Culture of Risk: Influence on Traumatic Brain Injuries Paul Bruning, MA ATC Clinic Manager Woodlake, Spinecare, and OrthoQuick

Objectives Review concussion definition and rates Understand CDC “Heads Up” program Understand the Culture of Risk and influence on concussion factors The general problem occurs as the culture of risk decreases the understanding of the consequences of concussion and encourages concealing s/s of concussion.

Traumatic Brain Injury/Concussion Definition of concussion remains debated End of the 1990’s; >20 scales existed for grading concussion and determining return to play Large number of those with Traumatic Brain Injuries (TBI) do not seek care Sojka, 2011

Rate of Concussion World Health Organization - >600 per 100,000 annually. (Sojka, 2011) Center for Disease Control and Prevention US ED’s treat >135,000 sports and recreation- related TBI’s annually. (Sarmiento, Mitchko, Klein, & Wong, 2010). 7.3 million high school athletes, estimated 1.6 – 3.8 million sport related concussions. (Frommer et al., 2011).

CDC – “Heads Up” 2005 CDC Initiated “Heads Up: Concussion in High School Sports” –Tool kit of educational materials –Sarmiento et al. (2010) barriers to management of concussions June 2011, Minnesota passed concussion law requiring coach and participant concussion education

“Culture of Risk” Expressed by Nixon (1993) to describe public culture of risk, pain, and injury in sport Athletic participation culture exalts –Pain –Injuries –Playing hurt

“Culture of Risk” Can foster –Guilt –Shame –Uncertainty –Job insecurity –Frustration if complain of pain or injury –Depression Nixon, 1993

Who is responsible for culture of risk? Parents Coaches Media Athletes

Risks Adults determine potential for young athletes Parental hopes for professional careers or scholarships Commercial Bergeron, 2010

Risks Coaches contribute to normalization of pain and injuries for athletes Support sacrifice and striving for greatness Encourage rejecting limits and pushing to edge Espouse playing hurt and risk taking Nixon, 1994

Risks Media –Kerri Strug –Curt Schilling –Brett Favre

Question Who was on the 1996 Olympic Gold Medal Team with Kerri Strug? –Shawn Johnson –Amanda Borden –Sabrina Vega –Dominique Moceanu

Risks Athletes themselves –Sense of invulnerability –Feeling of letting the team down –Do not want to be branded “wimp” –"I'm lucky to even be alive," Saum said. "I almost died for my team and honestly, now that I think about it, even if I went back and I had to make the same decision again, I would still have a hard time not playing and disappointing the team."

Summary No accurate assessment of true prevalence Just beginning to develop evidence-based diagnostic and treatment for concussion Multiple complicating factors Need for continued research and education

References Bergeron, M. (2010). The young athlete: Challenges of growth, development, and society. Current Sports Medicine Reports, 9(6), Frommer, L., Gurka, K., Cross, K., Ingersoll, C., Comstock, D. et al. (2011). Sex differences in concussion symptoms of high school athletes. Journal of Athletic Training, 46(1), Nixon, H. (1993). Accepting the risks and pain of injury in sport: Mediated cultural influences on playing hurt. Sociology of Sport Journal, 10, Nixon, H. (1994). Coaches views of risk, pain, and injury in sport with special reference to gender differences. Sociology of Sport Journal, 11,

References Sojka, P. (2011). Sport and non-sport concussions. Canadian Medical Association Journal, 183(8) Sarmiento, K., Mitchko, J., Klein, C., & Wong, S. (2010). Evaluation of the Centers for Disease Control and prevention’s concussion initiative for high school coaches “head’s up: concussion in high school sports”. Journal of School Health, 80(3)