management oftentimes falls upon the RSA. The purpose of this study was to assess the effect of a novel questionnaire on the SRCH of RSAs. A two-part questionnaire was sent to RSAs participating is sports with a greater than average risk of concussion at a university in Arizona. Data from 171 RSAs were analyzed to assess the change in RSAs’ suspected concussion estimates pre- and post-exposure to a CD and concussion symptom worksheet, as well as over the short-term (2.5 months). Approximately one-third of RSAs reported an increase in suspected concussion estimates immediately following exposure to the questionnaire, but the change was not maintained over the short-term. The results suggest that a single exposure to a CD is ineffective at increasing short-term SRCH estimates.

The article discusses a study examining the effectiveness of the Sport Legacy Institute Community Educator (SLICE) curriculum on recognition and appropriate response to concussions, for student athletes. The SLICE concussions education program was conducted, which provided interactive demonstration, discussions, and case studies of athletes. Evaluation of the outcomes revealed that there was a significant improvement in the concussion knowledge quiz after the presentation.

Objective: To explore patterns of postconcussion care at a level 1 trauma center., Design: Retrospective cohort study., Setting: U.S. level 1 trauma center and local satellite units., Participants: Patients of any age with a concussion diagnosis that reported to level 1 trauma center and local satellite units between 2016 and 2018 (N=2417)., Intervention: Not applicable., Main Outcome Measures: Age, sex, point of entry, rehabilitation referrals, and pre-existing comorbidity diagnosis., Results: Patient age (mean [SD]) significantly differed among points of entry, from youngest to oldest: 26.0 (14.0) years in sports medicine, 29.3 (23.0) years in the emergency department, 34.6 (23.6) years at primary care providers, and 46.0 (19.7) years at specialty care departments. Sex also significantly differed among points of entry; emergency departments reported more men (55.6%), whereas the other points of entry reported more women (59.3%-65.6%). Patients were more likely to receive a referral from sports medicine (odds ratio [OR] unadjusted =75.05, P <.001), primary care providers (OR unadjusted =7.98, P <.001), and specialty care departments (OR unadjusted =7.62, P <.001) than from the emergency department. Women were more likely to receive a referral (OR unadjusted =1.92, P <.0001), regardless of point of entry. Lastly, patients with a preexisting comorbidity were more likely (OR adjusted =2.12, P <.001) to get a rehabilitation referral than patients without a comorbidity., Conclusions: Point of entry, age, sex, and preexisting comorbidities are associated with postconcussion care rehabilitation referral patterns. Improving concussion education dissemination across all entry points of a level 1 trauma center may standardize the postconcussion rehabilitation referral patterns, potentially improving the time to recovery from a concussion., (© 2022 The Authors.)

This study reports on the use of ten knowledge competencies related to the behavioral management of concussion in schools. Trainings using these competencies as learning objectives were delivered to school personnel. This aims of the use of competencies in this way are to streamline the education of key stakeholders, to establish clear roles and responsibilities for constituents and equip individuals working with students following a concussion with the relevant knowledge to optimize outcomes. The majority of participants, primarily speech language pathologists working as related service providers in the schools where the trainings occurred, judged the use of the competencies to be informative and useful to their practice both immediately following the training and at a 5-month follow-up. The greatest gains in knowledge were noted by those participants self-reporting the least amount of knowledge pre-training. Participants also ranked the perceived value and relative importance of each of the ten competencies., Competing Interests: Financial disclosure This work was funded through the Nebraska Department of Health and Human Services as part of Preventive Health & Health Services Block Grant for Evidence-Based Primary or Secondary Prevention Projects (#92465) awarded to P Reisher and A Maerlender. A portion of this data was presented at the International Brain Injury Association Annual Meeting in New Orleans, 2017. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.

School nurses have an integral role in managing student health concerns throughout the school day, yet little is known about their specific role in concussion management. Therefore, the purpose of this study was to explore the challenges encountered by school nurses regarding concussion management in the secondary school setting. Twenty-two school nurses employed in the secondary school setting were interviewed via phone. We analyzed the data via the consensual qualitative research paradigm. Overall, we found school nurses face consistent challenges with their role on the concussion management team, specifically related to education of school personnel, parents, and community health-care providers. Challenging topics included the inconsistency of community health-care provider recommendations and others' perceptions of school nurses' preparation and training to be important members of the concussion management team. Efforts to increase concussion education and improve communication across all stakeholders of the concussion management team should be implemented., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2018.)

Purpose: This study aims to identify the concussion-related training and education needs of Gaelic Athletic Association (GAA) coaches in Ireland, as well as the preferred method of concussion education delivery., Methods: We used a self-report questionnaire to collect data from a convenience sample of 108 GAA coaches in Ireland. Data were captured on (1) informational needs and desires, (2) preferred methods of delivery, and (3) concussion practices and procedures. Questionnaires were completed electronically from June 3rd-September 29th, 2015., Results: Coaches indicated that they were most interested in receiving information about the (1) signs and symptoms of concussion, (2) assessment of concussion, and (3) return-to-play guidelines. Over two-thirds of participants indicated that in-person training would be the most effective mode of delivery of concussion education for this population. Additionally, only 10% coaches reported that before the start of the season they talked to their athletes about concussion management and safety, and this was more common among coaches who reported being formally educated about concussion., Conclusion: Our findings reveal a disconnect between the concussion education needs and the education that is currently provided to GAA coaches, in terms of content and delivery modality. Our results suggest a need for a multifaceted approach to concussion education, tailored to the needs and learning preferences of the target population.

Beginning in 2009 with the passage of the Zackery Lystedt law in the state of Washington, all 50 states have passed concussion laws that implement a mandatory framework of care for high school and youth athletes. The structure of these laws generally shares the three primary components of the Lystedt law: (1) preseason concussion education; (2) mandatory removal from play with suspected concussion; and (3) clearance from a healthcare professional prior to return to play. These same three policy components are also found at the collegiate and professional levels of sport, either through established policy or labor contracts. This chapter explores concussion-specific legal and policy developments that currently inform concussion management practices across multiple levels of the US athletic system., (Copyright © 2018 Elsevier B.V. All rights reserved.)