Perceptions of Concussion and Recovery in the Collegiate Athlete

The onus of concussion reporting is often on the athlete and research has found that many times concussions go unreported and athletes will play through symptoms. Reporting can be stigmatized in collegiate athletes due to lack of information on concussion, financial implications, or pressures from teammates, parents, coaches, or themselves. The purpose of this study was to examine collegiate athletes' perceptions of pressure, motivation, and knowledge associated with concussion and recovery. What are collegiate athletes' perceptions of concussion and recovery, return to play, and return to learn? Findings provide insight into the unique role of Occupational Therapy (OT) in the prevention, education, and recovery process. This research used phenomenological design. Inclusionary criteria included student athletes who suffered a concussion during their collegiate years. Participants were 3 actively enrolled student athletes at a Division I University, ages 22-23, all who were diagnosed with one or more concussion(s). Recruitment took place through printed information and direct person to person marketing. This qualitative research used a semi-structured interview to better understand athletes' demographic information and their perceptions of concussion and the recovery process. Transcriptions were coded in vivo and generated into 3 themes; perception of concussion, student athlete identify, and concussion protocols. Demographic results indicated all participants had at least 1 diagnosed concussion and other suspected concussions which they did not report. There was diversity in sport involvement (soccer, baseball, acrobatics) and therefore variety in typical number of head/body impacts reported on average per game/practice. It is noteworthy that with acrobatics the risk of whiplash was described as high. Reporting symptoms after head/body impact was variable and situational based on high stakes games/competitions and from lack of knowledge on what a concussion ‘felt' like. When deciding whether to report, comparisons were drawn from teammate experiences and severity of signs that correlated with diagnosed concussion. Unless visible signs existed, such as not being able to walk or blacking out, athletes would not report. If the risk of head impacts was lower, the athlete was more inclined to either continue to play and not report symptoms or return to play sooner. Recovery time for return to play varied among participants and was directly related to pressures such as time of season, year in college, upcoming games/competitions, role on the team, and symptomology. Return to learn also varied and indicators such as time of semester, upcoming exams, the desire to not fall behind in course work, and symptomology determined the amount of time a student athlete took for recovery. Results highlighted that each of the participant's athletic identity and intrinsic motivation for reporting and return to learn/play superseded symptomology. However, on the contrary, if a teammate exhibited signs of concussion, participants reported communicating immediately with a coach or athletic trainer on behalf of the teammate regardless of the situation, identifying the seriousness of the injury. Each participant reported different education on concussion prior to the start of the season but similar return to play protocols. Although protocols were individualized based on reported symptomology, no additional assessments were utilized to address client factors or performance patterns. Implications of this study can lead to further delineation for the role of OT in holistic and interprofessional concussion education, decision-making for reporting, management, and prevention with consideration for beliefs, values, and roles of the student athlete.

References

Conway, F. N., Domingues, M., Monaco, R., Lesnewich, L. M., Ray, A. E., Alderman, B. L., Todaro, S. M., Buckman, J. F. (2020). Concussion symptom underreporting among incoming National Collegiate Athletic Association division I college athletes. Clinical Journal of Sports Medicine, 30(3), 203-209. https://doi.org/10.1097/JSM.0000000000000557

Corman, S. R., Adame, B. J., Tsai, J., Ruston, S. W., Beaumont, J. S., Kamrath, J. K., Liu, Y., Posteher, K. A., Tremblay, R., van Raalte, L. J. (2019). Socioecological influences on concussion reporting by NCAA division I athletes in high-risk sports. PLOS ONE, 14(5), 1–23. https://doi.org/10.1371/journal.pone.0215424