Concussion Video—Educating Schools

Concussion is an injury of force – to the head or body. It is an injury of signalling in the brain at a cellular level and is thought to be of greater significance in teenagers, as the teenage brain undergoes a growth spurt during adolescence (Baillargeon, Lassonde, Leclerc & Ellemberg, 2012).

The frontal lobe, paramount for working memory, is more fragile and susceptible to the effects of concussion in the teenage years. Multiple studies, including Baillargeon et al (2012), have identified that teens with a concussion have a worse working memory than children or adults.

Concussion is not always obvious, and symptoms may take up to 72hrs to manifest. Like all brain injuries, every concussion is different. However, they all do need to be identified and managed appropriately. Assessing brain function is subjective with current tools and assessing concussion requires evaluation and testing by qualified members of a multi-disciplinary team (MDT).

Once a person has had a concussion, it can easily occur again, and will take less of a blow to cause injury and longer time to recover (Gornall, Takagi, Morawakage, Liu & Anderson, 2021). If not managed well, morbidities result, which in turn increases the burden of health costs.

For several years, there has been collaboration with a large private boy’s school within the Northern Sydney Local Health District (NSLHD), regarding head injury assessment, treatment, prevention and school guideline development. It became apparent that there were many boys sustaining concussive head injuries at school, particularly in winter season sport, requiring monitoring in sick bay and several serious enough to be referred to hospital. It was decided that a collaborative approach to find out more about the boys’ concussions was needed, to see in what numbers concussion was affecting this population and then, what could be done to lessen the numbers affected.

A questionnaire (Table 1) was collaboratively developed with school approval and distributed in class to 727 boys in Years 7-12 (excluding Year 11 as they had exams at the time). From that survey, 217 boys identified as having had a concussive head injury. Those 217 boys were given a further survey asking more in-depth questions about their concussion experience.

Not surprisingly, most injuries occurred during the winter sport season – rugby union and soccer, but also from school playground injuries and summer sports. Pleasingly, most identified that they were wearing mouthguards for contact sports. The symptoms most complained about included headache, visual disturbances, neck pain, and fuzziness/forgetfulness. Other symptoms identified were hearing issues, nausea, one who had a seizure and another, a bleeding nose.

58% came off the field but 25% stayed on playing. 76% reported the injury (school, family), but 24% did not report it. It is these two points – ¼ stayed on playing and ¼ did not report the injury, that is concerning. Two days after the injury, almost half still had headache (46%) and complained of fuzziness (23%), neck pain, visual and hearing issues.

35% reported this being their first concussion and pleasingly, 86% reported the incident to their teachers. Most returned to school the next day or day after. However, 10% returned to sport the same day, which was alarming. It is mandatory at this school to follow FIFA’s guidelines (international governing body of football) of 19 days until returning to sport, and the majority were found to have complied. Unfortunately, there was a small number who were out for the season and one out for the rest of the year due to ongoing concussive symptoms.

There is much discussion surrounding the risk of neurodegenerative diseases and complications associated with concussion and repetitive head knocks in sport, with rotational head motion as the primary contributor to brain injury (Tierney, 2021). Media saturation regarding Chronic Traumatic Encephalopathy (CTE) needs to be considered and properly understood. Public education needs to ensure that the threat of CTE does not overtake common sense. Already schools are seeing a move away from rugby to soccer, yet evidence shows that soccer is not necessarily ‘safer’, as concussions occur frequently in this sport as well.

Sport is synonymous with being Australian. It should be encouraged. However, so should the rules of the game, sportsmanlike behaviour, and in particular, neck strengthening exercises. Mouthguards and helmets (in rugby) should be mandatory. Although they will not wholly prevent a concussion, they will absorb some of the mechanical force, as well as protecting the teeth, skull, and jaw (Allison & Tamimi, 2020). Encouragement to ‘look after your mate’ should also be emphasised in schools – if your mate is injured, report it.

Similarly, concussion needs a higher educational presence in schools. Early injury identification, assessment and treatment produces better outcomes (Cassimatis, Orr, Fyffe & Browne, 2021). This video will assist in highlighting identification and management of concussion. As a video, it can be played whenever and wherever required.

With the rise of public concern regarding concussion, particularly in children and young adults, and the many presentations to school infirmaries and Emergency Departments, the need for concussion education was apparent. The NSLHD’s Concussion Video is an ideal way to provide education and information to local schools and sporting groups whenever required.