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