A survey by C.S. Mott Children's Hospital and the University of Michigan of parents of children age 12 to 17 years playing school sports reported a surprising lack of knowledge by parents of concussion risks, although six in ten were at least somewhat worried their children will suffer a concussion while playing school sports.
The survey also found that eight in ten support a requirement that an athlete be evaluated and cleared by a doctor before being allowed to return to play sports after suffering a concussion (as is now required by law, at least at the high school level, in virtually every state).
Parent knowledge limited
- Less than one parent in ten (8%) had read or heard a lot about the risk of repeated concussions in school sports; more than one third (36%) had not heard or read anything on the topic.
- More than half of the parents surveyed did not know if their child's school had a policy about returning to sports after a concussion; only a third (36%) were aware that their child's school had such a policy.
Many worried child will suffer concussion
Despite their lack of knowledge, parents of young athletes are concerned about concussions:
- One in five (18%) are "very worried" that their children will suffer a concussion while playing sports; and
- Nearly half (45%) are "somewhat worried."
Differing views on return to play
- 16% of parents felt there should be no specific time before a young athlete could safely return to play after a concussion.
- 11% felt there should be a 3-day waiting period
- 16% said an athlete should sit out a week
- 26% viewed a two-week waiting period as appropriate
- 22% said a player should wait a month or longer before returning to sports.
Note: the latest international consensus of sports concussion experts is that every concussion is different and that there are no hard and fast rules. Studies show, however, that most athletes recover from concussion in about 7 to 10 days. A 2010 study of concussions in nine high school sports during the 2008-2009 school year (Meehan, et al. 2010) found that 83.4% of those who suffered a concussion experienced resolution of their symptoms within a week.
For more on return to play guidelines, click here.
Confidence in school's handling
- Most parents (85%) agreed that coaches and trainers would handle concussions appropriately,
- 62% of parents, however, admitted knowing parents who would have their children return to sports too soon after a concussion; and
- 50% of the parents surveyed said they knew coaches who would do the same.
Strong support for concussion policies
- 84% of parents support a rule requiring athletes to be evaluated and cleared by a doctor before returning to play after a concussion [Note: the laws of 48 states and the District of Columbia now require written clearance by a health care professional before a return to play]
- 81% favor making training of coaches about concussion risks mandatory [Note: nearly half (48%) of states with a strong concussion safety (e.g. Lystedt) law now require formal concussion training of coaches, either online or in a classroom, while another 20% of the states offer some form of optional education or have no recommendations in their laws, and the remaining 32% require coaches to receive some form of education, consisting of an information sheet or other unspecified means of conveying the information. (Tomei KL, et al. 2012]
- 71% favor a mandatory waiting period before a player is allowed to return to sports [Note: of the states with strong concussion safety laws only New Mexico mandates a minimum 7-day waiting period before a return to sports]
- 67% support a requirement that high schools have a certified athletic trainer (AT) or health professional onsite for practices and games, but disagree about how to fund such a requirement:
- 43% say the money should come from the general school budget;
- 28% think funds should come from team fundraising or user fees;
- 20% say the state or federal government should fund the AT; and
- 9% believe volunteer health professionals should be recruited.
Substantial room for improvement
The survey indicates "substantial room for improvement, particularly in the area of educating parents [about concussions]."
"The involvement of parents in guarding against repeat concussions is critical," says the survey, particularly because most concussions do not result in a loss of consciousness, symptoms may not occur until several hours or even days after the injury (delayed onset is more common among youth athletes), and the reluctance of athletes to report symptoms.
Parents thus play an important role in the recognition and treatment of concussions and should notify school and/or health care personnel if they have any concerns.
March 5, 2014 editor's note: In the first study thus far to evaluate the impact of concussion legislation on familiarity with head injury (Shenouda C, et al. 2012), researchers at the University of Washington found that, a year after enactment in Washington State of its groundbreaking Zackery Lystedt Law, 96% of respondents (parents, coaches, and other persons involved in athletics) understood that concussion were a form of traumatic brain injury, and that 90% would delay an athlete's return to play when neurological symptoms were present. Fewer individuals understood return-to-play guidelines, including the requirement of written clearance (73%), or that a parent could not clear the athlete for RTP (88%).
A second study (Chrisman SP, et al. 2014), focusing on the knowledge of high school coaches in Washington State, found that concussion knowledge was high. Nearly all coaches answered the concussion knowledge questions correctly:
- Most responded correctly that only about 10% of concussions involved loss of consciousness;
- 95.9% understood that one can get a concussion without a blow to the head
- 97.4% would not allow an athlete to keep playing if he or she had a headache after a collision
- 95.5% disagreed with returning an athlete to competition, even if symptoms were brief (<15 minutes)
- More than 95% of coaches recognized dizziness, headache, nausea or vomiting, balance problems, sensitivity to light, difficulty concentrating, drowsiness, blurry vision, seeming ‘‘in a fog,'' and memory problems as symptoms of a concussion
- About 80% also recognized irritability and difficulty sleeping.
- Coaches less commonly identified being more emotional (68.9%), nervousness or anxiety (61.2%), and sadness (52.1%) as concussive symptoms.
Chrisman SP, Schiff MA, Chung SK, Herring SA, Rivara FP. Implementation of Concussion Legislation and Extent of Concussion Education for Athletes, Parents, and Coaches in Washington State. Am J Sports Med. 2014;20(10). DOI:10.1177/0363546513519073.
Meehan W, d'Hemecourt P, Comstock D, "High School Concussions in the 2008-2009 Academic Year: Mechanism, Symptoms, and Management" Am. J. Sports. Med. 2010; 38(12): 2405-2409 (accessed December 2, 2010 at http://ajs.sagepub.com/content/38/12/2405.abstract?etoc).
Shenouda C, Hendrickson P, Davenport K, Barber J, Bell KR. The effects of concussion legislation one year later - what we have learned: a descriptive pilot survey of youth soccer player associates. PM R 2012;4:427-435
Tomei KL, Doe C, Prestigiacomo, Gandhi CD. Comparative analysis of state-level concussion legislation and review of current practices in concussion. Neurosurg Focus 2012;33(6):E11.