National Athletic Trainers' Association Position Statement: Reducing Intentional Head-First Contact Behavior in American Football Players

Knowledge and Attitudes of Concussion Reporting Behavior Intentions in Parents of Youth Recreational Football Players

Purpose: This study: (1) Described the knowledge, attitudes, and reported behavior intentions of young recreational football players' parents toward concussion. (2) Investigated associations of the previous variables with parent demographics. Materials and Methods: A cross-sectional design utilized an online platform to survey parents of children (8-14 yrs.) in three youth football leagues in the southern United States. Demographics collected included items such as sex or concussion history. Knowledge was assessed via true/false items, with higher scores (0-20) representing greater concussion understanding. 4-point Likert scales were used to describe parents attitudes (1 = not at all, 4 = very much), confidence in intended recognition/reporting (1 = not-confident, 4 = extremely confident), and agreement with intended reporting behaviors (1 = strong- disagreement, 4 = strong-agreement). Descriptive statistics were calculated for demographics. Mann-Whitney U test or Kruskal-Wallis Tests examined survey responses across demographics. Results: Respondents (n = 101) were primarily female (64.4%), white (81.2%), and participated in contact sport (83.2%). Parents averaged 15.9 ± 1.4 on concussion knowledge, with only 34.7% (n = 35) of parents scoring > 17/20. Statements that received the lowest average agreement (3.29/4) regarding reporting intent were related to emotional symptoms. Some parents (n = 42, 41.6%) reported low confidence in recognizing symptoms of a concussion in their child. Parent demographics did not have clinically significant associations with survey responses, with 6/7 demographic variables resulting in no statistical significance (p > .05). Conclusions: Although one-third of parents attained high knowledge scores, several reported low confidence in recognizing concussion symptoms in their children. Parents scored lower in agreement with removing their child from play when concussion symptoms were subjective. Youth sports organizations providing concussion education to parents should consider these results when revising their materials.

Models of Video Feedback for Youth Athletes Performing an American Football Tackle

CONTEXT

Video feedback is an expeditious method for improving athlete safety when performing activities with an inherent risk of injury. Providing appropriate and validated feedback during tackling training in American football may be a mechanism for athletes to learn safe tackling performance.

OBJECTIVE

To determine the effect of video feedback in the instruction of tackling form.

DESIGN

Controlled laboratory study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 32 youth football athletes (28 boys, 4 girls; age = 11.8 ± 0.8 years) participated in 1 day of training. Of those, 14 participants completed 2 additional days of training and a 48-hour retention and transfer test.

INTERVENTION(S)

Video feedback using self as model, expert as model, combined self and expert model, and oral feedback to promote safe tackling performance in a laboratory environment.

MAIN OUTCOME MEASURE(S)

Shoulder extension, cervical extension, trunk angle, pelvis height, and step length by training block and over time.

RESULTS

For the 1-day training group, main effects for time were observed for shoulder extension (P < .01), cervical extension (P = .01), pelvis height (P < .01), and step length (P < .01), with better performance for pelvis height and step length after combined feedback. For the 3-day training group, main effects of time were identified in pelvis height (P < .01) and step length (P < .01), with combined feedback showing better performance than other methods in shoulder extension and pelvis height. Combined feedback resulted in better performance compared with its component parts and oral feedback alone. In the combined model, participants viewed both their performance and the expert model, enabling them to see the difference between current and required performance.

CONCLUSIONS

Combined feedback may be superior to other forms of feedback in improving movement performance. This effect can be generalized across disciplines that provide instruction and feedback in movement.

Efficacy of Guardian Cap Soft-Shell Padding on Head Impact Kinematics in American Football: Pilot Findings

Sport-related concussion prevention strategies in collision sports are a primary interest for sporting organizations and policy makers. After-market soft-shell padding purports to augment the protective capabilities of standard football helmets and to reduce head impact severity. We compared head impact kinematics [peak linear acceleration (PLA) and peak rotational acceleration (PRA)] in athletes wearing Guardian Cap soft-shell padding to teammates without soft-shell padding. Ten Division I college football players were enrolled [soft-shell padding (SHELL) included four defensive linemen and one tight end; non-soft-shell (CONTROL) included two offensive linemen, two defensive linemen, and one tight end]. Participants wore helmets equipped with the Head Impact Telemetry System to quantify PLA (g) and PRA (rad/s2) during 14 practices. Two-way ANOVAs were conducted to compare log-transformed PLA and PRA between groups across helmet location and gameplay characteristics. In total, 968 video-confirmed head impacts between SHELL (n = 421) and CONTROL (n = 547) were analyzed. We observed a Group x Stance interaction for PRA (F1,963 = 7.21; p = 0.007) indicating greater PRA by SHELL during 2-point stance and lower PRA during 3- or 4-point stances compared to CONTROL. There were no between-group main effects. Protective soft-shell padding did not reduce head impact kinematic outcomes among college football athletes.

Sport-related Structural Brain Injury in High School and College American Football Athletes, 2002-2020: Effect of Lystedt Law

BACKGROUND

A previous report revealed an average of 7.2 (0.67 per 100,000 participants) sport-related structural brain injuries (SRSBIs) with macroscopic lesions per year in high school (HS) and college football players. The Lystedt law and other rule changes have been implemented with intent to reduce the risk of brain injury in football.

HYPOTHESIS

To update the profile of SRSBIs in HS and college football players and evaluate the efficacy of legislation intended to reduce brain injuries.

STUDY DESIGN

Descriptive epidemiology study.

LEVEL OF EVIDENCE

Level 4.

METHODS

We retrospectively reviewed 18 academic years (July 2002 through June 2020) of SRSBIs catalogued by the National Registry of Catastrophic Sports Injuries. The incidence of SRSBIs was assessed at the HS level during the pre (July 2002 through June 2009), transitional (July 2009 through June 2014), and post (July 2014 through June 2020) universal adoption time periods of the Lystedt law. In addition, the incidence of SRSBIs during the second half of the study (2011-2012 through 2019-2020) was compared with the first half of the study (2002-2003 through 2010-2011).

RESULTS

During the study period, there was a total of 228 SRSBIs (12.7 per year, 1.01 per 100,000 participants): 212 (93%, 11.8 per year, 1.00 per 100,000) in HS athletes and 16 (7%, 0.89 per year, 1.17 per 100,000) in college athletes. There were 52 fatalities (2.9 per year, 0.22 per 100,000 participants) with 46 (2.56 per year, 0.22 per 100,000) in HS athletes and 6 (0.33 per year, 0.43/100,000) in college athletes. There was no significant difference in risk of HS total SRSBIs or fatalities during the 3 Lystedt periods. The risk of combined SRSBI cases [relative risk (RR) = 1.22, P = 0.13] and fatalities (RR = 1.20, P = 0.52) was similar in the second half of the study compared with the first half of the study.

CONCLUSION

Despite implementation of rule changes intended to reduce head injury, in particular the Lystedt law, the incidence of SRSBIs has remained unchanged. Further research is necessary to develop effective prevention programs for SRSBIs.

CLINICAL RELEVANCE

SRSBIs remain a persistent problem in HS and college American football. The recent head injury rule changes have not been effective at reducing SRSBIs.

Exploring athletic trainers’ experience and perceptions associated with a multifaceted approach to concussion management

Aim: To explore high school athletic trainers’ experience with, and perceptions of, a multifaceted approach to concussion management. Participants: A total of 20 high school athletic trainers that are certified and licensed to practice (if their state requires a license to practice) participated in this study. Materials & methods: A general qualitative design with descriptive coding and saturation was met at 20 interviews. Results: Lack of standardization allows assessment, referral and return-to-play experiences to vary significantly; referral experiences vary pending upon athletic trainers ability to refer to a trusted and responsive physician; barriers include clearances from unqualified physicians; pressure from coaches, parents and students to return students to play; benefits include increased knowledge and awareness resulting in more effective care for students. Conclusion: Athletic trainers have varying experiences and perceptions regarding their approaches to concussion management. However, there were many notable similarities in the experiences, pressures, barriers and benefits when applying their concussion protocol.