Concussion

The NCAA Sport Science Institute empowers campus personnel with the most up-to-date information on concussion safety. While sport-related concussion is an inherent risk in all contact and collision sports, the SSI has taken a leadership role, in collaboration with multiple key stakeholders, in evaluating the impact of concussions and repetitive head impact, as well as developing groundbreaking research and best practices to mitigate the potential effects of head injuries in sport.

NCAA member schools are a critical component of these efforts. Our campuses recognize the responsibility they have to care for their student-athletes. In addition to playing rules aimed at providing a safer playing environment, member schools are required to have a concussion management plan in place. The SSI also provides resources to raise awareness of concussions among student-athletes and collaborates with more than a dozen medical associations, as well as administrators, athletic trainers and coaches, to provide detailed best practice recommendations through its NCAA Sports Medicine Handbook and through interassociation guidance and tools.  

Concussion Reporting Process Frequently Asked Questions

Q1:      Are all member schools obligated to report concussion information?

A1:      Yes. Section IX.C. of the Arrington Settlement Agreement obligates the NCAA to “create a reporting process through which member institutions will report instances of diagnosed concussions in NCAA student-athletes and their resolution.” In January 2020, all three NCAA divisions passed emergency or noncontroversial legislation (Division I Constitution 4.3.4.21;Division II Constitution 3.3.4.18; Division III Constitution 3.2.4.18) requiring an active member institution “to report all instances of diagnosed sport-related concussions in student-athletes and their resolution to the NCAA on an annual basis pursuant to policies and procedures maintained by the Committee on Competitive Safeguards and Medical Aspects of Sports.”

The legislation requires all schools to collect and report on concussions diagnosed on or after May 18, 2020, the date that is six months after the effective date of the Arrington Settlement Agreement.

Q2:      What is the reporting deadline?

A2:      Pursuant to the legislation referenced above but intending to provide schools with flexibility, the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS) has approved an annual cycle or window during which schools will report concussions. The reporting cycle runs from July 1 to June 30 of the following year, which parallels the calendar footprint of a typical academic year. Schools may report at any time during the reporting cycle, or may report several times during a cycle, but it is anticipated that most schools will elect to report late in the cycle to ensure that they have an accurate accounting of the concussions that occurred during the preceding academic year. The NCAA Sport Science Institute will provide an annual reminder to schools of the reporting requirements ahead of the June 30 deadline.

Special Note – Initial Report: NCAA legislation requires that schools  report concussions that are diagnosed from May 18, 2020 forward. As the initial 2020-21 reporting cycle does not begin until July 1, 2020, schools will be expected to report all concussions that are diagnosed from May 18, 2020 thru the date the school chooses to report prior to the end of the first annual reporting cycle on June 30, 2021. In subsequent years, schools will report those concussions occurring since the date of their last reporting.

Q3.      Where can we find the reporting portal?

A3.      The concussion reporting portal will be available on July 1, 2020. Anytime on or after that date,  the portal can be found at www.annualconcussionreporting.com  

Q4:          Who should report concussions on behalf of the institution?

A4:      Neither NCAA legislation nor the CSMAS-approved reporting process prescribes which institutional personnel must complete the report on behalf of the institution. However, it must be an individual with an institutional email address as that contact information, along with the reporter’s role at the institution, will be requested at the time of reporting. While the oversight responsibilities of the Athletics Health Care Administrator should place that individual in an advantageous position to perform this reporting function, member institutions have flexibility to designate reporting responsibility as they deem appropriate. At a minimum, it is reasonable to expect that the Athletics Health Care Administrator will, as part of his or her broader oversight responsibilities, verify that this personnel decision has been addressed.

Q5.          Can my institution contract with a third party to report on behalf of the school?

A5:          Neither the Arrington Settlement Agreement nor NCAA legislation prohibit a third-party service provider from completing the required reporting activities on behalf of a member institution. However, the reporter’s school email address will be requested as part of the reporting process. Therefore, the institution will need to assign the third party an institutional email address or identify an alternative method of properly satisfying that step in the reporting process.

Q6:          What information must be submitted as part of the report?

A6:          Pursuant to the legislation described in response to Question #1 above, the CSMAS-approved reporting process establishes that, in addition to basic demographic and contact information (e.g., name, institutional affiliation), the individual reporting on behalf of the member institution will be required to report two data points: (1) Aggregate number of student-athlete concussions diagnosed within the defined reporting period as the result of practice or competition activities related to all NCAA sports at the institution; and (2) Of the aggregate number of diagnosed concussions reported, the number that resolved within the defined reporting period. No case, sport or patient-specific information will be required as part of the reporting process.  

Q7:      How is concussion “resolution” defined?

A7:      Pursuant to the legislation referenced in question #1 above, CSMAS has determined that a concussion should be considered resolved if the student-athlete has returned to baseline by the time of reporting.

Q8:          What if the student-athlete transfers or graduates and the school isn’t certain about return to baseline?

A8:          If, for any reason, the school does not have evidence of return to baseline at the time of reporting, it should not report the concussion as resolved.

Q9:          Do we have to report all concussions that have been diagnosed in all student-athletes during the defined reporting period?

A9:      Legislation requiring reporting and referenced in question #1 above intends that schools will report all instances of diagnosed concussions sustained by NCAA student-athletes as the result of practice or competition activities related to an NCAA sport.

Q10:    How will reported information be utilized, and with whom will it be shared?

A10:    The primary purpose of this concussion reporting process is to satisfy the requirements of the Arrington Settlement Agreement and established NCAA legislation as per question #1 above. In 2014, the NCAA and U.S. Department of Defense launched the Concussion Assessment, Research and Education Consortium project (CARE). It is the largest concussion and repetitive head impact study in history and now includes over than 50,000 participants from 30 campuses across the country. The CARE research, along with the NCAA Injury Surveillance System, will continue to be leveraged as the primary sources for validated research data and information pertaining to sport-related concussion. More information about the CARE research can be found here.

Neither the Arrington Settlement Agreement nor NCAA legislation requires that the data be disclosed after reporting and, in light of the limitations around the intent and design of the reporting system, we do not anticipate that reported data will be shared with member institutions or any external parties.

Q11:    If our school participates in the CARE study or the NCAA Injury Surveillance System, will that satisfy its concussion reporting obligation?

A11:    No. Data related to CARE research, the NCAA Injury Surveillance System (ISS) and the annual concussion reporting requirement will be separately reported and maintained in separate database systems, such that a school’s participation in CARE research or the ISS will not impact or satisfy the legislative requirement to also report concussion information. Regardless of whether a school is participating in CARE or ISS, it is still separately obligated to complete the annual concussion reporting. 

Q12:    How will student-athlete privacy/confidentiality be safeguarded?

A12:    As explained in question #5 above, required data are to be reported on a deidentified, aggregated basis; and, therefore, reporting will not involve the submission or maintenance of any protected personal or health information.

Q13:    How will I know if the system was working properly and that my report was successfully submitted?

A13:    The NCAA has developed step-by-step instructions to guide reporters’ use of the reporting website. They are communicated in a separate document, which is available here. As those instructions indicate, the designated reporter will receive a confirmation email after completing the online submission. This email will include a confirmation number as well as the number of concussions and resolved concussions so that reporters can verify the accuracy of their submission. Member institutions are encouraged to retain a copy of the confirmation email on file.

Q14:    What should the person reporting do if they don’t receive an email confirming submission  of concussion information?

A14:    Members with technical issues about the concussion reporting website or process may contact the site administrator directly by phone at 855-832-4222 or email at  info@datalyscenter.org.

 

Q15:    What should I do if I have substantive, non-technical questions about the concussion reporting requirements or related legislation and/or process?

A15:    Substantive questions about the NCAA concussion reporting requirements should be directed to the NCAA Sport Science Institute at: ssi@ncaa.org

Concussion Reporting Process

The purpose of this memo is to provide membership with 1) additional information about the availability of an online platform and process that has been established to facilitate membership compliance with association-wide concussion reporting requirements; and 2) access to related educational and instructional materials.

Reminder: Section IX.C. of the Arrington Settlement Agreement obligates the NCAA to “create a reporting process through which member institutions will report instances of diagnosed concussions in NCAA student-athletes and their resolution.” In January 2020, all three NCAA divisions passed emergency or noncontroversial legislation (Division I Constitution 4.3.4.21;Division II Constitution 3.3.4.18; Division III Constitution 3.2.4.18) requiring an active member institution “to report all instances of diagnosed sport-related concussions in student-athletes and their resolution to the NCAA on an annual basis pursuant to policies and procedures maintained by the Committee on Competitive Safeguards and Medical Aspects of Sports.”

Concussion Reporting Process

CSMAS has now established those policies and procedures. A website and online reporting process have been established and will be available to the membership on July 1, 2020. The URL for that website can be found in step-by-step reporting instructions for member institutions, which can be accessed here.

NCAA legislation requires that schools report concussions that are diagnosed from May 18, 2020 forward. The initial 2020-21 reporting cycle does not begin until July 1, 2020, so schools will be expected to report all concussions that are diagnosed from May 18, 2020 thru the date the school chooses to report prior to the end of the first annual reporting cycle on June 30, 2021. In subsequent years, schools will report those concussions occurring since the date of their last reporting.

Upon successful submission of the concussion report, the individual that reports on behalf of the institution will immediately receive an email confirming that the report has been submitted. This email will also contain a confirmation number and the number of reported and resolved concussions for the purpose of checking reporting accuracy.

Frequently Asked Questions

In addition to the instructional information about the reporting process, we have developed a Frequently Asked Questions document that contains answers to anticipated membership questions related to the concussion reporting process. A copy of the concussion reporting process FAQ can be accessed here.

As always, please contact us at ssi@ncaa.org in the event you have any questions.

Concussion Reporting Process Step-by-Step Instructions

The purpose of this document is to provide step-by-step instructions that can be used by member institutions to satisfy legislated annual concussion reporting requirements (Division I Constitution 4.3.4.21; Division II Constitution 3.3.4.18; Division III Constitution 3.2.4.18).

The reporting portal will open to Association membership on July 1, 2020. The annual cycle for reporting concussions is from July 1 to June 30 of the following year. This cycle parallels the footprint of a typical academic year. Schools may report at any time during the year, but it is anticipated that most schools will elect to report late in the cycle to ensure that they have an accurate accounting of the concussions that occurred during the preceding academic year. The NCAA Sport Science Institute will provide an annual reminder to schools of the reporting requirements well ahead of the June 30 deadline.

Note: In the initial 2020-21 annual cycle, NCAA legislation requires schools to report concussions that are diagnosed from May 18, 2020 forward. As the reporting cycle does not begin until July 1, 2020, schools will be expected to report all concussions that are diagnosed from May 18, 2020 to the end of the first annual reporting cycle on June 30, 2021.

For example: a school electing to submit an initial report on June 1, 2021 will report all concussions diagnosed from May 18, 2020 until June 1, 2021. In subsequent years, schools    will report those concussions occurring since the date of their last reporting.

The school should identify one employee who will report on behalf of the school (School Reporter). While the oversight responsibilities of the Athletics Health Care Administrator should place that individual in a beneficial position to perform this reporting function, member institutions have flexibility to designate reporting responsibility as they deem appropriate. At a minimum, it is reasonable to expect that the Athletics Health Care Administrator will, as part of their broader oversight responsibilities, verify that this personnel decision has been addressed. Schools are not obligated to submit their designated school reporter to the NCAA national office as this information will be captured at the time of report (see step #2 below).

Instructions

  1. Once the reporting website opens (July 1, 2020), the School Reporter should access the website by clicking here. The initial website page will provide the School Reporter with some important preliminary information that will facilitate the reporting activity. After reviewing the preliminary information, the School Reporter will click the gold box at the bottom of the page to move forward with reporting.
  2. Clicking on the gold box will bring the School Reporter to the reporting page where the reporting process begins with  a request for basic demographic information, including the name of the School Reporter, the school for which they are reporting, as well as an institutional email address and phone number (see screen shot example below). The School Reporter should complete the information as indicated.

  3. Once the demographic information is complete, the School Reporter will move on to the second and final section at the bottom of the page, entitled “Reportable Concussion Information.” In this section, the School Reporter should input the requested concussion and resolution information and complete the “I am human” inquiry activity by following the prompts (see screen shot example below). Once complete, the School Reporter should click the “Submit Report” button.

  4. Once the report is submitted, the School Reporter will receive an email confirming that the concussion reporting process has been completed. The email will originate from the address noreply@datalyscenter.org and will include a submission confirmation number, the concussion data provided by the School Reporter, information about where to report questions, and a prompt to archive the confirmation email for future reference. Member institutions are encouraged to retain a copy of the confirmation email on file.

Members with technical issues about the concussion reporting website may contact the site administrator directly by phone at 855-832-4222 or email at  info@datalyscenter.org. Substantive questions about the NCAA concussion reporting requirements should be directed the NCAA Sport Science Institute at: ssi@ncaa.org.

2020-21 Concussion Management Updates: Frequently Asked Questions

The purpose of this Frequently Asked Questions document is to facilitate and support the efforts of NCAA member institutions to comply with applicable divisional concussion safety legislation. In early 2015, the Concussion Safety Protocol Committee created the Concussion Safety Protocol Checklist (Checklist) to encourage and support institutional compliance with industry best practices and applicable concussion legislation. Consistency with the Checklist is now specifically referenced as part of the requirements in each of the three divisional manuals. The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS) recently approved an updated version of the Checklist and, while the NCAA has, through its governance process, relaxed many of the legislative requirements related to submission and reporting deadlines in response to the impact on schools resulting from the COVID-19 pandemic, member schools still need to ensure that institutional concussion management practices are consistent with applicable legislative and policy requirements and should incorporate a thorough analysis of the recent updates to the Checklist and any other concussion-related legislative and policy changes as part of that process. Specifically, schools should carefully review and understand the most recent updates to the Checklist, and related concussion management legislation, policies and guidance, and work with applicable institutional personnel to ensure any necessary adjustments to their concussion management practices are properly and timely implemented. In this Frequently Asked Questions document we have provided responses to some of the most anticipated membership questions related to those institutional review and update activities.

Q1. Have there been any legislative or policy updates related to concussion management since 2019?

A1. Yes. While there have been no changes to Division II or III legislation related to concussion management, a portion of Division I Constitution 3.2.4.20.1 (Concussion Safety Protocol) has been updated to require that an institution's Concussion Safety Protocol must be consistent with the Checklist. In addition, all three divisions are required to comply with the Interassociation Recommendations: Preventing Catastrophic Injury and Death in Collegiate Athletes, which contain content specific to concussion management and which were unanimously endorsed by the NCAA Board of Governors and announced as Association-wide policy under the Uniform Standard of Care Procedures in the summer of 2019. A copy of those materials can be accessed here.

Q2. Has the Checklist been updated since 2019?

A2. Yes. CSMAS approved updates to the Checklist at its most recent committee meeting in March of this year. These changes became effective immediately upon approval.

Q3. How is the Checklist updated?

A3. The NCAA Board of Governors designated CSMAS to prescribe the process and format recommendations related to applicable concussion legislation. The Concussion Safety Advisory Group (CSAG) was created by CSMAS for the purposes of providing focused review and advice around emerging developments in concussion science and policy, including those that may warrant an update to the Checklist and related policy and educational materials. CSAG meets annually in the spring to review and discuss available research data and accepted industry practices and how they may impact Checklist content. At its March 2020 meeting and based on input from the CSAG, CSMAS approved several substantive changes to the Checklist.

Q4. How do I know what has changed with the Checklist?

A4. The updated version of the Checklist can be accessed here. All updated content has been highlighted so that changes from the previous version can be easily identified.

Q5. Aside from the legislative and policy updates described in Item Q1 above and the updates to the Checklist, are there any other legislative or policy requirements related to concussion management that we should review or be aware of?

A5. Yes. While certain details of applicable concussion legislation vary depending on division, and each school should carefully review all legislative and policy requirements related to concussion management, all three divisions require that the following provisions be included as part of a school’s concussion management plan:

  • An annual process that ensures student-athletes are educated about the signs and symptoms of concussions. Student-athletes must acknowledge that they have received information about the signs and symptoms of concussions and that they have a responsibility to report concussion-related injuries and illnesses to a medical staff member;
  • A process that ensures a student-athlete who exhibits signs, symptoms or behaviors consistent with a concussion shall be removed from athletics activities (e.g., competition, practice, conditioning sessions) and evaluated by a medical staff member (e.g., sports medicine staff, team physician) with experience in the evaluation and management of concussions;
  • A policy that precludes a student-athlete diagnosed with a concussion from returning to athletics activity (e.g., competition, practice, conditioning sessions) for at least the remainder of that day; and
  • A policy that requires medical clearance for a student-athlete diagnosed with a concussion to return to athletics activity (e.g., competition, practice, conditioning sessions) as determined by a physician (e.g., team physician) or the physician’s designee.

Q6. Who is responsible for assuring the implementation of applicable concussion management updates at my institution?

A6. Independent Medical Care legislation in all three divisions requires the designation of an Athletics Health Care Administrator (AHCA) who independently oversees the administration and delivery of athletics health care on behalf of the institution. While we anticipate that the creation and implementation of any necessary concussion management changes and practices may require input from a variety of institutional medical and other personnel, it is reasonable to consider these activities as part of the broader administration and delivery of health care at each institution.

Q7. What is the NCAA Concussion Protocol Template and why was it created?

A7. To facilitate and support member compliance with concussion legislation, CSMAS approved a Concussion Safety Protocol Template (Template) that includes all components of the Checklist. The Template is available for download in Microsoft Word format and allows schools to individualize certain areas of the document and to otherwise modify the Template to accommodate and reflect individual needs and practices.

Q8. Which institutions can access and use the Template?

A8. The Template is available to every NCAA member institution and may be utilized by institutional staff as an educational and compliance tool.

Q9. Where can I find a copy of the Template and does it reflect the most recent Checklist updates?

A9. Yes. We have revised the Template to reflect the most recent changes to the Checklist and the updated version of the Template can be accessed here. All updated content has been highlighted so that changes from the previous version can be easily identified.

Q10. Will there be Checklist changes in the future?

A10. The NCAA Sport Science Institute (SSI) will continue to work with CSMAS and the corresponding CSAG at least annually to identify and review information that may inform recommendations about future Checklist changes.

Q11. How does the Checklist and other legislative and policy requirements relate to the certification requirement arising from the Arrington settlement?

A11. While many of the member obligations in Section IX.A of the Settlement Agreement are similar to or overlap with certain existing NCAA health and safety legislation, policies and guidance materials, each set of obligations is distinct from and, in some instances, different from the other. Compliance with one set of obligations should not be deemed to automatically or entirely satisfy compliance with the other. Therefore, it is important to consult with school legal counsel and other risk management staff as necessary to fully understand these differences and to evaluate your institutional practices and compliance with respect to the member obligations as they relate to the Arrington matter and applicable NCAA legislation, policy and guidance. Additional detailed information about institutional obligations related to the Arrington matter, and the differences between those and NCAA legislative requirements, has been provided to all member institutions by email in the form of two Frequently Asked Questions documents, which can be found here.

Q12. I have a question not covered here. Who can I contact?

A12. If you have reviewed the content of this FAQ and cannot find the answer, please email the Sport Science Institute at: ssi@ncaa.org.

Additional Considerations for Division I Schools

Q13. Are Division I autonomy schools still required to submit a concussion management protocol for review by the Concussion Safety Protocol Committee?

A13. No, not at this time. As part of a broader effort to provide support and flexibility to member institutions impacted by the COVID-19 pandemic, the NCAA Division I Council Coordination Committee decided to waive reporting and submission deadlines identified in Constitution 3 for active Division I member institutions, as needed (e.g., sports sponsorship and demographic form, health and safety survey, concussion safety protocol). The waiver effectively removed the obligation of Division I autonomy schools under Constitution 3.2.4.20.1 to submit concussion management protocols for review by the Concussion Safety Protocol Committee by May 1 of this year. This information was sent to impacted member schools by email late last month stating that institutions may work with NCAA staff to establish appropriately revised deadlines. However, due to the continued uncertainty around the timing of return to campus activities and the recognition that these timelines will likely vary from institution to institution, a new protocol submission deadline has not been identified at this time. If a new 2020-21 submission deadline is established, we will communicate that information to impacted institutions well ahead of time.

Q14. If the May 1 protocol submission deadline has been waived, what is the new deadline for Division I autonomy schools to submit their institutional protocols for review?

A14. The 2020 submission deadline has been waived. Due to the uncertainty around the timing of return to campus activities and the recognition that these timelines will likely vary from institution to institution, a new protocol submission deadline has not been identified at this time. If a new submission 2020-21 deadline is established, we will communicate that information to impacted institutions well ahead of time.

Q15. Can my institution utilize the Template that was created to conform to the updated Checklist?

A15. Yes. The Template may be used by every NCAA member institution as an educational and compliance tool.

Q16. My institution submitted its protocol last year for review and the Concussion Safety Review Committee confirmed that it was consistent with the Checklist. Do we need to do anything this year?

A16. Division I Constitution 3.2.4.20.1 (Concussion Safety Protocol) has been updated to require that an institution's Concussion Safety Protocol must be consistent with the Checklist. Because the 2020 Checklist includes material updates, you should carefully review these changes and other relevant legislative and policy requirements and work with applicable institutional medical and other staff to identify and incorporate any necessary adjustments to your concussion management protocol and practices.

Q17. I understand that the May 1 submission deadline has been waived; but can we still submit our updated concussion protocol to the Concussion Safety Protocol Committee for review and feedback?

A17. No. Due to the travel and other resource restrictions and impacts resulting from the COVID-19 pandemic, neither the Concussion Safety Protocol Committee nor its designated subcommittee that has historically reviewed Division I non-autonomy opt in submissions will be convening for or conducting protocol review activities at this time. However, the NCAA SSI staff is committed to providing membership with all of the tools and information necessary to identify applicable updates to concussion management practices resulting from the recent Checklist changes and will work, in conjunction with CSMAS as applicable, to respond to all membership questions on the topic. Specific questions about the Checklist or the recent updates should be directed to ssi@ncaa.org.

Q18. I understand that the protocol submission deadline has been waived. Do we still need to sign the annual Compliance Certification Form?

A18. Yes. Division I Constitution 3.2.4.20.1-(g) requires that a written certificate of compliance signed by the institution’s AHCA be included in the institution’s concussion safety protocol. We recommend that the signed form is kept on file in the office of the institution’s AHCA along with a current copy of the concussion safety protocol and other concussion management materials.

Q19. Is there a specific Compliance Certification Form that my AHCA needs to use to meet the legislative requirement?

A19. No. However, to facilitate and support member compliance with this requirement, the NCAA has developed a standard Compliance Certification Form. A blank copy of the form can be accessed here. We recommend that your AHCA print, sign and keep the form on file in his or her office along with a current copy of the concussion safety protocol and other concussion management materials.

Q20. How do I know if my institutional protocol was reviewed as part of the 2019 process and whether we received any related feedback?

A20. If your institution participated in the 2019 Concussion Safety Protocol Review Process, feedback would have been provided in the form of a letter addressed to your institution's athletics director, AHCA, conference commissioner and senior compliance administrator. Any inconsistencies between your protocol and the then current version Checklist would have been identified and described as part of that feedback communication. If you are unable to locate a copy of this communication and are unsure of your 2019 submission or review status, you can request that information by emailing ssi@ncaa.org.

Mind Matters Research Challenge findings

In January 2016, nine schools selected from a field of 22 finalists, each received $400,000 research grants to fund projects designed to improve the understanding of how to spur changes in the culture surrounding concussion in target communities, including student-athletes and military populations.

The schools have used those funds to produce dozens of research papers that, taken together, mark an important step toward that goal. A brief review of the research and their findings to date, and links to the abstracts or full study articles, follow. The page will be updated regularly with links to new study publications.  

Arizona State University

Chestnut Hill College

  • Development of a peer-education program to improve concussion knowledge and reporting in collegiate athletes (Abstract 2020) Brief Summary: A novel peer concussion-education program (PCEP) was developed to enhance concussion knowledge and reporting among collegiate student-athletes. The PCEP was developed based on the Theory of Reasoned Action and Planned Behavior. Following a focus-group discussion and pilot implementation, the investigators revised the PCEP and its education modules and developed an online manual to facilitate broad dissemination.
  • Randomized controlled trial of a novel peer concussion-education program for collegiate athletes (Abstract 2020) Brief Summary: The objective of this study was to evaluate the effects of a novel peer concussion-education program (PCEP). Compared with a control group, participation in a peer concussion-education program increased discussion of concussions with peers, coaches and athletic trainers. Athletic trainers who implemented the peer concussion-education program reported positive experiences using well-organized and engaging materials and guidelines for peer selection.  In conclusion, the PCEP showed promise in increasing concussion knowledge, intention to report concussion, reporting a teammate’s concussion, and facilitating attitudinal changes that support reporting among student-athletes.

Colorado State University

  • Three research manuscripts currently under peer review

Northern Arizona University

  • The indirect influence of organizational safety climate on football players’ concussion reporting intentions (Abstract 2020) Most of the health interventions designed to increase athletes’ reporting of potential concussion symptoms have focused only on the individual athlete. To date, no studies have examined the role of organizational safety climate has on concussion-symptom reporting behavior. We hypothesized that players’ perception of organizational safety climate would be indirectly related to their concussion symptom reporting intentions, via the influence of safety culture on supportive social norms and self-efficacy, two well-known predictors of concussion reporting intentions. We used structural equation modeling techniques to create robust latent measures of our model variables and then examined the indirect influence of football program safety climate on football players’ symptom reporting intentions. Surveys were completed by NCAA Division I football players (N = 223) before and after the 2017 football season. Results support the indirect and influence of perceived safety climate on concussion reporting intentions primarily via the relationship between safety climate and social norms, and to a lesser extent between safety climate and self-efficacy.
  • Understanding and reducing concussion-related risk in collegiate football programs: a longitudinal team science project in organizational settings (Abstract 2020) Concussions present a significant health risk to athletes in contact sports. Despite the increased availability of concussion education, football players remain reluctant to report potential concussion symptoms, largely due to cultural norms that are evident in football programs such as football players should “play through pain” and accept big hits as a normal part of the game. This case study describes the successes and challenges we experienced conducting this interdisciplinary research in an applied, real-world setting, including the use of multiple data collection methods (observational, qualitative, quantitative) and designs (correlational, experimental, descriptive) and in the context of diverse theoretical and applied research perspectives (health psychology, organizational psychology, public health, clinical athletic training).
  • Improving concussion-reporting behavior in National Collegiate Athletic Association Division I football players: evidence for the applicability of the socioecological model for athletic trainers (Abstract 2019) Promising evidence indicates growing stakeholder awareness of the importance of exosystem-level factors [for example, medical personnel and concussion-reporting behavior (CRB) policies] in influencing CRB rates. However, frontline stakeholders and policy makers may benefit from practices that bridge these influences (for example, coach involvement and communication), allowing for a more integrated approach to influence student-athletes' willingness to improve their CRBs.
  • Relationship of athletic and academic identity to concussion reporting intentions (Abstract 2019) Athletic and academic identities offer additional insight into athletes' motivation for concussion symptom reporting intentions, above and beyond traditional socio-cognitive predictors. Discussion focuses on the benefit of incorporating these important self-identities into educational health interventions to improve their impact.
  • Football team social structure and perceived support for reporting concussion symptoms: insights from a social network analysis(Abstract 2019) Our research seeks to inform the next generation of educational interventions to consider important social influence dynamics for not only the creation of educational materials, but also ensure that they are accepted and transmitted through the team social network. It likely comes as no surprise to athletic trainers, who have developed close working relationships with coaches and athletes alike, that identifying potential “opinion leaders” could be a fruitful next step in the development of educational intervention materials. Studies and programs that ignore these relations miss out on the opportunity to advance the science of human behavior and, for interventions, potentially fall short of their true capacity to improve outcomes. Social network theory specifies the conditions under which people are likely to be connected and how these individuals influence one another.
  • Psychosocial experiences of concussed collegiate athletes: the role of emotional support in the recovery process (Abstract 2019) Results from this pilot study suggest that emotional support during the concussion recovery process should be understood and fostered by university officials charged with the health and well-being of collegiate football players.
  • A simple field-based tool to assess concussion reporting behavior (Abstract 2019) Brief Summary: Study evaluated concussion symptom reporting behavior and measures that capture key features of concussion symptom reporting behavior. Data were collected from a small number of Division I football programs over the span of two seasons. Investigators found that concussion symptom reporting behavior was most often initiated by athletes in practice contexts, followed by athletic trainers in game contexts. Results led to development of a brief concussion symptom reporting behavior recording tool that can be used in practice, game, and athletic training room settings.
  • Investigation of strategies to improve concussion reporting in American football (Abstract 2019) Brief Summary: Investigators used a multi-site, repeated measures design to assess concussion reporting at a small number of Division I football programs and to subsequently work with stakeholders to develop and assess strategies to improve reporting. In all programs studied, concussion knowledge was unrelated to reporting intentions. For programs that implemented the intervention strategies, there was evidence that the interventions were effective.  Authors believe the study demonstrates that working with stakeholders to develop site-specific strategies to improve concussion reporting is an effective approach to help improve reporting behaviors.
  • Improving concussion-reporting behavior in Division I football: evidence for the applicability of the socio ecological model for athletic trainers (Article 2019) Brief Summary: This quantitative study of a small number of Division I football players examined the extent to which stakeholders' beliefs about what influences concussion reporting behavior reflect system-level influences that go beyond individual-level factors. Participants largely identified individual-level factors (attitudes), followed by exosystem-level factors (university policies and support for athletic trainers), with fewer microsystem- and mesosystem-level factors (coach influence and communication between coaches and ATs, respectively) and almost no macrosystem-level factors (media influence, cultural norms about aggression and toughness in football). The authors believe results  indicate growing stakeholder awareness of the importance of exosystem-level factors (e.g. medical personnel and concussion-reporting behavior policies) in influencing concussion reporting rates; but also think that frontline stakeholders and policy makers may benefit from practices that bridge these influences (e.g. coach involvement and communication) in a way that allows for a more integrated approach to influence student-athletes' willingness to improve their concussion-reporting behaviors.
  • Concussion reporting behaviors of athletes: a systematic review (Abstract 2019) Brief Summary: Authors mined data from twenty PubMed and Web of Science studies to summarize current evidence related to barriers pertaining to and strategies implemented to improve concussion reporting behaviors. General findings demonstrated that some barriers to reporting were still present, although there were numerous education interventions being implemented, but with little evidence regarding the effectiveness of these educational efforts. The authors believe that athletic trainers should include intention to report and norms adjustment as part of their knowledge of sport-related concussion.
  • An exploratory study on the culture of concussion reporting from the athletes’ perspective (Abstract 2017) Brief Summary: The study evaluated the concussion-reporting behaviors of a very small number of collegiate football student athletes, using interviews and focus groups, in order to gain insight into reasons contributing to the underreporting of concussion signs and symptoms. Six major themes emerged from the data: minimization of risk, misconceptions about lasting effects, diagnostic uncertainty, pressure from coaches, athletic identity, and social identity. The authors concluded that the participants appeared to have a strong knowledge of the signs and symptoms of concussions, but it did not necessarily translate into reporting. While they were aware of the lasting effects, the identity of being a football player and possibly letting their team down motivated them to continue playing.

U.S. Air Force Academy

  • Pilots and athletes: different concerns, similar concussion non-disclosure (Article 2019) Brief Summary: Dozens of research studies have demonstrated that concussion non-disclosure is a pervasive problem in athletic populations and have identified several important contributors to concussion non-disclosure. Investigators hypothesized that non-athlete populations might experience this same type of dilemma, but for different reasons. The study examined concussion disclosure in cadets at the United States Air Force Academy using anonymous surveys to assess intention to self-disclose undiagnosed concussions as well as several variables potentially related to concussion self-disclosure: perceived cost, perceived reward, personal identity, attitudes, normative behavior, social support, and self-efficacy. Results demonstrated that concussion non-disclosure developed when disclosure was perceived as more costly (i.e. directly or emotionally) and less rewarding. Authors believe that the results suggest that cultures of concussion non-disclosure can develop in any population where disclosure is perceived as having undesirable consequences, not just athletic populations.
  • Reconsidering return-to-play: a broader perspective on concussion recovery (Article 2018) Brief Summary: The study retrospectively assessed probable recovery and return to play time for understudied populations, such as women and nonelite athletes, after concussion. Sex and athletic status both affected return-to-play time with understudied groups, such as women and nonelite athletes, demonstrating notably longer recovery times; however, it is unclear how other population-specific factors may have contributed.
  • Predictive power of head impact intensity measures for recognition memory performance (Abstract 2019) Brief Summary: Authors studied cadets at the US Air Force Academy engaged in boxing and physical development, measuring head impact motions during exercise with accelerometers to understand what types of subconcussive impacts might prove detrimental to cognition. When head impact measures were compared with post-exercise memory performance, boxers were found to receive more head impacts and achieve lower performance in post-exercise memory than non-boxers and impact intensity appeared to set an upper bound on post-exercise memory performance with stronger impacts leading to lower expected memory performance. Investigators also explored multiple techniques for characterizing the magnitude of head impacts and found that the novel technique of principal component analysis captured more distinct impact information than seven traditional impact measures also tested.
  • Return-to-learn: a post-concussion academic recovery program at the U.S. Air Force Academy (Article 2018) Brief Summary: The U.S. Air Force Academy created a return-to-learn program that is specific to the cadet learning environment by reviewing available NCAA return-to-learn resources and other available return-to learn programs and then selecting and modifying the best practices for their institution.  The article describes the resulting program. The Academy is in the process of institutionalizing the program at the Air Force Academy and intend to measure whether the program increases the likelihood of concussion self-report, improves academic performance, and ultimately benefits retention at the Air Force Academy.
  • The prevalence of concussion within the military academies: findings from the Concussion Assessment, Research, and Education Consortium (Abstract 2017) Key takeaway: This prospective study evaluated data from a significant number of NCAA and non-NCAA athlete cadets enrolled in the CARE Consortium at three different U.S. service academies with hopes of understanding prevalence and risk factors for concussion among USA Service Academy cadets. When examining NCAA status, contact-sport, gender, and brief sensation seeking scale (BSSS) as risk factors for previous concussion and Poisson regression modelling, the number of previous concussions revealed significant main effects for contact-sport and BSSS. Controlling for BSSS, contact-sport cadets had higher rates of previous concussion compared to non-contact sport athletes and, controlling for contact-sport, higher BSSS scores increased prevalence of previous concussions. While overall concussion prevalence among all service academy cadets was similar to prevalence of concussion previously reported for NCAA athletes, within the academies, cadets who are also NCAA athletes had greater odds of concussion, likely due to increased risk exposure.

Unversity of Georgia

  • Collegiate student-athlete gender, years of sport eligibility completed, and sport contact level influence on concussion reporting intentions and behaviours (Abstract 2019) Brief Summary: A cross-sectional population of student-athletes were asked to reported their sex, years of sport eligibility completed, sport, and completed concussion reporting intentions and behaviours via survey. Nonparametric statistics were conducted to compare intentions and behaviours between groups and to determine whether the reported variables influenced those reporting intentions and behaviours. Data suggests that female and limited/non-contact sport student-athletes intended to report more concussions, however differences did not translate to reporting behaviours.
  • Post-concussion driving behaviors and opinions: a survey of collegiate student-athletes (Abstract 2018) Brief Summary: Authors surveyed a small number of student-athletes regarding their post-concussion driving behaviors and opinions. Data indicated that, despite generally believing that driving immediately following a concussion is unsafe, a majority of student-athletes did not refrain from driving at any point following their previous concussions. The authors believe that post-concussion driving restrictions may have had some influence on student-athletes' decisions to report the injury to a health care provider and that, while health care providers played a critical role in post-concussion driving restriction, they lacked standardized recommendations to guide their care.
  • Immediate removal from activity after sport-related concussion associated with shorter clinical recovery and less severe symptoms in collegiate student-athletes (Abstract 2018) Brief Summary: Authors reviewed data from a small cross-sectional subset of participants in the CARE Consortium study for the purpose of evaluating the effect of timing of removal from play after concussion on clinical outcomes and determining whether immediate removal from activity after sport-related concussion (SRC) might be associated with less time missed from sport, a shorter symptomatic period, and better outcomes on acute clinical measures. Diagnosed SRC events were classified as either immediate removal from activity (I-RFA) or delayed removal from activity (D-RFA). Outcomes of interest included time missed from sport attributed to their SRC, symptom duration, and clinical assessment scores. I-RFA status was associated with significantly less time missed from sport and shorter symptom duration while controlling for other SRC recovery modifiers and I-RFA athletes had significantly less severe acute SRC symptoms and were at lower risk of delayed recovery. Authors believe that I-RFA was a protective factor associated with less severe acute symptoms and shorter recovery after sport-related concussion.
  • The influence of concussion knowledge on reporting intentions in collegiate student-athletes (Abstract 2019) Brief Summary: The purpose of the study was to examine if concussion knowledge predicts reporting intentions and identify concussion knowledge differences based on demographics (sex, age and years of eligibility) in collegiate student-athletes. 105 student-athletes from three universities completed three surveys over a 4-month period. The results showed small differences in concussion knowledge between sexes, but these differences may not be clinically meaningful. Neither age nor years of eligibility affected concussion knowledge outcome measures. Overall, concussion knowledge was shown to play a role, albeit minor, in influencing student-athletes’ concussion reporting intentions such that authors propose that clinicians should understand that concussion knowledge is valuable and needed for student-athletes to have basic comprehension of concussions but should also be cautious of relying on improving concussion knowledge alone to influence a student-athlete’s reporting intentions or behaviors.
  • Improving concussion reporting across national college athletic association division using a theory-based, data-driven, multi-media concussion education intervention (Abstract 2020) Brief Summary: In this study, the investigators used survey data to compare student-athlete concussion reporting intentions and behaviors prior to and one year after exposure using a theory-based, data-driven, multimedia, simulated concussion reporting intervention for one group and a control treatment for the other. The results showed a modest, but significant rise in concussion reporting intentions among the intervention group relative to the control group, with the effect retained for an entire calendar year. The survey results showed that the intervention was more effective at targeting elements of the overall sport culture in a way that substantively improved concussion reporting in that group. The investigators propose there may be value in using this type of intervention in combination with other evidence-based educational materials.
  • Examination of collegiate student-athlete concussion reporting intentions and behavior (Abstract 2020) Brief Summary: The purpose of this study was to determine whether knowledge, attitudes, subjective norms, self-efficacy social identity and athletic identity explain variability in student-athlete concussion reporting intentions and behavior. The results showed that a student-athlete’s confidence, or self-efficacy was a frequent predictor of concussion reporting intentions and behavior. Based on the findings, authors propose that clinicians should aim to increase student-athlete knowledge attitudes and subjective norms, but most importantly their confidence in reporting concussions.

University of North Carolina, Chapel Hill

  • Determinants of intention to disclose concussion symptoms in a population of us military cadets (Abstract 2018) Brief Summary: Investigators reviewed cross-sectional survey responses from a significant number of first-year service academy cadets to assess perceptions of concussion disclosure (and non-disclosure) in a military setting. Independent variables included: gender, race, ethnicity, high school athlete status, NCAA athlete status, previous concussion history, previous concussion education, socioeconomic proxy, concussion-related knowledge, attitudes about concussion, perceived social norms (perceived peer/organizational support and actions), and perceived control over disclosure. Log-binomial regression was used to identify determinants of high intention to disclose concussion symptoms. Data indicated that concussion-related perceived social norms, attitudes, and perceived control were associated with intention to disclose in this military setting. More specifically, in the simple models, previous concussion history was associated with lower intention to disclose concussion symptoms while high perceived control over disclosure, higher concussion knowledge, more favorable attitudes and social norms about concussion were associated with high intention to disclose. In the multivariable model, a shift towards more favorable perceived social norms about concussion were associated with high intention to disclose concussion symptoms and high perceived control over disclosure was associated with high intention to disclose concussion symptoms. The authors believe that organizationally appropriate (e.g.; military-specific) intervention strategies can be developed from these data.
  • Influence of concussion education exposure on concussion-related educational targets and self-reported concussion disclosure among first-year service academy cadets (Abstract 2020) Brief Summary: The objectives of this study were to 1.) describe concussion education exposure among first-year service academy cadets and 2.) examine the association between exposure to concussion education sources and concussion-related knowledge, attitudes, perceived social norms, intention to disclose symptoms and disclosure behaviors. The survey data from first year service academy cadets suggest disparities in concussion education exposure that can be addressed in first-year cadets. Additionally, authors propose that the findings support the importance and use of multiple sources of concussion education in improving cadet’s concussion-related decision-making.
  • Perceived social norms and concussion-disclosure behaviours among first-year NCAA student-athletes: implications for concussion prevention and education (Abstract 2020) Brief Summary: The purpose of this study was to describe concussion disclosure behaviours and identify the association between perceived social norms and these disclosure behaviours. Survey results from first-year NCAA student-athletes demonstrated that a supportive social environment that models and supports appropriate concussion disclosure behaviours was associated with improved concussion disclosure. Authors propose that concussion disclosure should be addressed at multiple levels of the college/university environment to provide an optimal social environment and to promote improved concussion identification and disclosure among student-athletes and that education and environmental support concerning disclosure are key to optimizing identification of concussion and concussion symptoms among NCAA student-athletes.

University of North Carolina, Greensboro

  • Using the Integrated Behavioral Model to Determine Sport-Related Concussion Reporting Intentions Among Collegiate Athletes (Abstract 2020) Brief Summary: The purpose of this study was to test factors associated with collegiate athletes' intentions to (1) self-report concussion symptoms; (2) report another athlete's concussion symptoms; and (3) encourage others to report. Drawing on the Integrated Behavioral Model, results from a survey of collegiate athletes indicated that Bystander descriptive norms, positive reporting expectancies, concussion reporting attitudes, self-efficacy to communicate about a concussion, and athletes' perceptions of their coach's communication were positively associated with all three outcomes, while subjective norms were only positively associated with intentions to self-report and bystander reporting intentions, negative reporting expectancies were only associated with intentions to self-report, and positive and negative expectancies for playing through a concussion were only associated with intentions to self-report and bystander encouragement. Authors propose that multiple factors within the Integrated Behavioral Model may be predictive of reporting intentions and underscore the complexity of athletes' concussion reporting behaviors and offer guidance for the development of prevention strategies.

University of Wisconsin

  • Reporting skill: the missing ingredient in concussion reporting intention assessment (Abstract 2019) Brief Summary: Investigators administered a set of items to a significant number of young adults aged 18 to 24 years and analyzed the data in three separate waves to evaluate the relationship between reporting skill and reporting intention and whether reporting intentions will be more closely associated with reporting skill than with concussion/symptom knowledge of if the relationship between concussion (or symptom) knowledge and reporting intentions may differ by level of reporting skill. Exploratory/confirmatory factor analyses were conducted on 2 waves of data to develop the scale and hypotheses were tested using structural equation modeling on the responses from the third wave of participants. Data indicated that reporting skill, not concussion or concussion symptom knowledge, was associated with higher intentions to report symptoms and that, among those with higher levels of reporting skill, concussion symptom knowledge (but not general concussion knowledge) was associated with higher intentions to report symptoms.

Mind Matters Challenge Executive Statements

The NCAA-DoD Mind Matters Challenge, part of the NCAA and U.S. Department of Defense Grand Alliance partnership, is an education and research grand challenge aimed at changing important concussion safety behaviors.

Overall Goal.

Increase early and honest symptom reporting post-concussion by developing effective approaches to intervention (e.g., education). To achieve this goal, it was first necessary to understand the factors that drive non-disclosure of concussion symptoms and the critical components of effective approaches to promote concussion disclosure.

Outputs of the Mind Matters Challenge.

Eight institutions were funded under the 3-year Mind Matters Research Challenge and six institutions under the 1-year Education Challenge, with one team receiving continued funding for an additional 2 years. To date, 24 published manuscripts in academic journals have resulted from the work of these groups, and 23 manuscripts are currently under peer review. To synthesize the emergent results of these groups and other contemporary research on concussion disclosure, a formal consensus process was undertaken in concert with the final Mind Matters Challenge meeting. Mind Matters grantees, in partnership with campus and military stakeholders, developed and refined actionable recommendations for institutions, aimed at increasing early and honest care-seeking for suspected concussions.

Process for Consensus Building.

The Delphi method allows for an efficient, unbiased approach to aggregating expert opinion to reach consensus. Each of the nine investigator groups contributed one to three foundational statements. Investigator-generated statements were synthesized into non-overlapping and actionable recommendations. Participants, all of whom were considered experts in their field based on their research and publications, voted on each statement in terms of its utility and feasibility, and provided open-ended written feedback. Statements meeting a priori quantitative thresholds for consensus were retained, and others were edited based on qualitative participant feedback. This process continued for three rounds and resulted in 17 statements addressing five domains: (1) content of concussion education for athletes/service members; (2) dissemination of concussion education for athletes/ service members; (3) other stakeholder concussion education; (4) team-level processes; and (5) organizational processes. The following consensus statements will be used as the springboard for the development of subsequent educational resources, peer-reviewed publications and future research studies.

Domain 1: Content of concussion education for athletes and military service members

Provide athletes/service members with education that addresses:

  1. The potential dilemma individuals face when deciding to disclose a concussion (e.g., tradeoffs, concerns about what might happen next, knowing how to report, etc.);
  2. Short-term benefits of early concussion symptom disclosure (e.g., athletic, academic, occupational);
  3. What is known about possible long-term manifestations of concussion and head injury;
  4. Concussion-related misperceptions (e.g. population-specific knowledge gaps);
  5. Site-specific information regarding institutional concussion resources and policies.

Domain 2: Dissemination of concussion education

  1. Actively collaborate with organizational stakeholders (including coaches/commanders, primary health care providers, student-athletes/service members, military chain of command) to select concussion education approaches that are engaging, interactive, and that foster discussion.
  2. Share messaging about concussion symptom disclosure on a regular basis and in a variety of ways (e.g., formal education, informal conversation, posters).
  3. Integrate messaging about the importance of complete concussion symptom disclosure throughout the recovery process.

Domain 3: Concussion education for other stakeholders

  1. Provide coaches/leaders in the military chain of command with evidence-based concussion education that is aimed at supporting student-athletes/service members in concussion symptom disclosure.
  2. Provide sports medicine/front line medical staff with strategies about how to engage coaches/ leaders in the military chain of command in supporting student-athletes/service members in concussion symptom disclosure.
  3. Provide easily accessible information to parents/guardians of student-athletes/service members about how to support athlete/service member concussion symptom disclosure.
  4. Provide easily accessible information to other key site-specific stakeholders (e.g., student-life administrators, faculty athletic representatives, leadership, chain of command) about how to support student-athlete/service member concussion symptom disclosure. 

Domain 4: Team- and unit-level processes

  1. Provide student-athletes/service members with education that addresses the role they can play in encouraging peers to disclose possible concussion symptoms (e.g., share evidence-based bystander education programming).
  2. Provide opportunity for team/unit members and coaches/leaders to discuss and establish team values that are supportive of concussion symptom disclosure.

Domain 5: Organizational processes

  1. Actively collaborate with organizational stakeholders (including coaches/leaders in the military chain of command, primary health care providers, student-athletes/service members) to identify and address organizational barriers to concussion symptom disclosure. 
  2. Evaluate the effectiveness of institutionally selected concussion education approaches in changing athlete/service member concussion symptom disclosure behavior.
  3. Communicate in a deliberate manner institutional values that emphasize safety and its importance in athletic performance/military readiness.

Closing comments and next steps. The NCAA-DoD Mind Matters Grand Challenge has already had a major global impact in the understanding of concussion disclosure through the publication of 24 peer reviewed manuscripts, with many more forthcoming. The results of these investigations provide guidance for athletics departments and service academies about how to develop and maintain a culture that supports concussion disclosure. They also provide the foundation for an augmented research agenda on this topic. One emergent theme was the need for consistent data collection across sites using valid and reliable measures in understanding the impact of different approaches that have been used to support concussion disclosure.

2018 NCAA Football Data Task Force

The NCAA Sport Science Institute hosted the 2018 Football Data Task Force in Indianapolis February 26 and 27, 2018. The purpose of the meeting was to: 1) review emerging information from the NCAA-DoD CARE Consortium, The Datalys Center and the Ivy League Conference regarding concussion and repetitive head impact exposure in football, and; 2) facilitate dialogue around how the emerging information may impact and help shape college football rules, policies and procedures going forward. The event was attended by concussion scientists and experts as well as by Divisions I, II and III conference commissioners, directors of athletics, sports medicine staff and football coaches and officials. The meeting was co-chaired by Bob Bowlsby, commissioner of the Big 12 Conference, and Brian Hainline, NCAA chief medical officer.

Resources:

Participants of the 2018 NCAA Football Data Task Force

Organization and Member Representatives

  • Ray Anderson, Arizona State University
  • Stevie Baker-Watson, DePauw University
  • Brad Bankston, Old Dominion Athletic Conference
  • Todd Berry, American Football Coaches Association
  • Bob Bowlsby, Big 12 Conference
  • Steve Broglio, University of Michigan
  • Carolyn Campbell-McGovern, The Ivy League
  • Jim Catanzaro, Lake Forest University
  • John Chandler, Coe College
  • Dick Christy, University of North Carolina at Pembroke
  • Christy Collins, Datalys Center
  • Stefan Duma, Virginia Tech
  • Richard Johnson, Wofford College
  • Kerry Kenny, Big Ten Conference
  • Larry Kindbom, Washington University
  • William King, Southeastern Conference
  • Tom McAlister, Indiana University of School of Medicine
  • Michael McCrea, Medical College of Wisconsin
  • Jack McKiernan, Kean University
  • Bob Nielson, University of South Dakota
  • Mike Norvell, University of Memphis
  • Michael Ortiz, Pac-12 Conference
  • Gary Pine, Azusa Pacific University
  • Julie Ruppert, Northeast-10 Conference
  • Steve Shaw, Southeastern Conference
  • Jon Steinbrecher, Mid-American Conference
  • Brian Stemper, Medical College of Wisconsin
  • Michael Strickland, Atlantic Coast Conference
  • Erin Wasserman, Datalys Center
  • John Wristen, Colorado State University-Pueblo

National Office Staff

  • Scott Bearby, Office of Legal Affairs
  • Brian Burnsed, Communications
  • Dawn Buth, Sport Science Institute
  • Dan Calandro, Championships
  • Amanda Conklin, Academic and Membership Affairs
  • Amanda Dickey, Sport Science Institute
  • Dan Dutcher, Governance
  • Brian Hainline, Sport Science Institute
  • Ty Halpin, Championships
  • Maritza Jones, Governance
  • Kevin Lennon, Governance
  • Cassie Langdon, Sport Science Institute
  • Eric Mayes, Academic and Membership Affairs
  • John Parsons, Sport Science Institute
  • Ron Prettyman, Championships
  • Kris Richardson, Academic and Membership Affairs
  • Terri Steeb, Governance

Concussion Safety Protocol Template

The following template* is designed as an aid for NCAA schools to consider using in order to satisfy Divisions I, II and III concussion safety protocol legislation. The template highlights all components of the updated NCAA Concussion Safety Protocol Checklist and provides shaded cells that schools may use to personalize their protocol. The NCAA Concussion Safety Advisory Group recommended modifications to the prior Concussion Safety Protocol Checklist, and these recommendations were prescribed by the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports.  The updated Checklist items are highlighted so that the prior Concussion Safety Protocol Template can be modified more easily.  Template content that is outside the scope of the Checklist has been indicated with an asterisk (*) and is included for your convenience and consideration. A signature line for the athletics health care administrator is included in the template. Additional signature lines may be personalized based on the requirements of a school or conference office.

Institutions are not required to use the template; rather, it is offered as a resource to support athletic departments in their concussion safety efforts.  The content of this template is offered for educational purposes only and is not intended to constitute, or be a substitute for, medical or legal advice. The content is not intended to be exhaustive, and we encourage membership to review these materials with applicable campus medical, legal and risk management authorities to determine whether and how best to use this information to address individual institutional risks and requirements. All concussion safety protocols, regardless if developed using the template or another mechanism, must be consistent with all applicable divisional legislative requirements.

 

*Highlighted content represents an update from the prior template.

School Name

Concussion Safety Protocol

School Name Concussion Safety Protocol

Introduction

School Name is committed to protecting the health of and providing a safe environment for each of its participating NCAA student-athletes. To this end, and in accordance with NCAA legislation, School Name has adopted the following Concussion Safety Protocol for all NCAA student-athletes. This protocol identifies expectations for institutional concussion management practices as they relate to (1)  the definition of sport-related concussion*; (2) independent medical care*; (3) preseason education; (4) pre-participation  assessment; (5) recognition and diagnosis; (6) initial suspected concussion evaluation; (7) post-concussion management; (8) return-to-learn; (9) return-to-sport; (10) limiting exposure to head trauma; and (11) written certificate of compliance signed by the athletics health care administrator.

1. Definition of Sport-Related Concussion*

The Consensus Statement on Concussion in Sport, which resulted from the 5th international conference on concussion in sport, defines sport-related concussion as follows:

Sport-related concussion (SRC) is a traumatic brain injury induced by biomechanical forces. Several common features that may be utilized to clinically define the nature of a concussion head injury include:

  • SRC may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.
  • SRC typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms evolve over a number of minutes to hours.
  • SRC may result in neuropathological changes, but the acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.
  • SRC results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive features typically follows a sequential course. However, in some cases symptoms may be prolonged.
  • The clinical signs and symptoms cannot be explained by drug, alcohol or medication use, other injuries (such as cervical injuries, peripheral vestibular dysfunction, etc.) or other comorbidities (e.g., psychological factors or coexisting medical conditions).

2. Independent Medical Care*

As required by NCAA Independent Medical Care legislation, team physicians and athletic trainers shall have unchallengeable autonomous authority to determine medical management and return-to-activity decisions, including those pertaining to concussion and head trauma injuries, for all student-athletes.

3. Preseason Education

All NCAA student-athletes will be provided and allowed an opportunity to discuss educational material (e.g., the NCAA Concussion Education Fact Sheet) and be required to sign an acknowledgement, on an annual basis and prior to participation, that they have been provided, reviewed and understood the concussion education material.  

All coaches, team physicians, athletic trainers, directors of athletics and other athletics personnel involved in NCAA student-athlete health and safety decision making will be provided and allowed an opportunity to discuss educational material (e.g., the NCAA Concussion Education Fact Sheet) and be required to sign an acknowledgement, on an annual basis, that they have been provided, reviewed and understood the concussion education material. 

4. Pre-Participation Assessment

All NCAA student-athletes will undergo a pre-participation baseline concussion assessment. This pre-participation assessment will be conducted at School Name and, at a minimum, will include assessment for the following:

  • History of concussion or brain injury, neurologic disorder, and mental health symptoms and disorders.
  • Symptom evaluation. (Identify tool to be used, e.g., Symptom evaluation in SCAT5)
  • Cognitive assessment. (Identify and describe, e.g., ImPACT, Axon, paper and pencil)
  • Balance evaluation. (Identify and describe, e.g. BESS, modified BESS, SCAT5, other)

The team physician will determine pre-participation clearance and any need for additional consultation or testing and will consider for a new baseline concussion assessment at six months or beyond for any NCAA student-athlete with a documented concussion, especially those with complicated or multiple concussion history.

5. Recognition and Diagnosis of Concussion

Medical personnel with training in the diagnosis, treatment and initial management of acute concussion will be present at all NCAA competitions in the following contact/collision sports: (list all sports that your institution sponsors from the following: basketball; equestrian; field hockey; football; ice hockey; lacrosse; pole vault; rugby; skiing; soccer; wrestling).

NOTE: To be present means to be on site at the campus or arena of the competition. 

Medical personnel with training in the diagnosis, treatment and initial management of acute concussion will be available at all NCAA practices in the following contact/collision sports: (list all sports that your institution sponsors from the following: basketball; equestrian; field hockey; football; ice hockey; lacrosse; pole vault; rugby; skiing; soccer; wrestling).

NOTE: To be available means that, at a minimum, medical personnel can be contacted at any time during the practice via telephone, messaging, email, beeper or other immediate communication means and that the case can be discussed through such communication, and immediate arrangements can be made for the athlete to be evaluated.

Any NCAA student-athlete that exhibits signs, symptoms or behaviors consistent with concussion:

  • Must be removed from practice or competition for evaluation.
  • Must be evaluated by an athletic trainer or team physician (or physician designee) with concussion experience.
  • Must be removed from practice/play for that calendar day if concussion is confirmed or suspected.
  • May only return to play the same day if the athletic trainer, team physician or physician designee determines that concussion is no longer suspected.

6. Initial Suspected Concussion Evaluation

The initial concussion evaluation will include:

  • Clinical assessment for cervical spine trauma, skull fracture, intracranial bleed and catastrophic injury.
  • Symptom assessment. (Identify the name of the tool)
  • Physical and neurological exam. (Identify by name any additional special tests, such as King-Devick, Visual Ocular Motor Screen, etc.)
  • Cognitive assessment. (Identify the name of the tool)
  • Balance exam. (Identify the name of the tool)

7. Post-concussion Management

Activation of emergency action plan+, including immediate assessment for any of the following scenarios:

  • If performed, Glasgow Coma Scale < 13 on initial assessment, or GCS <15 at 2 hours or more post-initial assessment.
  • Prolonged loss of consciousness.
  • Focal neurological deficit suggesting intracranial trauma.
  • Repetitive emesis.
  • Persistently diminished/worsening mental status or other neurological signs/symptoms.
  • Spine injury.

+ Emergency action plan may require transportation for further medical care.

Because concussion may evolve or manifest over time, for all suspected or diagnosed concussions, there will be in place a mechanism for serial evaluation of the student-athlete. 

For all cases of diagnosed concussion, there must be documentation that post-concussion plan of care was communicated to both the student-athlete and another adult responsible for the student-athlete, in oral and/or written form.

Any NCAA student-athlete with atypical presentation or persistent symptoms will be re-evaluated by a physician in order to consider additional diagnoses, best management options, and consideration of referral. Additional diagnoses may include, among others: fatigue and/or sleep disorder; migraine or other headache disorders; mental health symptoms and disorders; ocular dysfunction; vestibular dysfunction; cognitive impairment and autonomic dysfunction.

8 Return-to-Learn

Returning to academic activities after a concussion is a parallel concept to returning to sport after concussion. Cognitive activities require brain energy utilization and after concussion, brain energy may not be available to perform normal cognitive exertion and function. The return-to-learn concept should follow an individualized and step-wise process overseen by a point person within the athletics department, who will navigate return-to-learn with the student-athlete and, in more complex cases of prolonged return-to-learn, work in conjunction with a multidisciplinary team that may vary student-to-student depending on the specifics of the case but may include, among others:

(list all that apply)

  • Team physician.
  • Athletic trainer.
  • Psychologist/counselor. (Identify if student health services or department of athletics)
  • Neuropsychologist consultant.
  • Faculty athletics representative.
  • Academic counselor.
  • Course instructor(s).
  • College administrators.
  • Office of disability services representative.
  • Coaches.

A student-athlete who has suffered a concussion will return to classroom/studying only as tolerated with modification of schedule/academic accommodations, as indicated, with help from the identified point-person. Campus resources will be engaged for cases that cannot be managed through schedule modification/academic accommodations.  Campus resources will be consistent with the ADAAA and will include one of the following:

  • Learning specialists.
  • Office of Disability Services.
  • ADAAA Office.

A student-athlete will be re-evaluated by a team physician (or their designee) if concussion symptoms worsen with academic challenges or in the event of atypical presentation or persistent symptoms lasting longer than two weeks.

9. Return-to-Sport

Unrestricted return-to-sport should not occur prior to unrestricted return-to-learn for concussions diagnosed while the student-athlete is enrolled in classes. Final determination of unrestricted return-to-sport will be made by a School Name team physician or his/her medically qualified designee following implementation of an individualized, supervised stepwise return-to-sport progression that includes: 

  1. Symptom-limited activity.
  2. Light aerobic exercise without resistance training.
  3. Sport-specific exercise and activity without head impact.
  4. Non-contact practice with progressive resistance training.
  5. Unrestricted training.
  6. Unrestricted return-to-sport.

The above stepwise progression will be supervised by a health care provider with expertise in concussion, with it being typical for each step in the progression to last at least 24 hours.

NOTE: If at any point the student-athlete becomes symptomatic (more symptomatic than baseline), the team physician or physician designee will be notified, and adjustments will be made to the return-to-sport progression. *

10. Limiting Exposure to Head Trauma

School Name is committed to protecting the health of and providing a safe environment for each of its participating NCAA student-athletes. To this end and in accordance with NCAA association-wide policy, School Name will limit student-athlete head trauma exposure in a manner consistent with Interassociation Recommendations: Preventing Catastrophic Injury and Death in Collegiate Athletes. For example:

  • School Name teams will adhere to existing ethical standards in all practices and competitions.
  • Using playing or protective equipment (including the helmet) as a weapon will be prohibited during all practices and competitions.
  • Deliberately inflicting injury on another player will be prohibited in all practices and competitions.
  • All playing and protective equipment (including helmets), as applicable, will meet relevant equipment safety standards and related certification requirements.
  • School Name will keep the head out of blocking and tackling in contact/collision, helmeted practices and competitions.

Compliance Certification*
Academic Year 2020-21

School Name
Concussion Management Plan

By signing and dating this form, I hereby acknowledge, on behalf of the institution identified above, that for the 2020-21 academic year, the attached School Name Concussion Safety Protocol is consistent with the NCAA Concussion Safety Protocol Checklist and otherwise fulfills the requirements of all applicable NCAA Concussion Management Plan legislation.

Required Signature
Athletics Health Care Administrator

Print Name:

Sign:

Date:

 

Option Signature**

Print Name:

Sign:

Date:

 

Option Signature**

Print Name:

Sign:

Date:

 

Option Signature**

Print Name:

Sign:

Date:

 

**   The form allows for additional optional signatures to accommodate conference or institutional signature requirements beyond the signature required by NCAA legislation.

CARE-Based Policy Changes And Resources

Data from the CARE Consortium will be used to shape rule changes designed to facilitate ongoing safety objectives in college sports.

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