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Impact of Coach and Trainer Support on the Athletes Concussion Management

Impact of Coach and Trainer Support on the Athletes Concussion Management

Lyndsey Burns, Paul Canevari, Georgio Elian, Allison Miller, Dylan Miller, George Smith
Bryant University

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Impact of Coach and Trainer Support on the Athletes Concussion Management

Abstract

Using the concepts of traumatic brain injuries and concussion management, this project

examines the factors that impact an athletes views of head injuries and how to recognize and

manage them. Eighty individuals participated in the study. Results indicated that (a) the listening

and social support of an athletes head coach, assistant coach, and athlete trainer all impact an

athletes well-being before and after sustaining a head injury, and (b) an athletes knowledge and

beliefs about concussions and other traumatic brain injury did not impact their perceptions of

listening and social support from their coaches and trainers. This study provides evidence that it

is important for individuals to possess an adequate knowledge about concussions and other brain

injuries, as we do not rely on the beliefs and perceptions of our coaches and trainers when

deciding how to view and manage head injuries.

Literature Review

Sports-related concussions have become a major public health concern and a focus of

increasing interest for medical and social researchers (McCrea et al., 2004). It is estimated by the

Centers for Disease Control and Prevention (CDC) that between 1.6 and 3.8 million concussions

are sustained from sport and recreational activities each year in the United States (Kroshus et al.

2015). About 460,000 college students participate in organized interscholastic sports (NCAA,

2015), a large population at risk to sustaining head trauma. While it is difficult to give an exact

number of concussions sustained by college athletes due to a history of insufficient and scarce

reporting in the community (Miller, Wendt, & Potter, 2011), it is estimated that for every

100,000 athlete exposures to a game or practice, 43 concussions are sustained (Kroshus et al.

2015).

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Impact of Coach and Trainer Support on the Athletes Concussion Management

The incidence of diagnosed concussions is higher in college athletes than in younger

athletes participating in lower-level competitive sports (Baugh et al., 2014). At the college level,

many people are involved in the athletes lives both before and after they sustain an injury and

help to make up the athletes social support network (Bone & Fry, 2006). Coaches and athletic

trainers become increasingly important figures in an athletes social support system following a

sustained injury (Yang et al., 2010). Social support, in its various forms, is crucial during the

recovery period following head trauma (Podlog et al., 2011).

The goal of this research is to examine the factors that influence an athletes ability to

manage, cope, and recover from head injuries. Specifically, it gauges the relationship between an

athletes perception of social and listening support from their athletic trainers, coaches, and

assistant coaches. These factors are investigated in a sample of college students who previously

or currently participate in sports.

Concussion Reporting

Evidence suggests that repeated concussive head trauma may lead to sustained neurologic

conditions throughout life (Kroshus et al. 2015). Terms such as ding or having your bell

rung are sometimes used informally to refer to concussive injuries, but they diminish the

seriousness of concussion symptoms. As there is currently no medical test that can detect

concussions, diagnosis is completely dependent on athletes reporting their concussion symptoms.

It is estimated that half of all concussions go undetected due to a lack of reporting (Baugh et al.,

2014).

Various issues may influence an athletes decision to not report their concussion

symptoms. Lack of information and knowledge about concussions was a longtime hindrance to

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Impact of Coach and Trainer Support on the Athletes Concussion Management

reporting of symptoms; currently, however, concussion education is heavily promoted in

organized sport, especially at the collegiate level (NCAA, 2015). Often, barriers to concussion

reporting are calculated and voluntary, usually reflecting the fear of being pulled from the game

or practice, receiving less play time, or disappointing their coach (Baugh et al., 2014).

Given the circumstances that deter athletes from wanting to report their concussion

symptoms, an athletes relationship with their coach can be considered a risk to non-reporting.

Baugh, Kroshus, Daneshvar, and Stern (2014) studied differences between high school and

college athletes and noted the difference in the nature of the athletes relationship with their

coaches. It was particularly noticed that college athletes have a less personal relationship and

bond with their coach, given that the college coaches often have more consuming roles and many

players to deal with (Baugh et al., 2014).

The relationship with and perceived support from the coach can be monumentally

influential in an athletes likelihood to report their concussion symptoms. In Baugh, Kroshus,

Daneshvar, and Sterns (2014) study, perceived coach support was found as a significant

predictor in the likelihood that an athlete would report their concussion symptoms. Perceived

coach support is extremely valuable to the athlete in reporting their concussion symptoms

(Baugh et al., 2014) and in the rehabilitation process once their concussion is diagnosed

(Clement & Shannon, 2011).

Social Support

The understanding of social support is a tremendously important pillar in the study of

communication. Social support encompasses various components and is therefore difficult to

specifically define. An example definition is provided by Schumaker and Brownell (1984) who

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Impact of Coach and Trainer Support on the Athletes Concussion Management

define social support as: "an exchange of resources between two individuals perceived by the

provider or the recipient to be intended to enhance the wellbeing of the recipient.'' Richman et al.

(1993) identified eight distinguishable behaviors of social support. The eight components

include: listening support, emotional support, emotional-challenges support, reality confirmation,

task-appreciation support, task-challenge support, tangible support, and personal assistance

(Corbillon, Crossman, & Jamieson, 2008).

A key part of the Schumaker and Brownell (1984) is the use of the word perceived.

While social support does involve two individuals, it is not absolutely necessary for the provider

of the social support to know that they are in fact doing so. Malinauskas (2008) develops

established research to urge that in instances of health behaviors, perceived social support might

actually be more significant than established social support. The rationale for this is that if

resources of support are not perceived by an individual, they cannot be utilized (Malinauskas,

2008).

Social support is considered crucial in facilitating the coping process after an injury. As

athletic injury may create emotional disruption, social support can be more useful to the athlete

following a sustained injury than before an injury. Social support has been found to create a

buffering effect on negative life stress (Green & Weinberg, 2001). It is important to note that

this buffering effect is only considered relevant to individuals who are experiencing stress,

further developing the claim that social support might be more significant to an athlete post-

injury. Social support is counted as a vital tool in the rehabilitation process, as it is linked to

many positive outcomes, including the lessening of the alienating and isolating aspects of the

injury period (Podlog et al., 2011).

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In terms of effectively utilizing the rehabilitation process, effective social support is

positively associated with impacting the athletes feelings regarding the value of rehabilitation

(Bone & Fry, 2006). Bone and Frys (2006) research offers a connection between social support

and rehabilitation compliance. Considering that strong beliefs about rehabilitation is associated

with compliance to rehabilitation programs and that social support is linked to strong beliefs

about rehabilitation, social support may be a direct or indirect influence on compliance (Bone &

Fry, 2006). Compliance, of course, is connected to the effectiveness of the rehabilitation process,

possibly meaning that social support can impact the effectiveness of rehabilitation. Throughout

the recovery of the injury, it is argued that different providers of social support - including

athletic trainers and coaches - play different roles in the athletes recovery process and are able to

provide varying forms of social support (Corbillon, Crossman, & Jamieson, 2008).

Listening Support

Of the eight types of social support, the component most prevalent in current research is

listening support. Listening support is defined in Barefield and McCallisters (1997) research as:

the perception that another is listening without giving advice or being judgemental. Of all of

the types of social support, athletes often report having the highest satisfaction with listening

support (Corbillon, Crossman, & Jamieson, 2008). It is also reported that listening support is the

most meaningful type of social support that injured athletes receive during the rehabilitation

process (Bone & Fry, 2006). Immediately following sports-related injuries and at the very

beginning of related rehabilitation, athletes prefer and expect listening support (Johnston &

Carroll, 1998). In addition to being a preferred form of social support, it is also the most readily

available (Corbillon, Crossman, & Jamieson, 2008), likely because as discussed, it simply

involves listening to the injured person.

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At the beginning of rehabilitation post-injury and throughout the rehabilitation process,

listening support remains the most important form of social support out of the eight behaviors

(Clement & Shannon, 2011). Listening support allows athletes to discuss their injury and the

emotions associated with it. It is thought that talking about their circumstance might actually

help injured athletes become more aware of their situation (Clement & Shannon, 2011). As

outlined in its basic definition, proper listening support is free of judgement and advice

(Barefield & McCallister, 1997), making it an opportunity for the athlete to reflect. Listening

support is also important as it offers an opportunity for injured athletes to validate athletic goals

for the post-injury period, helping them get through the rehabilitation process (Martin &

Mushett, 1996).

It is stressed that listening support is important immediately following and in the

beginning stages of post-injury rehabilitation (Clement & Shannon, 2011). As the rehabilitation

period develops, listening support has been subject to decreased positive rankings. It is theorized

that as time goes on, injured athletes better accept their situations and therefore feel less of a

need to rehearse thoughts and emotions with others. Some athletes even claim that doing so is

destructive to their healing process (Johnston & Carroll, 1998).

When warranted, however, continued listening support can be useful to recovering

athletes. In a study which examined athletes with disabilities - many of which were a result of

serious injury - it was found that the athletes who received strong listening support expressed

greater efficacy in their ability to train well enough to reach their potential (Martin & Mushett,

1996).

The Role of the Athletic Trainer

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A conversation on ethics in the sports community is centered on the conflicts of interest

involved in care of concussed athletes (Kroshus et al. 2015). With college sport teams generating

revenues upwards of $100 million (ESPN, 2015), there can be pressure to return star athletes to

game before they are medically ready. Of the 101 major-college football trainers surveyed by

The Chronicle regarding the protection of college athletes, over half reported that they had felt

pressure from football coaches to return concussed players to action before they were medically

ready (Wolverton, 2013).

Many athletic trainers report directly to the teams head coach, an arrangement that might

ultimately force trainers to choose between their job security and player safety (Wolverton,

2013). In fact, the research of Kroshus and her colleagues found that at schools where athletic

trainers reported to the athletic department instead of a medical institution, trainers experienced

greater pressure from coaches (Kroshus et al., 2015). Despite concerns that athletic trainers

might not always behave in the best interest of the athletes (Wolverton, 2013), they are often

considered the most effective and important advocate to the athlete during the rehabilitation

process (Johnson & Carroll, 1998). In addition to seeing the athlete regularly during their normal

season, the athletic trainer is charged with diagnosing and rehabilitating injured athletes, making

them even more of a fixture in the athletes life following a sustained injury (Robbins &

Rosenfeld, 2001).

Often, athletic trainers are an athlete's most frequent point of contact with the healthcare

system, and they are especially relevant in the athletes life during times of injury (Barefield &

McCallister, 1997). Bone and Fry (2006) urge that the social support from an athletic trainer

during an athletes rehabilitation period trumps social support from anyone else, including

coaches, assistant coaches, family, and friends. Social support from athletic trainers is extremely

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valuable to athletes; it has been argued that when athletes perceive a high level of social support

from athletic trainers, it can sincerely maximize the effectiveness of the rehabilitation process

post-injury (Bone & Fry, 2006).

In an examination of the types of social support that athletes needed or expected from

athletic trainers, it was found that injured athletes most strongly desired for their athletic trainers

to provide listening support, by listening to them and understand what they were going through

(Yang et al., 2010). Established research comparing the roles of athletic trainers, assistant

coaches, and coaches found that listening support provided by athletic trainers tends to be more

influential to an athletes well-being than the same type of support provided by their coaches or

assistant coaches. Overall social support provided to athletes by their athletic trainers contributes

more to their well-being than social support from any other figure (Clement & Shannon, 2011).

The Role of the Coach

Coaches play a significantly important role in the lives of college athletes, of course

taking an important role on their team, but also acting as a sort of parental figure while the

athlete is away from home (Baugh et al., 2014). General social support from the coach is

important to athletes. In terms of injury reporting, athletes with perceived coach support are more

likely to report symptoms of concussions (Baugh et al., 2014). The relationship between social

support and coaches is a bit more complex than the relationship to athletic trainers.

As established previously, athletes tend to perceive better social support from their

athletic trainers than from coaches or other social fixtures in their lives (Bone & Fry, 2006).

However, when it is perceived as available, satisfaction with social support from coaches is

generally rather high (Clement & Shannon, 2011). Social support from coaches has been linked

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as a psychosocial contributor to well-being and is even considered to provide athletes with a

sense of control over their situation post-injury (Malinauskas, 2008).

While perceived social support from coaches has been proved especially useful to

athletes post-injury (Clement & Shannon, 2011), it has been repeatedly noted that athletes often

do not feel they are getting adequate social support from their coaches. Athletes have noted

feeling that their coaches seem distant post-injury, and that they were unavailable to provide

instrumental and social support (Podlog et al., 2011).

It is possible that athletic trainers are regarded to be better providers of social support

given their increased prevalence in an athletes life post-injury (Clement & Shannon, 2006).

Because an athlete is likely removed from sport following a sustained injury, they are likely less

exposed to their coach, limiting the coachs ability to be a fixture of social support. Many

researchers actually suggest that to provide injured athletes with the best possible social support,

coaches should refer them to other professionals, like athletic trainers, who might be better suited

to counsel the athlete and provide worthwhile social support (Johnson & Carroll, 1998).

The Role of the Assistant Coach

The role of the assistant coach is often studied in conjunction with the head coach. Both

have been found to contribute less meaningfully to the impact of social support on athletes (Bone

& Fry, 2006). Despite this, the assistant coach does have a meaningful and profound impact on

the life of an athlete. Consider that in conjunction with the head coach, the assistant coach

decides the direction of an athletes career through choices regarding play. As the assistant

coaches might be more likely to see an athlete than the head coach on a given day, it gives them

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the power to add to or negate feelings of frustration and isolation during an athletes recovery

period via the way that they treat the athlete (Robbins & Rosenfeld, 2001).

While an assistant coach is often paired with the head coach for comparisons in terms of

job responsibility, the role of the assistant coach is often compared to that of the athletic trainer

in regard to providing social support. Robbins and Rosenfeld (2001) extensively compared

athletes perception of social support from athletic trainers and assistant coaches. It was found

that before sustaining an injury, athletes valued the effect of listening support from athletic

trainers more highly than listening support from assistant coaches.

Pre-injury, athletes did report the highest satisfaction with their assistant coachs task-

challenge support, a type of social support identified as the challenge to think about an activity

with the purpose of motivation. However, this trend declined following an injury (Robbins &

Rosenfeld, 2001). In informal discussions with study participants, Robbins and Rosenfeld (2001)

noted that many athletes felt that assistant coaches see their roles as technical advisors for

practice and skill-learning. Using this to attempt to explain why perception of task-challenge

support decreased with injury, athletes noted that if they were injured and not participating, the

assistant coach would likely see no reason to provide task-challenge support (Robbins &

Rosenfeld, 2011). While distinct differences are highlighted between the perception of support

between athletic trainers and coaches, and athletic trainers and assistant coaches, little difference

has ever been detected between coaches and assistant coaches.

Athletes tend to not perceive any influential levels of social support from their assistant

coaches. The perceived social support most influential on the well-being of athletes post-injury

comes from athletic trainers (Bone & Fry, 2006). Athletic trainers have not been found to impact

the well-being of athletes via social support post-injury. There are concerns that a perceived

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deduction in task-challenge support from pre-injury to post injury could have a negative impact

on injured athletes, possibly causing them to feel isolation or neglect as a result of their injury.

While no notable positive effects are perceived by athletes from the social support of their

assistant coaches, there are implications that a deduction in types of social support might

contribute to negative feelings post-injury (Robbins & Rosenfeld, 2001).

In our study, we are looking to answer two questions that are important in understanding

how people manage concussions and other brain injuries, as well as how much of an impact our

coaches and trainers have on our physical and emotional well-being when recovering from a

head injury. Specifically, we are proposing that (a) athletes rely on the knowledge of their

coaches rather than their own knowledge and beliefs when assessing how to manage and cope

with a concussion or head injury and (b) coaches, assistant coaches, and athletics all play an

equal role in helping the injured athlete recover and cope with their head injury.

Methods

Participants

A total of 80 students from a northeastern university were selected to participate. The

average age of participants was approximately 20 years old, with a range of 18-22. The majority

of participants were males, with a small percentage, about 10%, being female. Of the 80 students

surveyed, 100% of them either currently participate in a collegiate level sport or had previously

participated in either a high school or collegiate level sport. Participants were not necessarily

athletes who had suffered a diagnosed concussion, but rather current or former athletes who have

sustained some type of injury and can recall their perceptions of listening and social support

from their coaches and trainers.

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Procedure and Design

Participants were volunteers recruited from the universitys athletic teams, as well as

from a variety of undergraduate classes in different areas of study. After agreeing to participate,

respondents were given a survey divided into three sections. The first section asked participants

about their personal history of head injuries (e.g. Have you ever been diagnosed with a

concussion by a medical professional (doctor, athletic trainer, or nurse)?)The second section

evaluated the participants knowledge of and attitude towards head injuries, as well as their

perceptions of their coachs knowledge of and attitude towards them. This section required

participants to read a statement either about head injuries or the way their coach manages head

injuries and answer yes or no.

The third section of the survey contained six questions presented on a 5-point Likert

Scale (1 = Strongly disagree, 5 = Strongly agree) that asked participants to evaluate the

listening support they received from their coach, assistant coach, and athletic trainer before and

after they encountered a head injury.

Measurement

Concussion History

Participants were asked to indicate their history of concussion and other related brain

injuries. They were asked if they had ever sustained a concussion, as well as if they had ever

sustained a head injury that was never diagnosed as a concussion. They were then asked if they

had ever suffered from a head injury that was never diagnosed as a concussion, but as an injury

that they believe was a concussion. The last question in this section asked if participants had

more than one concussion or other sport related head injury.

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Knowledge and Attitude

To assess the participants knowledge and beliefs towards concussions and head injuries, as well

as their perceptions of the knowledge of their coaches, assistant coaches, and athletic trainers, we

presented a series of statements that required participants to either agree or disagree with the

statement with a yes or no answer. Statements in this section included ones regarding

terminology that is synonymous with the word concussion, proper concussion management,

and instructions the participant may receive from their coaches after sustaining an injury.

Perceived Listening Support

To assess participant perceptions of listening and social support from athletic personnel, a

series of six statements were provided on three different Likert scales. All three scales presented

the same statements, but there were separate scales for evaluations of coaches, assistant coaches,

and athletic trainers. Participants were presented with 5-point Likert scales of 1 = strongly agree

to 5 = strongly disagree. Statements involved the extent of listening support that participants

received from their athletic personnel before and after sustaining a concussion or other injury, as

well as how much this listening and social support contributed to the participants well-being and

satisfaction.

Items presented on the scale measuring the perceived support of coaches showed

excellent reliability (alpha = .946), as did the scale measuring perceived support of assistant

coaches (alpha = .925). The scale measuring the perceived support of athletic trainers had good

reliability (alpha = .888).

Results

Knowledge and Beliefs

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When assessing the knowledge of our participants, we found that 76.25% of them (N =

61) were unable to correctly identify terminology that is synonymous with a concussion, 77.5%

of them (N = 62) answered positively to suspending game play following a head injury, and that

92.5% (N= 74) answered that it was necessary to report concussion symptoms. While the

majority of participants had beliefs about managing concussions that correspond with what

medical professionals would suggest, most of them were unable to recognize a common term

that is synonymous with sustaining a concussion.

Relationship Between Knowledge and Perceptions of Coach Support

To assess the impact of a coachs listening and social support on their athletes, we

conducted a series of independent t-tests to compare the athletes level of knowledge with their

perception of how important the support of their coaches are. A total of three t-tests were done to

analyze this, and none of the tests produced significant results.

The first independent t-test compared the participants understanding of common

concussion terminology with how much they rely on coach support. Those who correctly

recognized the terminology as being synonymous with sustaining a concussion (N = 19) reported

very similar perceptions of the importance of coach support as those who failed to recognize the

terminology (N = 61). Those who answered correctly (M = 3.93, SD = 1.16) surprisingly

reported slightly higher levels of reliance on coach support compared to those who answered

incorrectly (M = 3.58, SD = 1.2). However, there is no significance at t(78) = -.249, p < .05.

The second independent t-test compared the participants beliefs about how best manage

head injuries with how important their coachs support was. The results showed that those who

think it is necessary to suspend gameplay after being injured (N = 62, M = 3.67, SD = 1.21)

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relied on coach support just as much as those who did not think it was necessary (N = 18, M =

3.6, SD = 1.12). This test produced no significant results at t(78) = .124, p < .05.

The final t-test in this portion of the study compared the participants belief that

concussion symptoms do or do not need to be reported with the way they view coach support.

While almost everybody responded that they believe concussion symptoms do need to be

reported (N = 74), there was no significant difference in their perception of coach support

compared to those who believe that concussion symptoms do not need to be reported (N = 6).

Positive attitude towards reporting (M = 3.65, SD = 1.2) vs. negative attitude towards reporting

(M = 3.78, SD = 1.15) showed no significant difference, t(78) = -.249, p < .05.

Relationship Between Coach Knowledge and Participant Perception of Coach Support

The next set of independent t-tests assessed the relationship between the coachs level of

knowledge, as perceived by the participant, with how important coach support was before and

after sustaining an injury. A total of five tests were done to assess this, and none of them showed

significance.

One independent t-test compared a coachs views on continued game play following a

head injury with the level of perceived support from the coach. According to 80% of participants

(N = 64), their coaches do not expect them to continue game play after sustaining a head injury.

However, the remaining 20% (N = 16) who believes their coaches would expect them to play

had almost equal perceptions of support from their coach (M = 3.2, SD = 1.28) as those with the

opposite belief (M = 3.78, SD = 1.15). This test produced no significant results at t(78) = 1.755,

p < .05.

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Another independent t-test compared coachs perceptions of the importance of winning to

how much support they provided their athletes. 73.75% (N = 59) of participants stated that their

coach is more concerned with their health than they are with winning the game, while the

remaining 26.25% (N = 21) felt that their coach was more concerned with winning than making

sure they received the proper medical treatment for a head injury. Both groups, however, viewed

coach support in a relatively equal manner; (N = 59, M = 3.75, SD = 1.16) and (N = 21, M = 3.4,

SD = 1.28). This test produced no significant results at t(78) = 1.181, p < .05.

Another independent t-test compared the way coaches handle head injuries with their

level of support as perceived by the participant. 70% of participants (N = 51) believe that their

coaches would refer them to medical personnel after experiencing concussion symptoms, and the

remaining 30% (N = 24) did not believe their coaches would do this. Both groups reported

similar perceptions of coach support, (N = 56, M = 3.65 SD = 1.14) and (N = 24, M = 3.68, SD =

1.34). This test was not significant at t(78) = -.132, p < .05.

The next independent t-test compared the way participants view their coachs knowledge

of concussions with the way they perceive their listening support. 77.5% of participants (N = 62)

indicated that their coaches do believe concussion symptoms always need to be reported, and

22.5% (N = 18) did not think that their coaches believe that concussion symptoms always need

to be reported. Those who believed that their coach perceived concussion reporting as important

had similar perceptions of their coachs listening support (N = 62, M = 3.70, SD = 1.10) when

compared to those who believed that their coach did not perceive concussion reporting as

important (N = 18, M = 3.50, SD = 1.51). The results of this test were not significant at t(78) = -

.683, p < .05.

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The last independent t-test compared the participants obedience towards coach orders to

the perceived level of support from this coach. 55% of participants (N = 44) stated that they

would obey their coachs orders if they were instructed to return to game play immediately after

suffering a head injury, while 45% (N = 36) would not obey their coach if they instructed them

to return to game play immediately after suffering a head injury. However, despite the differing

views of these two groups, perceptions of coach support were very similar. Those who would not

obey their coach (N = 36, M = 3.75, SD = 1.28) viewed their coachs listening support almost

exactly as those who would obey their coach (N = 44, M = 3.59, SD = 1.13). This test produced

no significance at t(78) = .605, p < .05.

While our goal was to test the impact that only the head coachs listening and social

support had on their athletes, we performed the same set of t-tests to test the impacts that

assistant coaches and athletic trainers had on their athletes. The results for these two athletic

personnel did not produce any significance, except the for the independent t-test that compared

an athletic trainers views on continued game play following a head injury with the level of

perceived support from the athletic trainer. This test showed significance at t(78)=2.230, p < .05.

Perceptions of Coaches, Assistant Coaches, and Athletic Trainers

A series of correlations were performed to test if there is a relationship between the

perceived support of head coaches, assistant coaches, and athletic trainers. Correlations were

done to determine the relationship between levels of support before the injury was sustained and

after, as well as how satisfied the participant was with the level of support they received before

and after the injury.

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The first correlation tested the relationship between perceived supports of all three

athletic personnel prior to the participant being injured. When comparing perceived levels of

listening support from the head coach with that of the assistant coach, there was a strong positive

correlation at r(80) = .768, p < .001. When comparing perceived levels of listening from the head

coach with that of the athletic trainer, there was a strong positive correlation at r(80) = .563, p <

.001. When comparing perceived levels of listening supports from the assistant coach with that

of the athletic trainer, there was a strong positive correlation at r(80) = .632, p < .001.

The next correlation tested the relationship between the perceived support from coaches,

assistant coaches, and athletic trainers with regards to how much it contributed to the

participants well-being prior to being injured. When comparing the contribution the head coach

made to the participants well-being with that of the assistant coach, there was strong positive

correlation at r(80) = .777, p < .001. When comparing the contribution that the head coach made

to the participants well-being with that of the athletic trainer, there was a strong correlation at

r(78) = .699, p =.0. When comparing the contribution that the assistant coach made to the

participants well-being with that of the athletic trainer, there was a strong positive correlation at

r(80) = .768, p < .001.

The next set of correlations tested the relationship between perceived supports of all three

athletic personnel after the participant sustained an injury. When comparing perceived levels of

listening support from the head coach with that of the assistant coach, there was a strong positive

correlation at r(80) = .628, p < .001. When comparing perceived levels of listening support from

the head coach with that of the athletic trainer, there was a moderate positive correlation at r(80)

= .487, p < .001. When comparing perceived levels of listening support from the assistant coach

with that of the athletic trainer, there was a strong positive correlation at r(80) = .709, p < .001.

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The last set of correlations tested the relationship between the perceived support from

coaches, assistant coaches, and athletic trainers with regards to how much it contributed to the

participants well-being after sustaining an injury. When comparing the contribution the head

coach made to the participants well-being with that of the assistant coach, there was a strong

positive correlation at r(80) = .698, p < .001. When comparing the contribution the head coach

made to the participants well-being with that of the athletic trainer, there was a strong positive

correlation at r(80) = .536, p <.001. When comparing the contribution of the assistant coach to

the participants well-being with that of the athletic trainer, there was a strong positive

correlation at r(80) = .731, p < .001.

Discussion

Based off of the results of our series of independent t-tests, our first hypothesis, which

stated that athletes rely on the knowledge of their coaches rather than their own knowledge and

beliefs when assessing how to manage and cope with a concussion or head injury, was not

supported. In our study, the results showed that it did not matter whether or not an athlete had

correct perceptions of concussion management or an adequate understanding of concussion

terminology, they had similar perceptions of the importance of coach and trainer support.

However, our second hypothesis, which stated that coaches, assistant coaches, and athletics all

play an equal role in helping the injured athlete recover and cope with their head injury, was

partially supported by the results of the correlation. The correlation does not tell us the exact

strength of the relationship, but we can conclude that there is a relationship between the importance

of the head coachs listening and social support and that of the assistant coaches and athletic

trainers. This information is important to the average person because it tells us that we need to

focus on the individuals knowledge and beliefs towards concussions as we implement further

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education programs and campaigns to spread awareness regarding the severity of concussions and

traumatic brain injury. While it is important that coaches and athletic trainers are adequately

equipped to handle traumatic head injuries, our study shows that people pay more attention to their

person instincts rather than to what their coaches and trainers are saying.

A persons reaction to sports related head injuries and concussions can vary widely, and

both the severity and the duration of the injury can depend on a number of factors. At times,

symptoms can be observed instantly on the field, such as when the player displays loss of

consciousness or confusion. Previous studies and research have found that concussions

symptoms can be found through careful neurocognitive testing by use of speech-language

pathology. (Harmon et al., 2013; McCrea et al., 2013) While managing concussions, it is

important to use an interdisciplinary team of professionals working together to analyze

symptoms and behaviors in different scenarios to make the best decisions regarding return to

play. (Harmon et al., 2013)

As mentioned in the article Speech-language pathology and concussion management in

intercollegiate athletics: The Miami University Concussion Management Program, to set up an

interdisciplinary team of professionals that can suitably manage concussions, great

communication is necessary to provide reliable and efficient services. Therefore, building trust

and establishing collaboration is key to having logical recommendations for the athlete. (Porter,

K. K., Constantinidou, F., & Marron, K. H., 2014) Furthermore, the concussion management

team should work to provide reliable education on the signs, symptoms, and risks associated with

concussions or other traumatic head injuries, as well as collect baseline neurocognitive data to

better detect when an athlete has sustained a concussion (Bramley et al.,2012).

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Limitations

With the research being conducted at a college campus, and the hypothesis being based on

current collegiate athletes or former athletes at the high school or collegiate level, we were

limited to a small population. The study was conducted at Bryant University, a private

university, which limits diversity because of the economic toll it takes on families for students to

attend this university. With the high prices to attend this college, it takes many of the lower

middle class, to low class college students out of the research. Although socioeconomic class

does not affect concussions in sports, having a majority of the research done on students who

attend a private university makes the population less diverse.

Because the focus of the research was on college aged athletes, or college students who

previously participated in athletics, the sample was limited. The age of the participants were

between 18 and 23, and it was made a point to avoid giving the surveys to high school aged or

younger students, because of the ethical issues associated with conducting research with

adolescents. The research provided was not conducted using a random sample, and with sport

affiliation by the researchers who conducted the study, the gender of the sample is skewed.

With two members of the team being football players, and football being a sports with

severe effects of concussions, many of the survey participants were current or previous members

of the football team. With this being the case, many of the participants who then took the survey

were male, with a limited amount of females who participated. In the future, if this study were to

be recreated, it would be useful to have a more diverse sample having athletes from both male

and female. With the research study being conducted in a time where there is concussion

research and awareness increasing, some of the answers from the participants could have been

skewed not by relationships with coaches, but by the media. With questions from the survey

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asking about how severe concussions are, and if concussions should hold an athlete out of sports,

the participants could have answered the questions how they believe society as a whole would

have, not based on what they personally thought.

The research study was conducted on the relationship between a coach and an athlete,

and if the coaches support would affect the athletes ability to recognize and manage concussions.

With the majority of the participants playing football at the collegiate level, and being male,

there are some cultural and gender bias involved in decision making. With questions about

concussion symptoms, and if an athlete should return to athletic activity after suffering from

concussion like symptoms, some participants may have answered in a way that projected

masculinity and toughness rather than what they were taught about concussions and the negative

effects of returning to athletics after suffering a concussion. With gender equality and gender

biases dwindling in todays world, male athletes are still effected by general stereotypes that

rarely apply, but because of the stereotypes, the athletes feel as if they have to live up to those

standards. Because of the stereotypes linked to gender in athletics, the answers produced from

the participants could have been skewed.

The sample in the study was limited because of the size of the private university where

the study was conducted, Bryant University. As of 2014, Bryant University had about 3,200

undergraduate students. Comparing Bryant University to other colleges and universities, private

or public, is relatively small. Also, only about 15% of Bryant University are varsity athletes, so

that limits the sample even more so.

In the survey, in Section III, there are several questions that deal with listening supports

from an athletes, coach, assistant coach, and athletic trainer. While conducting the survey, many

of the participants were confused with the questions because of the use of the term listening

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support. With confusion on questions, the surveys may have been filled out without

understanding, which can affect the results. With the data found in our survey being self-

reported, it should be considered and used with caution. Despite the limitations we had while

conducting the research for the project, we feel as if we have interesting and necessary

information on concussion reporting due to coach relationships.

Future Research

Concussions and the effect they have on athletes, coaches, assistant coaches, and athletic

trainers leave opportunity for immense research done in this area. One encouraging trend we

found when conducting our research was the participants excitement and willingness to

complete a survey on concussions. Many of the participants were willing to complete a survey on

concussions, because it is known among athletes the importance of concussion research, and

with concussion research being conducted, there is more of a chance of safety in sports.

With the research found in our project, it is encouraged for future teams to take a more in

depth look at how trainers affect a players chances of reporting injuries in general, as well as

concussions. While this research conducted base findings, with a general set of questions, it

would be interesting to conduct a study on a step by step sequence of events following a sports

related injury or concussion. If a survey was given regarding the questions an athletic trainer

asked, the tests they conducted on an athlete, and if the trainer did or did not have a second

opinion on the athlete. This type of study could specifically gauge whether or not the athlete

believed the tests being conducted by the athletic trainer were useful or not, if the rehab was

conducive with recovery, and if they believe the athletic trainer overall was handling the sports

related injury or concussion correctly. Through previous research and through our findings, it

was found that among an athletes head coach, assistant coach, and athletic trainers, that an

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athletes head coach gives an athlete the least amount of support prior to a concussion, during,

and during rehabilitation. With a head coach of at least collegiate athletes being the person who

has the final say on whether they want that one athlete to be a part of their program, one would

believe that the head coach would be truly invested in each player, especially if a player suffers

from an injury. Our team would like to encourage future research teams to discover why the head

coach does not support players as much as assistant coaches and athletic trainers. Also, through

research on head coach support with athletes with concussions, questions can be used in a survey

on how athletes believe support can be increased by their head coach, and how the athlete can

build more of a personal relationship with their head coach.

Another interesting future research topic would be a players willingness to return to

athletic play following a concussion compared to a doctor or athletic trainers recommendation.

In the survey we conducted there were questions about reporting concussion symptoms or

obeying a coach orders to return to sport after suffering from concussion like symptoms, but it

would be interesting to see if an athlete, after returning to full health from a concussion, would

be willing to return to the sport. There are many examples in the NFL, college football, college

rugby, college soccer, and other collegiate and professional sports with athletes stepping away

from large contracts, endorsements, and scholarships because of their concussion and head

injuries. But, there are many athletes who have had history of concussions and concussion like

symptoms who continue to play their sport. Thereofre, it would be interesting to see a study

conducted on both pro and collegiate athletes, and their willingness to return to the sport they

play after enduring a sport induced concussion.

An athlete who as suffered several concussions is likely to have long lasting or permanent

symptoms from repeated head and brain trauma. There have been studies conducted on deceased

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athletes, to see if there was permanent damage to their brains after playing professional contact

sports, but it would be interesting to conduct a study on living retired athletes and if the

symptoms they have could have been avoided. While knowledge and studies on concussions

have been increasing since the early 2000s, many athletes who participated in professional

sports before the turn of the century are left with injuries that they were not aware of. Many

sports, including football, had helmets and other protective padding that was not adequate, and

left athletes unprotected on the field or court.

Doing a study to see what, if any, measures were taken to help athletes from the 1980s to

the 1990s avoid concussions, and if they were educated about the negative effects of not

reporting symptoms would be helpful and informative to society. It would also be useful to

conduct a long-term study on young athletes and how their knowledge of concussions can help

prevent concussions in the future. If a research group were able to take a group of young talented

athletes and teach them of all the symptoms, negative effects, and the need to report concussion

symptoms, and follow them throughout their athletic careers while teaching them the new and

innovative practices along the way, this could provide significant insight into the ways

concussions are viewed and handled. Comparing these athletes to other athletes from the same

age group would be interesting to see the effects of knowledge on the athletes. A similar study

could be done that focuses on the parents of the athletes, researching the need for educating the

parents and to see if the knowledge of the athletes caregiver can affect concussion reporting or

avoidance.

Conclusion

In conclusion, it is very important that coaches, along with the assistant coaches and

athletic trainers, learn and understand what symptoms and signs of concussions or head injuries

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look like, even under tense and stressful natures of gameplay. It is even more pivotal for high

school coaches and those coaching younger athletes, from football to soccer to gymnastics, to

understand the signs that might lead to or be concussion. As we see in the news and media,

concussions are much more talked about and relevant today than ever before.

In recent events, possibly the most prominent story related to tragedy and concussion in

sports was the case of Junior Seau, the former NFL linebacker whose last season was with the

New England Patriots. After sitting out for his freshmen year at the University of South Carolina,

he was able to play for the three years, until he was drafted in the 1990 NFL Draft in the first

round (overall pick #5). He had experience playing for the San Diego Chargers and Miami

Dolphins before finally retiring with New England in 2009. His professional football career

lasted a lengthy 20 seasons. It was only three years after retiring from the NFL that Seau

unfortunately took his life. He was alone in his home at the time when his girlfriend found him

with a self-inflected gunshot wound to his chest. As studies emerged from the National Institute

of Health (NIT), it was found the Seau did not suffer a major concussion, but instead had signs of

chronic traumatic encephalopathy, or CTE, which happens as a result of concussion-based brain

damage. (Smith) A long term side effect as a result of both concussions and CTE can be

depression. Suicides and head injuries in sports are and have been synonymous throughout

history and all though one cannot predict the outcome of an athlete who has suffered some

degree of injury, we should focus our attention at prevention on a full scale.

Today, there is increasing work on how the game of football, or other contact sports, can

become safer for the participating athlete, whether in the form of new advances in players gear

and helmets, or in the knowledge and education that is required to fulfill concussion reporting

and successful treatment and management. Numerous studies have been done using many

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different approaches and methods and we hope that future research like this one, can only help

athletes, coaches and trainers likewise, of all levels and all ages to better report concussion

symptoms, be familiar with the signs, and effectively manage those who have been diagnosed

with concussed brain trauma injuries.

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