As a physician who has chosen the field of Neurology as my life’s
work, when it comes to concussion there are few things more important
to me than returning my patients to full and active lives, without permanent
brain damage, after they’ve suffered one. A significant part of
that commitment is a strong, unwavering desire to ensure that safe, appropriate
and effective concussion management protocol is available for all –
especially the most vulnerable among us – youth athletes. But today,
if you studied what one youth team from one city does to address concussion
and compared it to a team from another city, you might get a different
answer for each. If you performed the same study and compared virtually
any other team to one in an underserved community – the difference
would likely be striking, disturbing even. And that is a problem we cannot
afford to ignore.
While deeper research into why this crisis in concussion management consistency
occurs in underserved communities is required, there are some likely and
complicated causes. Discussing and understanding them is paramount to
developing a plan of action that can effectively address the needs of
underserved community youth teams so that their players can be well cared for.
From a practical standpoint, there is a wide range of access to medical
care and management of concussion based on existence (or lack thereof)
of trained professionals to monitor injury and provide first-responder
care. Medical staff (a team physician and/or certified athletic trainer)
may not even exist for teams in underserved communities. Teams in these
areas more often rely upon personal physicians of individual players/families
(if present), and/or emergency room staff for immediate and follow-up
medical care. This results in inconsistent and often inaccurate diagnoses
and return to play recommendations.
Financial resources available for coaches, trainers and parents to take
courses and seminars geared toward learning concussion best practices
through donated, personal or public funds are likely to be vastly different
in underserved communities. Additionally, facilities and equipment (the
field/playing surface, training room, helmets and/or other gear which
are known contributors to risk of concussion and other musculoskeletal
injury) in underserved communities are more likely in disrepair.
Coaching staff (head coaches and assistants) in underserved communities
are more likely to be volunteers and may or may not have received formal
training in recognition or injury and appropriate response/management.
Furthermore, many volunteer coaches in underserved communities have not
maintained awareness of current approaches to training and practice techniques
(limited contact days in practice, updated tackling technique drills),
or other strategies meant to mitigate the risk of concussion.
Pre-participation counseling regarding concussion risk, post-concussion
cognitive restructuring, and counseling regarding retirement from play
are evidence-based recommendations from the American Academy of Neurology.
But the risk-benefit equation and analysis may be starkly contrasted in
underserved communities where there are likely far fewer alternatives
to participation in contact/collision sports and where the promise of
a college scholarship can represent one of few opportunities for players
in particularly difficult areas to escape their environmental conditions
and attend college. Participation in organized sport and a significant
reduction in school dropout rates as a result, might also be more likely
to outweigh the risks of concussion in underserved populations than in
State-of-the-art best practices regarding concussion management include
preseason activities such as the development of a concussion plan. The
concussion plan (which includes documenting a protocol regarding philosophy
and approach to concussion, baseline testing, acute management, plans
for follow-up and return to play) is necessary at every level of participation
in sport, no matter where that participation is taking place. That necessity
is resource dependent. More recognition must be paid to formally studying
how and to what extent socioeconomics and other factors contribute to
the issue of concussion.