Articles of interest
15th February 2021
Book in Focus
Arthur Maerlender, Jennifer Parent-Nichols, Jonathan Lichtenstein and Sandra Singer
In recent months, concerns have been growing over the long-term impact of concussion, particularly in professional sports, with instances of dementia in former players being increasingly linked to a lifetime of sporting activity, from frequent heading in football, to high-intensity contact sports such as rugby. Some actions are beginning to be taken, such as FIFA recently introducing a trial for additional substitutes in cases where concussion is suspected. It is clear, however, that there is still a lack of general understanding in the long-term effects of concussion, as well as in recognising when concussion has occurred.
But while the majority of professional sports clubs employ club doctors who can quickly recognise a concussion and take appropriate action, amateur clubs and, more pertinently, schools, may not have the tools to do so, increasing the risk of long-term complications and the development of neurological conditions such as dementia.
Concussion Competencies: A Framework for School-Based Concussion Management, and its counterpart text, Concussion Competencies from a British Perspective: A Framework for Concussion Management, present information needed for people working with concussion recovery, as well as anyone currently experiencing a concussion, especially those which are sports-related. With no currently defined body of knowledge that practitioners in this field need to know, this book serves to fill that gap. While medical attention is often needed at the beginning of the injury, the most important parts of ongoing treatment are behavioural, namely managing and monitoring the patient and engaging them in appropriate “active rehabilitation” strategies. In this edition of Book in Focus, the authors, Arthur Maerlender, Jennifer Parent-Nichols, and Sandra Stalker provide an overview of both volumes and offer their perspective on why the need for greater overall understanding of the condition is so vital.
Concussion Competencies: Frameworks for Knowledge and Treatment
by Arthur Maerlender, Jennifer Parent-Nichols, Sandra Stalker
Having treated and assessed concussions since before they became a well-known public health issue, the more recent concern about, and focus on, this injury has been both remarkable and welcome. While the injury itself is rather mild, the consequences of improper treatment have serious effects. As a result, medics of sports teams began approaching the injury as a necessary part of sports medicine to protect players from second injuries and facilitate safe and efficient recovery. However, sports medicine had historically dealt with orthopaedic and soft tissue injuries: knowledge of the brain was typically based on a brief presentation on a professional course. It became clear early on that the gaps in knowledge, conflicting information and sometimes incorrect opinions were rate-limiting steps to effective identification and treatment or management.
Perhaps because of the ability of patients to ambulate and show no outward signs of injury, care was often disjointed or de-centralised. The patient, their family, the primary care physician, the school and specialists all might have input into a specific injury, and all seemed to claim expertise in the matter. Through workshops to educate sports medicine and education professionals, we began to understand ‘who needed to know what’ for best practice concussion care and a framework of topic areas began to emerge. As medical education requires competency-based learning, we sought to provide an initial description of the competencies needed for understanding and working with concussion patients.
Because so much of our work involved schools, the Concussion Competencies volumes were targeted towards school-based programmes and health care professionals who intersect with, or work directly in, schools or community sports teams. However, most of the competencies and the information contained therein are relevant to non-school professionals, and other interested parties. In addition, while educational and health care systems are quite different between the US and the UK, the core knowledge features seemed relevant in both countries. Therefore, we have published two editions: a US edition, Concussion Competencies: A Framework for School-Based Concussion Management, and a UK edition, Concussion Competencies from a British Perspective.
The de-centralised nature of care creates many challenges for consistency and attention to best practice standards. As a clinical condition, there is, as yet, no gold-standard biomarker to confirm the presence of concussion or its resolution. Indeed, many concussions are diagnosed out of caution. Thus, these competencies reflect the state of the art and will require updating. However, while the details of identification and treatment will change, the need for competent care will not. Our hope is that the establishment of these initial categories will allow researchers in medicine, health, teaching pedagogy and education to use these as a starting point for better definition and structure of the knowledge needed to be effective in this work.
The first section of the books was intended to provide enough digestible information to convince the audience of the physiological nature of the injury and the consequences that could accrue. Despite its benign appearance, a concussion is physiologically-based and can cause a wide range of problems. The second part provides outlines of issues regarding identification, diagnosis, assessment and management. The final section addresses the programming which is often found in schools and clinics. Here, the focus shifts to regular monitoring that should typically be provided by schools, where young people spend most days, and where the consequences of brain injury are most dramatic.
Both volumes are structured to facilitate learning and can be used as texts. They can also serve as handbooks for those already in the field. To address the question of ‘who needs to know what?’, we have highlighted topics of importance for specific constituents (administrators, school leaders, teachers, coaches, health care professionals, parents and patients). The goal is to put concussion education and treatment on a solid footing that will be adjusted and improved with time.
“There is a crucial need for a complete source of information on the important aspects of concussion for school-aged children. This research-based curriculum provides a comprehensive, practical guide for understanding effective management of concussion to support the best outcomes in recovery. Its competency-based design allows for different school professionals and families to access the information germane to their roles in understanding concussion for school-aged children. I love the convenience of the easy-to-follow charts of competencies for each role. This is a must-have for all schools and sports coaches.”
Cynthia Pahr, MEd, CBIST
Educational Consultant and Brain Injury Services Coordinator, San Diego Unified School District
“As a neuropsychologist who consults with multiple school districts for return-to-play decision making, I was thrilled to read this much-overdue and desperately needed, well-written, comprehensive yet easily digested manual. The authors are modest in their scope with regards to for whom this was written. While this is truly going to be a game-changer for school personnel and educators, it will be equally as useful (and much-needed) for all healthcare professionals working with student athletes. It is an excellent review and “how to” manual for any professional from any discipline who works with concussed students.”
Ted Davis, PhD.
Former Director, Center for Neuropsychology, Learning and Behavioral Medicine, Saint Joseph Hospital, Nashua, USA
“This is a wonderful resource that is well-written and easy to understand. The Brain Injury Alliance of Nebraska is always looking for useful brain injury information that can be shared and used by key school personnel for work with students. The authors of this training manual created the perfect, user-friendly tool which offers easy to read and easy to follow concussion information for school personnel. This training manual is a must have for all schools!”
Peggy Reisher, MSW
Executive Director, Brain Injury Alliance of Nebraska
Dr Arthur Maerlender, PhD, ABPP-CN, is a board-certified clinical neuropsychologist and a Research Associate Professor and former Director of Clinical Research at the University of Nebraska, Lincoln. After obtaining his PhD in Counseling Psychology from the University of Notre Dame, USA, he completed a postdoctoral fellowship in Neuropsychology at Dartmouth (Geisel) Medical School, USA, where he remained for twenty years, before retiring as the Director of the Pediatric Neuropsychology service. He has conducted research in learning disabilities, autism and traumatic brain injury, and has served on the boards of the Vermont Learning Disabilities Foundation, the Brain Injury Association of New Hampshire, and the Academy of Brain Injury Specialists of the National Brain Injury Association. He also served on the Institute of Medicine Committee on Concussions in Youth, and has been funded by the National Institute of Health and the Center for Disease Control, as well as numerous foundations.
Dr Jennifer Parent-Nichols, EdD, DPT, is a physical therapist, and is certified as a pediatric specialist by the American Board of Physical Therapy Specialties, which she also serves a board member. She has earned certification as a brain injury specialist and certification in vestibular rehabilitation. She has worked extensively in the area of pediatrics with experience in early intervention, school-based therapy, and adolescent sports medicine. She is an Associate Professor in the Doctor of Physical Therapy Program at Franklin Pierce University, USA, where she teaches Pediatrics and Neurology. In January of 2020, she will assume the role of Director of Student Affairs for Doctor of Physical Therapy Program at Tufts University. Her areas of research include pediatric and adolescent sports medicine, and education.
Sandra Stalker served as Director of General Qualifications and Life Skills at the Qualifications and Curriculum Development Agency (QCDA), where she was responsible for the development, implementation and monitoring of the national curriculum, assessments and qualifications for 14-19 year olds in England. She played a significant role in shaping national education policy, including leading QCDA’s input into the 2004 report on 14-19 Education Reform. She has spent 27 years in the teaching profession and served as a Senior Educational Policy Consultant to the Governor of Minnesota, Jesse Ventura, from 1999 to 2003. Since 2011, she has worked as a freelance Education Policy Consultant, including work for the Universities and Colleges Admission Service (UCAS).
Dr Jonathan Lichtenstein, PsyD, MBA, is the Director of Pediatric Neuropsychology and Sports Neuropsychology at Dartmouth-Hitchcock Medical Center, and an Assistant Professor of Psychiatry, Pediatrics, and the Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, USA. He is the clinical director of Concussion Chalk Talk, a grant-funded, school-based concussion management program, which places an emphasis on return-to-learn and changing concussion culture in schools. His research and publications in peer-reviewed journals have focused on test administration, effort, recovery, and program evaluation in concussion management.
Concussion Competencies: A Framework for School-Based Concussion Management and Concussion Competencies from a British Perspective are available now. Enter the code PROMO25 at the checkout for a 25% discount.