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Impact Sensors: Frequently Asked Questions

Question: Why don't athletes report experiencing concussion symptoms? 

Answer: For a number of reasons.

Some athletes don't report because they don't know what the symptoms are, or because the concussions they have suffered adversely affect their judgment and cognition, so, even if they do know the symptoms, they don't recognize that they are experiencing them.

Unfortunately, most don't report because a deeply engrained culture in contact of contact and collision sports (dubbed by one recent study as the "culture of resistance") tells them not to; they don't report because they don't want to disappoint teammates, coaches, and parents by removing themselves from the game; or they fear losing playing time or their starting position. 

The laws of every state now mandate - at least at the high school level - that athletes with suspected concussion not only be removed from the game or practice in which they are participating, but be barred from returning to play that same day, and obtain written authorization to return to play from a health care professional with expertise in the identification, diagnosis, and management of concussion.  The laws, some experts fear, make athletes even less willing to report experiencing concussion symptoms because they know that, if they do, they will be benched (and, indeed, there is some evidence in studies that suggests just that).

Question: Why, then, isn't the answer to the chronic under-reporting of concussions to educate athletes about the symptoms of concussion and the dangers of continuing to play with such symptoms? Isn't that the law now in almost all states?

Answer: Yes, it is true that 48 of 50 states have passed laws requiring that athletes and their parents sign forms acknowledging receipt of information about concussion signs and symptoms and the dangers of continuing to play with concussion.  Unfortunately, however, recent studies suggest that education of athletes about the symptoms of concussion and the dangers of continuing to play with such symptoms has not resulted in increased reporting, with athletes continuing to resist honestly self-reporting that they are experiencing symptoms or voluntarily removing themselves from game action.

Some of the same studies suggest that athletes may be more likely to self-report if they feel safe in self-reporting, in other words, when they don't fear adverse repercussions if they report in terms of decreased playing time, losing their starting positions, or being embarrassed by the coach in front of their teammates for their lack of toughness, such as, for example, by being labeled a "wimp" (or worse).

This has led an increasing number of experts to recommend that concussion education should be as much about removing the stigma associated with reporting, changing the attitudes of players, coaches, and parents towards reporting, and creating an environment in which players feel safe about reporting symptoms, as it is about educating them about concussion signs and symptoms and the dangers of continuing to play with symptoms.

The problem is that no such programs yet exist (although this is going to be a key objective of our SmartTeams program, and our pilot program for the NCAA and Department of Defense under our Mind Matters Challenge grant), and even if were implemented on a widespread basis (which, once again, I hope will happen once we launch the full SmartTeams program in 2016), it is unclear whether such a shift in emphasis in concussion education will achieve any meaningful increase in rates of self-reporting, at least in the short term. The reason, again, is that it would not only require a paradigm shift in the "warrior" culture of contact and collision sports, but a fundamental change in a risk-taking attitude which is in virtually every adolescent's DNA.

Question: So if athletes won't report concussion symptoms, why can't we just rely on sideline personnel to watch for signs of concussion in athletes so they can be removed from play?

Answer: Relying on the observational skills of sideline personnel is not enough for a number of reasons. To begin wBrady Davis wearing Rawlings helmet with i1 Biometrics impact sensing mouthguardith, the signs of concussion are often either subtle or non-existent, so they escape detection by sideline personnel. Gone are the days when it took a player's loss of consciousness or heading to the wrong sideline or end zone to raise a red flag about possible concussion. Many escape detection by even well-trained sideline personnel. One Canadian study, for instance, found that physician observers in the stands identified concussed athletes at a rate seven times that of coaches and athletic trainers on the bench.

Add in the possibility that sideline personnel responsible for monitoring athletes for signs of concussion, such as team doctors and athletic trainers, or coaches and parent volunteers, may be away from the sideline attending to other injured athletes when a player sustains a high force blow, or, even if they are watching the field/court/rink, may miss significant impacts because they occur away from the play, and one can see why better concussion detection methods are needed. (And this assumes that there are personnel on the sideline trained in the identification of concussions. The most recent statistics from the National Athletic Training Association suggest that almost 4 out of 10 U.S. high schools still do not have access to an athletic trainer (although this statistic may be somewhat misleading, as the percentage of high school students with AT coverage is higher, perhaps as high as 70%, due to the fact that larger high schools in more densely populated states are much more likely to have one or mor athletic trainers on staff), and the likelihood that trained personnel will be present during games or practices at the youth level is low).