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It’s the first junior varsity soccer game of the season. Sarah, a novice player, collides on the field, body to body with an opposing player. Sarah stumbles after she gets up and doesn’t seem to know which side of the field she should be on. As her coach, what do you do?
ACTive: Athletic Concussion Training™ can help you answer that question.
Coaches play a critical role in reducing the risks associated with concussion in young athletes. ACTive (Athletic Concussion Training using Interactive Video Education) is a FREE training that provides the information every coach — from little league to pro sports — needs to keep players safe.
Each day, youth sports coaches face situations like this in practices and games across the country. A soccer player runs into another player, a cheerleader falls doing a stunt, or a basketball player hits her head when she falls after making a shot. In many cases, the coach is responsible for deciding whether to return the youth to play, and whether follow-up medical care is needed. Unfortunately, most individuals coaching children in high school and youth sports rarely receive any type of formal training in concussion management (American Academy of Pediatrics, 2001). The presence of a team physician or certified athletic trainer on the sideline is rare, even at the high school level. Thus, the initial evaluation of any injury, including concussion, is often left to the coach.
It is estimated that 1.6–3.8 million sports and recreation-related traumatic brain injuries occur in the United States yearly (Langlois, Rutland-Brown & Wald, 2006) with the highest rates of emergency department visits for sports concussion occuring for youth ages 10 to14, followed by those ages 15 to19 (CDC, 2007). Young athletes appear to be particularly vulnerable to the effects of concussion (Buzzini & Guskiewicz, 2006; Kirkwood, Yeates & Wilson, 2006). They are more likely than college athletes to experience memory and attention problems after concussion (Field, Collins, Lovella & Maroon, 2003) and often take longer to recover. Teenagers also appear to be more prone to Second Impact Syndrome (SIS) a condition attributed to the effects of a second injury to the brain that occurs while the brain is still healing from an initial concussion (Iverson, Gaetz, Lovell & Collins, 2004). SIS results in rapid swelling of the brain and almost always results in death or severe long-term injury (McCrory & Berkovic, 1998; Ommaya, Goldsmith & Thibault, 2002). The importance of proper recognition and management of concussed young athletes cannot be over-emphasized.
Despite their lack of training, youth and high school coaches are in an important position to identify the typical behavioral and physical signs of concussion and to mitigate the risks associated with concussion in young athletes. Like the general public, coaches have misconceptions about concussion (Guilmette & Paglia, 2004). However, with adequate training, they are able to recognize signs and symptoms that may point to serious problems (McLeod, Swartz & Bay, 2007). They can also play an important role by educating their athletes about concussion and emphasizing the importance of reporting any concussion symptoms.
A new e-learning program has been specifically designed to address the knowledge gaps of youth sports coaches and empower them to make decisions regarding athletes with possible concussion. ACTive: Athletic Concussion Training™ using Interactive Video Education, is now available free of charge. Developed with funding from the National Institute of Child Health and Human Development, the 20-minute interactive training program consists of modules covering general information about youth sports concussion, as well as how to recognize and manage athletes with signs or symptoms of a possible concussion. Content for the ACTive program was based on the recommendations of the National Athletic Trainers’ Association and the International Conference on Concussion in Sport (Guskiewicz et al., 2004; McCrory et al., 2009). Specific content and design elements were modified based on input from focus groups with youth sports coaches and interviews with sports medicine physicians, pediatricians, neuropsychologists, public health professionals and certified athletic trainers, all representing a variety of athletic and community contexts.
The training emphasizes three key messages:
- When in doubt, pull them out (pull a player from a game or practice if concussion is suspected),
- Stand tall, make the call (it is the coach’s responsibility to keep players safe) and
- No play without OK (a player should not return to play until cleared by a healthcare provider).
The program uses graphics, video, and interactive quizzes that reinforce key teaching points, and includes printable reference materials on concussion management. Critical to the training are application exercises in which the user responds to sample athletic scenarios involving a possible concussion. Coaches can print a certificate of completion after completing the training.
Evaluation. Results from a randomized controlled trial with 75 youth sports coaches were reported in a recent article in the Journal of Sports Science and Coaching (Glang, Koester, Beaver, Clay & McLaughlin, 2010). Outcome measures included two standardized instruments (Guilmette et al., 2007; McLeod, Swartz, & Bay, 2007) as well as scenario-based questions designed to assess how well coaches might apply concussion management strategies on the field. Results showed that the coaches who viewed the ACTive program showed significantly greater improvement than those in the control group in their knowledge of concussion symptoms, their confidence regarding recommended actions following concussion, and their intention to take action in situations like those presented in the scenarios. Importantly, coaches rated the e-learning training as highly interesting and very easy to use. Sample comments from coaches who participated in the training include:
“The program reinforced some things I already knew, but I also learned very much and will never feel bad about making the decision to remove a player if I suspect a concussion.”
“I thought it was very informative and I downloaded the forms to keep them with me while I am at practice and games.”
“I thought the program was very user friendly. It was not too long and kept my attention. I think the longer a web based program is, the quicker to lose the attention of one who is watching and taking the course on line. This program was to the point and moved through page to page in an appropriate amount of time where you aren't on one page for too long. I loved it and will utilize the resources that you have provided with our Youth program.”
Overall, these results suggest that the ACTive training program can have a measurable impact on coaches’ understanding of how to recognize and manage athletes with signs or symptoms of sports concussion. Used in conjunction with education for athletes and the larger athletic and school community (e.g., parents, teachers, and school administrators), concussion education for coaches has the potential to minimize the risks associated with sports concussion in youth and high school athletics. It also provides an evidence-based, standardized education program for youth and high school sports coaches at a time when a number of states have passed legislation requiring coaches to receive sports concussion education.
The ACTive program was created by the Oregon Center for Applied Science, Inc., and is now available free of charge at http://activecoach.orcasinc.com. To access the program, a coach must provide a valid email address and answer a short questionnaire of demographic questions, such as location, sports and grades coached.
For more information, contact:
Click here to read the full article published in the International Journal of Sports Science and Coaching.
- American Academy of Pediatricians, (2001). AAP Policy Committee on Sports Medicine and Fitness and Committee on School Health 107 (6): 1459.
- Buzzini, S.R. and Guskiewicz, K.M. Sport-related concussion in the young athlete. Current Opinion in Pediatrics, 2006, 18, 376-382.
- Centers for Disease Control. Nonfatal Traumatic Brain Injuries from Sports and Recreation Activities--United States, 2001—2005. Morbidity and Mortality Weekly Report, 2007, 56(29); 733-737.
- Field, M., Collins, M.W., Lovell, M.R. and Maroon, J. Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. The Journal of Pediatrics, 2003, 142, 546-553.
- Guilmette, G. and Paglia, M.F. The public's misconceptions about traumatic brain survey: A follow-up survey. Archives of Clinical Neuropsychology, 2004, 19, 183-189.
- Iverson, G.L., Gaetz, M., Lovell, M.R. and Collins, M.W. Cumulative effects of concussion in amateur athletes. Brain Injury, 2004, 18(4), 1.
- Kirkwood, M.W., Yeates, K.O. and Wilson, P.E. Pediatric sport-related concussion: A review of the clinical management of an oft-neglected population. Pediatrics, 2006, 117, 1359-1371.
- Langlois, J.A., Rutland-Brown, W. and Wald, M.M. The epidemiology and impact of traumatic brain injury. Journal of Head Trauma Rehabilitation, 2006, 21, 375-378.
- McCrory, P.R. and Berkovic, S.F. Second impact syndrome. Neurology, 1998, 50(3), 677-683.
- McCrory, P., Meeuwisse, W., Johnston, K., Dvorak, J., Aubry, M., Molloy, M. and Cantu, R. Consensus statement on concussion in sport. Clinical Journal of Sport Medicine. 2009, 19(3), 185-2009
- McLeod, T.C.V., Swartz, C. and Bay, C. Sport-related concussion misunderstandings among youth coaches. Clinical Journal of Sport Medicine, 2007, 17(2), 140-142.
- Ommaya, A.K., Goldsmith, W. and Thibault, L. Biomechanics and neuropathology of adult and paediatric head injury. British Journal of Neurosurgy, 2002, 16(3), 220-242.