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Concussion in School Athletes: FAQs

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Concussion in School Athletes: FAQs

All material Copyright © 2009 Lash & Associates Publishing/Training, Inc
This article is reprinted with the express permission of Lash & Associates as it appears on their website
By: Phil Hossler, ATC Certified Athletic Trainer ATSNJ & NATA Halls of Fame

NB: This article was originally written for parents. We present it here as it is an excellent resource to share with the parents of the kiddos you are treating.

How common is concussion?

A mild brain injury, often called a concussion, is the most common brain injury in sports. The Centers for Disease Control and Prevention estimate that there are over 300,000 concussions in the United States each year.

Is there anything to worry about?

Although the majority of concussions have no lingering effects, some concussions result in persistent long-term and even devastating disabilities. Every concussion is a brain injury and injuries need evaluation, adaptations in routine and time to heal. This is especially true in adolescents whose brain tissue has increased vulnerability when compared to that of an adult (1). Phil Hossler and Ron Savage take a unique approach to concussion in schools by addressing everyone in the athlete’s “neighborhood” including teachers, the athlete, parents, friends, the school nurse, coach, physician, and certified athletic trainer.

What should teachers do?

Teachers are often the first to notice subtle changes in the student’s ability to concentrate, remember new information and interact with classmates after a concussion. Teachers can help by being aware of the student’s need for mental rest and by making accommodations in the classroom and for homework while the athlete is still feeling the effects of a concussion. Example: Tests taken while the student still has symptoms of a concussion may affect academic achievement levels.

What can the athlete do?

The athlete usually is disappointed when faced with sitting out practice or games. The athlete may be incapable of thinking clearly after a concussion. It is important that the athlete not dismiss any changes and report any headaches, worsening vision or ringing in the ears. Example: Be honest with yourself. Your brain is too important to gamble with; when in doubt, sit out.

How can parents help?

Parents know their child better than any other person in the neighborhood. They are best suited to pick up subtle changes in a child’s behavior, problem solving and organizational skills after a concussion. Example: Parents need to know and watch for the danger signs of a blood clot forming on the brain after a concussion.

When can friends help?

The athlete’s friends are a vital source of information. They are often there when the athlete’s guard is lowered and true feelings are expressed. A friend to an athlete with an undiagnosed concussion might be the first to suspect that “something just isn’t right.” Example: Peers may be annoyed by their friend’s behavior if they aren’t aware of the signs of a concussion.

How about the school nurse?

School nurses play a very important role in monitoring the concussed athlete during recovery. They can notify teachers so that accommodations are made in the classroom. They can be the communication link between parents and school staff. Example: A student may report to the nurse’s office complaining of a headache.

What should the coach do?

Every coach should know how to recognize the signs and symptoms of a concussion and be prepared to help the athlete deal with its effects. Coaches must not ignore signs and symptoms on the field. They must help the athlete still feel “part of the team” while recovering. Example: When I asked Tim why he missed those last two passes, he didn’t remember the plays.

Should the physician be involved?

Doctors are the legal/medical guardians of the athlete’s health. They should be included in the athlete’s evaluation at an early stage of care and communicate with all parties involved to ensure the athlete’s safe return to activity. Example: Doctors should know the clinical guidelines for return-to-play decisions and use them.

What about the certified athletic trainer?

Athletic trainers who are certified by the National Athletic Trainers’ Association are gatekeepers of the athlete’s health during sports. They are first on the scene and make key decisions related to injury severity and referral. Seeing the athlete daily, speaking with parents, coaches, teachers and the school nurse ensure comprehensive care of the athlete with a concussion. Example: Always insist on safety first, participation second.


Health care professionals are learning more about the recognition and management of the physical demands and restrictions associated with concussions. However, close scrutiny, care and management do not always accompany athletes when they return to school. Academic accommodations may be needed as part of the overall management plan for student-athletes to ensure their health and to promote educational growth. Thus, an entire “neighborhood” program needs to be put into action so that all members are aware of their roles when a student athlete has a concussion. These roles are explained in the manual Getting A-Head of Concussion, Educating the student-athlete’s neighborhood by Phil Hossler and Ron Savage.


(1) Collins MW, Iverson GL, Lovell MR, McKeag DB, Norwig J, Maroon J. On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Clinical Journal of Sport Medicine 2003:13:222-229

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