(Reuters Health) - High schools across the U.S. face numerous barriers to implementing laws intended to help students recover from concussions, a small U.S. study suggests.
Researchers interviewed 64 high school athletic trainers from 26 states and the District of Columbia about challenges they encountered when trying to follow state policies designed to educate coaches and parents about concussions, remove athletes from sports during concussion recovery and ease athletes back into sports participation safely.
"Not giving the brain enough time to heal after a concussion can be dangerous," said senior study author Jingzhen Yang of Nationwide Children's Hospital in Columbus, Ohio.
"A repeat concussion that occurs before the brain heals fully from the first concussion can slow recovery and increase the individual's risk for short- and long-term health problems," Yang said by email. "If a child or teen is believed to have a concussion, they need to be removed from play immediately, and . . . only return to play or practice after obtaining permission from a healthcare professional."
Concussion education materials given by schools to athletes, coaches and parents were often loaded with jargon, lacking in active learning approaches and only available in English, the study found.
One challenge in removing students with suspected concussions from sports is that athletes may be unwilling to be sidelined or may mask symptoms to avoid it, the study found. Coaches and parents can also resist taking athletes out of competition, and many athletic trainers also noted a culture that encourages students to "tough it out" instead of leaving games.
Finding the right time to return injured athletes to practices and competitions can be tricky because many students don't have access to concussion specialists, who are in the best position to determine readiness, the study found. Students may lack insurance or live far from specialists or face other barriers to care. When they do receive care, they may not always be forthcoming with coaches about the need to remain on the sidelines when they want to get back to playing.
One limitation of the study is that researchers only looked at schools with the resources to hire athletic trainers and with written concussion policies. Barriers to implementing state concussion laws might differ at schools without athletic trainers or written policies in place, the study team notes in the Journal of Adolescent Health.
"Laws are passed with good intent but organizations like schools that are mandated to implement these laws are often not resourced to do so," said Dr. Monica Vavilala, director of the Harborview Injury Prevention and Research Center at the University of Washington, in Seattle.
"So, schools have to prioritize care needs and not all schools have athletic trainers or school nurses," Vavilala, who wasn't involved in the study, said by email. "Therefore, the students with the most serious and life-threatening conditions get more attention."
The study results underscore how crucial it is for parents of student athletes to be proactive in concussion prevention, detection and treatment, said Avinash Chandran, a brain injury researcher at the University of North Carolina at Chapel Hill who wasn't involved in the study.
Parents should talk about concussions with their children, coaches and especially with doctors, Chandran said by email.
"Conversations with their children about concussions will help emphasize the seriousness of concussions in youth sports, encourage the reporting of symptoms (as they are felt and for as long as they are felt) and subsequently minimize the risk of recurrent concussions as well as of long-term adverse outcomes following concussions," Chandran added.
SOURCE: https://bit.ly/2RE6qqV Journal of Adolescent Health, online November 19, 2019.