protocols and preparticipation assessments used for incoming student-athletes
in National Collegiate Athletic Association member institutions

ZY., Snook EM., Lynall RC., Dompier TP., Sales L., Parsons JT., Hainline B.
Journal of Athletic Training. 2015;50(11):1174-1181.

Take Home Message: 43%
of NCAA institutions fully complied with concussion legislation for
preparticipation assessments and roughly 1 in 3 institutions lacked a
return-to-learn policy. Many schools need to implement a balance assessment
into the preparticipation exam as well as a return-to-learn policy during
concussion management.

Collegiate Athletic Association (NCAA) requires member institutions to have
policies regarding concussion diagnosis, management, and education; however,
the legislation is broad, and there is flexibility on how these policies are
carried out. The research concerning conformity with recommendations is minimal.
It is imperative that the use of concussion-related protocols and preparticipation
assessment be explored within the NCAA to identify areas of needed improvement.
Therefore, the authors examined the characteristics and prevalence of
concussion-related protocols at member intuitions of the NCAA as of the
2013-2014 academic year. The authors contacted head athletic trainers from 1113
institutions and received completed surveys from 327 head athletic trainers (29%
response rate). The athletic trainers answered questions about university
information, concussion-related protocols, and preparticipation assessments. Most
universities had protocols for concussion management and return to play (97%).
Return-to-learn policies were less prevalent (63%), and only 3% reported that
they involve academic support in the management of concussed athletes. Many of
the universities also provided concussion education to student athletes (95%)
and coaches (90%). Common preparticipation assessments were the Immediate
Post-Concussion Assessment and Cognitive Testing (ImPACT; 77%) and Balance
Error Scoring System (BESS; 47%). Many universities also incorporated concussion
history (99.7%), neurocognitive exam (83%), and symptom checklist (92%) into
their preparticipation exam.  In total,
44% of the universities complied with the recommendations for preparticipation
assessments that included concussion history, balance testing, neurocognitive
testing, and symptom checklist. Many of the universities that were not in full
compliance did not have a balance assessment (57%). Division I institutions
(55%) complied with baseline assessment recommendation more often than
Divisions II or III (38% and 36% respectively).

the authors found that the many of the institutions implemented some form of concussion
preparticipation assessment. However, there was not 100% compliance. One of the
more distressing findings was that there was not 100% compliance regarding
concussion education. If the athletic trainer is not there to witness the
concussive event, than it is up to the players and coaches to recognize a
potential concussion. Concussion education is vital to distribute during the
preparticipation exam prior to athletic participation. Additionally, the
authors found that almost 1 in 3 institutions lack a return-to-learn policy and
only 3% involve academic support in the management of these athletes. Return to
learn should be part of the management protocol. Concussion recovery involves
both physical and cognitive rest; therefore, it is essential for a return-to-learn
policy be implemented. With the aid and involvement of academic advisors this
could be carried out efficiently. The results also indicate that Divisions II
and III may need more resources to carry out the more time consuming
concussion-related policies such as the concussion history and balance testing.
Athletic trainers should be aware of the concussion legislation and should
continue to improve upon the concussion-related policies and preparticipation
exam to advance patient care and improve long-term patient outcomes.

Questions for Discussion:
What is your institution’s policy on preparticipation concussion evaluation? Do
you use a balance assessment during baseline testing? How can we best implement
return to learn?

Jane McDevitt, PhD
by: Jeff Driban


Kerr ZY, Snook EM, Lynall RC, Dompier TP, Sales L, Parsons JT, & Hainline B (2015). Concussion-Related Protocols and Preparticipation Assessments Used for Incoming Student-Athletes in National Collegiate Athletic Association Member Institutions. Journal of Athletic Training, 50 (11), 1174-81 PMID: 26540099