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Context: Concussions are a serious injury that could result in both short and long-term consequences, particularly if not recognized and managed appropriately. Concussion education has been implemented, mostly as a result of Concussion legislation. Coach and athlete concussion education has been evaluated in the literature, however the literature is scarce on parental concussion education. Purpose: To assess concussion knowledge and understanding in guardians of Georgia High School Association (GHSA) student-athletes that completed the GHSA concussion awareness form, in comparison to those that received additional concussion education. Methods: This study utilized a prospective cross-sectional descriptive research design. Participants were GHSA guardians (n=102) that were recruited during athletic events throughout the Fall 2016 athletic season. Participants completed a 34 item paper-based survey. The survey included demographic questions, concussion knowledge questions, and scenario questions to assess concussion understanding. Participants were divided into groups based upon level of concussion education they had received. Independent-t tests were calculated to evaluate differences in concussion knowledge, understanding, and overall score. A Pearson correlation examined the correlation between knowledge and understanding score. All statistical analyses were conducted using SPSS 23.0. Significance levels were set a priori at p < 0.05. Results: There was a response rate of 82%, with a sampling rate of 35%. Overall, the group that only completed the form had a mean knowledge score of 75% and mean understanding score of 82%, while the group that completed additional concussion education had a mean score of 79% for knowledge, and 84% for understanding. No statistically significant differences were found between groups on knowledge (t(100) =1.742, p=.085), understanding (t(100)=.833, p=.407), and total scores (t(100)=1.878, p=.063).The Pearson correlation revealed a non-significant weak correlation between concussion knowledge and understanding (r = .03; p = 0.76). Conclusions: Guardians of high school student-athletes displayed a moderate knowledge and understanding of concussion. Knowledge transfer techniques, such as the Knowledge to Action framework, as well as learning strategies that are geared towards adult learners may benefit this population. A multifaceted approach to concussion education should be utilized in order to most effectively reach every guardian in order to meet their educational needs. INDEX WORDS: Concussion, Education, Knowledge, Understanding, Guardians

Recent legislation in the state of Ohio now allows chiropractic physicians who possess certain credentials to both diagnose and clear young patients who have sustained concussions. Unfortunately, little if any existing research examines the knowledge and abilities of chiropractic physicians regarding the management of this condition. Therefore, the purpose of this study was to provide a general overview of chiropractic physicians' knowledge regarding the diagnosis and management of pediatric concussions. A survey was emailed to 1,344 chiropractors in the state of Ohio. Of those who were contacted, 71 completed the survey. The survey included questions regarding demographics, patient scenarios, and concussion management. Although 66.7% of chiropractors qualified to care for concussions reported the utilization of guidelines, the rate dropped to 35.2% when all respondents were included. There were statistically significant differences concerning familiarity with the Graded Symptom Checklist (p=0.001) and the Post-Concussion Symptom Scale (p=0.007). In addition, the results of a question regarding the implementation of graduated return-to-play protocols were found to be borderline significant (p=0.06).The results of the study indicated that chiropractors who possess the credentials required by law are more knowledgeable regarding concussion diagnosis and management than those who do not.

Mounting research in the field of sports concussion biomarkers has led to a greater understanding of the effects of brain injury from sports. A recent systematic review of clinical studies examining biomarkers of brain injury following sports-related concussion established that almost all studies have been published either in or after the year 2000. In an effort to prevent CTE and long-term consequences of concussion, early diagnostic and prognostic tools are becoming increasingly important; particularly in sports and in military personnel, where concussions are common occurrences. Early and tailored management of athletes following a concussion with biomarkers could provide them with the best opportunity to avoid further injury. Should blood-based biomarkers for concussion be validated and become widely available, they could have many roles. For instance, a point-of-care test could be used on the field by trained sport medicine professionals to help detect a concussion. In the clinic or hospital setting, it could be used by clinicians to determine the severity of concussion and be used to screen players for neuroimaging (CT and/or MRI) and further neuropsychological testing. Furthermore, biomarkers could have a role in monitoring progression of injury and recovery and in managing patients at high risk of repeated injury by being incorporated into guidelines for return to duty, work or sports activities. There may even be a role for biomarkers as surrogate measures of efficacy in the assessment of new treatments and therapies for concussion.

Abstract Concussion symptoms are nonspecific and may be related to other causes. Symptom scores and timeline of return to activity at many institutions are based on having no symptoms at baseline with the current measurement tools. This assumption in the diagnosis and treatment of concussions may lead to prolonged return to activity, compounded concussion symptoms, and unintended psychological and social sequelae. More baseline data is needed, especially in military academies, according to the CARE Consortium Study. During the high-stress initial training period at one mid-Atlantic military college a no-symptom baseline is unlikely for first-year students. The potential overlap of concussion and typical baseline symptoms make diagnosis and release to activity a challenge for providers. A baseline survey of first-year, non-concussed students using a standard concussion scoring tool showed that 95 % of participants were symptomatic at baseline. Stakeholders were presented the results and a policy analysis using Bardach's Eight-fold Path was performed comparing three other policy options. The policy analysis found that a narrower or less descriptive baseline description could have unintended negative impacts on clinical outcomes and provider liability. It also found that preseason baseline testing should be included for all students at the mid-Atlantic military college. Colleges, especially those in high-stress settings, should consider reevaluating baseline descriptions and testing recommendations in concussion policy to accommodate normal variations in symptomatology and provide freedom in clinical judgement.

The approach to and management of the athlete with concussion can be a challenging endeavor to physicians who care for athletes who have suffered a head injury—this group includes family physicians, pediatricians, internists, emergency medicine physicians, primary sports medicine physicians, orthopedic surgeons, neurologists, and neurosurgeons. Sometimes questions regarding the need for neurologic, psychological, or radiographic imaging can make the decision for return to play unclear. New legislation will undoubtedly increase physician visits for these athletes to return to play. Thus, the goal of this article is to review the latest guidelines regarding concussion management to help all physicians who care for athletes do so appropriately.

There has been a growing trend of local and national coverage of and interest in concussion injuries over the past 2 decades. Increasing public concern over potential catastrophic and unknown long-term effects of sports-related concussion injuries has led to an acknowledgment of the strong public health need for addressing all concussion injuries, regardless of mechanism of injury. In efforts to address this need for concussion prevention and management, both in sports and nonsports, The University of Kansas Health System initiated the interdisciplinary Center for Concussion Management program in 2012. The program was created as a virtual clinic concept and includes voluntary participation from various providers across the institution, limited budget, and space obstacles. Since its inception, the program has continued to operate as its initial design of a multidisciplinary team model outside the sole ownership of 1 department, and has expanded to include education and outreach to local and regional schools and groups.

Research has shown that exposure to a concussion definition (CD) increases self-reported concussion history (SRCH) immediately, however, no research has been performed that examines the effects of exposure to a CD on SRCH over time. Collegiate recreational student-athletes (RSAs) have limited access to monitoring and supervision by medical staff. As such, recognition of concussion symptoms and need for medical management oftentimes falls upon the RSA. The purpose of this study was to assess the effect of a novel questionnaire on the SRCH of RSAs. A two-part questionnaire was sent to RSAs participating is sports with a greater than average risk of concussion at a university in Arizona. Data from 171 RSAs were analyzed to assess the change in RSAs' suspected concussion estimates pre- and post-exposure to a CD and concussion symptom worksheet, as well as over the short-term (2.5 months). Approximately one-third of RSAs reported an increase in suspected concussion estimates immediately following exposure to the questionnaire, but the change was not maintained over the short-term. The results suggest that a single exposure to a CD is ineffective at increasing short-term SRCH estimates.

Self-reporting of concussion is essential to appropriate intervention, and failure to report concussion-like symptoms is a significant issue. In the current study we sought to investigate factors that contribute to the process of self-reporting concussion symptoms within the context of the Canadian Football League. A constructivist grounded theory methodology was adopted, employing in-depth, semi-structured interviews with ten Canadian League Football (CFL) players. We found significant complexity within the decision-making process for CFL players, when assessing whether or not to report a concussion. In the preliminary grounded theory emerging from the study, we identified two stages involving 1. pre-game preparation, and 2. assessing the impact. In addition, we determined three related processes (themes): 1. intrapersonal symptom checklists, 2. perceived pressures to play, and 3. certainty of symptoms.