When in doubt, sit it out--Concussion Awareness Campaigns

Cheerleading injuries have often made the headlines; however, few epidemiological studies that correctly use participation and exposure data have been conducted to give a detailed analysis that accurately reports injuries and provides data to minimize risk. That has now changed as Nationwide Children's Hospital conducts such studies for most high school sports, including cheerleading. These studies, along with others, highlight areas of concern--those types of injuries that statistically indicate more needs to be done to promote awareness and prevention. Concussion, a type of traumatic brain injury, is a health concern that has dominated the news for the past few years. One study reports that concussions account for 15% of injuries in high school sports. The effects of concussion injuries can be long lasting and life changing. Groups from all sports, including cheerleading, have called for better attention to concussion awareness. This has led to concussion awareness campaigns that cross all sports' boundaries. With the participation of parent groups, state athletic boards, safety groups, and medical professionals, the awareness campaigns have enabled coaches, parents, and athletes to be prepared to know signs and symptoms of concussion, danger signs of concussion, how to get help, and what to expect in return to play policies.

While I cannot give the financial costs of the various awareness campaigns or the different campaign plans launched, I can detail some of the methods used to promote awareness. After middle schooler Zackery Lystedt was severely injured in a football game, his parents, state representative Jay Rodne, and other interested groups campaigned for stricter guidelines concerning sports-related concussions. In 2009, three years after Lystedt's injury, the state of Washington (the first state to enact such a law) enacted the Zackery Lystedt Law which mandated specific concussion policies for youth and school sports. The law includes the Washington Interscholastic Activities Association in the development of educational information and policies. Since then, forty-two other states and the District of Columbia have enacted similar laws. In my home state of Alabama, the Alabama High School Athletic Association (AHSAA) has a concussion policy that requires any athlete removed from play due to suspected concussion injury cannot return to play until released by a medical doctor. The AHSAA website also has other information pertinent to concussions free to anyone.

The Centers for Disease Control and Prevention (CDC) has collaborated with over 26 groups to develop their "Heads Up:  Concussion" educational training. What makes the CDC's efforts heartening is that they have information geared toward athletes, parents, teachers, and physicians. They provide free educational material, promotional material, videos, podcasts, and radio public service announcements. They provide a free online training course for those involved in youth sports in which anyone can participate. You even get a certificate for passing the course.

The National Federation of State High School Associations (NFHS) teamed up with the CDC to provide quality information and education for coaches, parents, students, and officials on the topic of concussion safety. Their course is free and provides information on the effects of concussion injury, recognizing the signs and symptoms of concussions, protocols to follow and return to play procedures.

 The American Association of Cheerleading Coaches & Administrators (AACCA) is another one of those groups collaborating with the CDC for concussion safety awareness. AACCA offers safety training for cheer coaches online and in classroom settings. AACCA is also in the forefront in making safety guidelines and supporting research in injury prevention. AACCA joined the "Heads Up" campaign to promote concussion awareness. AACCA produced cards with adhesive backs so coaches could put these on clipboards, notebooks, etc. The card, shown at the left, gives the signs of a concussion which can be observed by a coach and the symptoms that may be reported by the athlete. The card also gives an action plan for the coach and a place to list important phone numbers that may be needed if an injury occurs. The card says, "It's better to miss one game than the whole season." These cards are distributed to coaches at summer camps, workshops, when participating in AACCA or NCSSE courses and at competitions. AACCA's website offers concussion management information and return to play protocol with downloads and additional resources hot linked to their respective pages.

The concussion awareness campaigns all have similar features that help make the campaigns relevant and useful. They appeal to several important groups--not just coaches or parents.  Much work has been done to make the individual athlete knowledgeable and responsible for his or her own safety. Athletes are given information that emphasizes the concerns related to concussions--this is a brain injury. The athlete is encouraged to report signs or symptoms of injury to responsible adults. The athlete is given information that emphasizes how harmful concussions can be--not just for now but for a lifetime--so they understand the importance of reporting how they feel. This information also encourages friends of injured athletes to talk with an adult if they suspect a concussion. Parents have an opportunity to access information that is easy to understand and not loaded with medical terms. Parents are encouraged to know the warning signs of a concussion injury and are given the steps for what to do next. Much of the information available encourages parents to find medical practitioners who are specially trained in neurology. Parents are informed of the importance of following return to play policies and the risks of additional head injuries. Coaches are given all of the information listed above and guidelines from their state associations. In states with specific concussion guidelines, coaches are required to take a concussion safety course. School teachers have been included in concussion awareness campaigns as students suffering from moderate to severe concussion may have problems with memory, reasoning, communicating, and other functions associated with school work.

All of us concerned with an athlete's safety should understand that the brain needs time to heal after a concussion. Ignoring the signs or doing too much too soon can cause more problems. The awareness campaigns have contributed much to the understanding of concussions and the importance of reporting any signs to a responsible adult. The days of joking about "he got his bell rung" are long gone. We all have a responsibility to work to keep our athletes safe. It is gratifying to see so many groups join in concussion awareness campaigns. Safer sports mean safer athletes.