SURVEY OF STUDENT DISABILITIES SERVICES’ CURRENT
PERCEPTIONS ON CONCUSSIONS AND/OR MILD TRAUMATIC BRAIN
INJURIES AND CURRENT DISABILITY ACCESS ACCOMMODATIONS
AVAILABLE TO RECOVERING COLLEGIATE ATHLETES

A THESIS
Submitted to the Faculty of the School of Graduate Studies
and Research
of
California University of Pennsylvania in partial
fulfillment of the requirements for the degree of
Master of Science

by
Andrew James Jakiel, ATC

Research Advisor, Dr. Ellen J. West
California, Pennsylvania
2013

ii

CALIFORNIA UNIVERSITY of PENNSYLVANIA
CALIFORNIA, PA

THESIS APPROVAL

Graduate Athletic Training Education

We hereby approve the Thesis of

Andrew James Jakiel, ATC
Candidate for the degree of Master of Science

Date

Faculty

____________

___________________________________
Ellen J. West, EdD, ATC(Chairperson)

____________

___________________________________
Linda Platt Meyer, EdD, ATC, PES

____________

___________________________________
Samuel Cervantes, MS, ATC

iii

ACKNOWLEDGEMENTS

Thank you to my wonderful family and friends who have
supported me over the years in my pursuit of obtaining a
Master’s Degree and in every endeavor I have undertaken.
Your constant support and belief has helped me to achieve
many of the goals I have set for myself and has helped
shape me into the person I am today.
I would also like to thank Ellen J. West, EdD, LAT,
ATC, Linda Platt Meyer, EdD, LAT, ATC, PES and Samuel
Cervantes, MS, ATC for serving on my thesis committee.
This thesis is dedicated to my loving father who
passed away from lung cancer this past year. Thank you for
always pushing me to excel in all of life’s endeavors and
for keeping me focused and on track. You are forever missed
but not forgotten. I hope I continue to make you proud and
bring honor to our family.

iv

TABLE OF CONTENTS
Page
SIGNATURE PAGE

. . . . . . . . . . . . . . . ii

AKNOWLEDGEMENTS . . . . . . . . . . . . . . . iii
TABLE OF CONTENTS
LIST OF TABLES
INTRODUCTION
METHODS

. . . . . . . . . . . . . . iv

. . . . . . . . . . . . . . . vii

. . . . . . . . . . . . . . . . 1

. . . . . . . . . . . . . . . . . . 5

Research Design
Subjects

. . . . . . . . . . . . . . 6

. . . . . . . . . . . . . . . . . 7

Preliminary Research. . . . . . . . . . . . . 9
Instruments . . . . . . . . . . . . . . . . 10
Procedures

. . . . . . . . . . . . . . . . 11

Hypotheses. . . . . . . . . . . . . . . . . 13
Data Analysis
RESULTS

. . . . . . . . . . . . . . . 14

. . . . . . . . . . . . . . . . . . 15

Preliminary Study . . . . . . . . . . . . . 15
Demographic Information
Hypothesis Testing

. . . . . . . . . . . 16

. . . . . . . . . . . . . 19

Additional Findings . . . . . . . . . . . . . 21
DISCUSSION . . . . . . . . . . . . . . . . . 28
Discussion of Results . . . . . . . . . . . . 30
Recommendations for Future Research. . . . . . . 34

v
Implications to the Profession

. . . . . . . . 36

Conclusions . . . . . . . . . . . . . . . . 37
REFERENCES . . . . . . . . . . . . . . . . . 41
APPENDICES . . . . . . . . . . . . . . . . . 44
APPENDIX A: Review of Literature

. . . . . . . . 45

Introduction . . . . . . . . . . . . . . . . 46
Current Protocols and Statements . . . . . . . . 46
Incidence and Reporting

. . . . . . . . . . . 50

Management and Reporting . . . . . . . .

. . . 54

Changes in Cognitive Functions . . . . . . . . . 60
Neuropsychological Changes and Challenges . . 66
Post Concussive Syndrome . . . . . . . . . . . 68
Perception of MTBI and Services Required. . . . . 73
Academic Support and Accommodations. . . . . . . 76
Summary. . . . . . . . . . . . . . . . . . 80
APPENDIX B: The Problem . . . . . . . . . . . . 81
Statement of the Problem . . . . . . . . . . . 82
Definition of Terms . . . . . . . . . . . . . 82
Basic Assumptions . . . . . . . . . . . . . . 83
Limitations of the Study . . . . . . . . . . . 83
Delimitations of the Study . . . . . . . . . . 84
Significance of the Study

. . . . . . . . . . 84

APPENDIX C: Additional Methods .

. . . . . . . . 86

Informed Consent Form (C1) . . . . . . . . . . 87

vi
IRB: California University of Pennsylvania (C2) . . 89
Panel of Experts Letter

(C3) . . . . . . . . . 90

Email to Participants (C4) . . . . . . . . . . 92
Jakiel OSD Perceptions Concussion and/or
MTBI Survey (C5) . . . . . . . . . . . . . . 93
REFERENCES . . . . . . . . . . . . . . . . . 105
ABSTRACT

. . . . . . . . . . . . . . . . . 111

vii

LIST OF TABLES
Table

Title

Page

1

Jakiel OSD Perceptions
Concussions and/or MTBI Survey Variables. . 7

2

Frequency Table of Demographic

3

Frequency Table of Participant Gender . . . 18

4

Frequency Table of Staff Size . . . . . . 18

5

Frequency Table of Employment Status . . . 18

6

Contact and Comfort Means

7

Disability access accommodations most
commonly requested and approved. . . . . . 22

8

Frequency Table of Familiarity,
Medical History , Familiar with
guidelines, & ATS collaboration
with Concussions/MTBI . . . .

9

Frequency Table of Terms of Concussion
vs. MTBI
. . . . . . . . . . . . . 24

10

Frequency Table of Yearly Average of
Concussion/MTBI cases . . . . . . . . . 25

11

Frequency Table of Average Visits
to OSD . . . . . . . . . . . . . . . 25

12

Frequency Table of Liaison between OSD
and ATS . . . . . . . . . . . . . . . 26

13

Frequency Table of Perception
If enough is being done in regards to
Education on Concussions/MTBI?. . . . . . 26

14

Frequency Table on Need for
Enhanced Communication Between
OSD and Athletic Training Departments . . . 26

. . . . . 17

. . . . . . . 21

Previous
Zurich
for protocols
. . . . . 23

viii

15

Frequency Table of Attendance and
Interest in Attending Educational
Lectures on Concussions/MTBI. . . . . . . 27

16

Frequency Table of Cost and Willingness
to Attend Educational Lectures. . . . . . 28

17

Frequency Table on Need for
Enhanced Communication Between
OSD and Athletic Training Departments.

. 28,40

1

INTRODUCTION

The purpose of this study was to examine the current
perceptions, protocols and disability access accommodations
most commonly requested and approved by a university’s
office of student disability services (OSD) for postsecondary student-athletes recovering from concussions
and/or mild traumatic brain injuries (MTBI). Concussion is
defined as a traumatically induced transient disturbance of
brain function and is caused by a complex pathophysiologic
process.1 Concussions have also been referred to as mild
traumatic brain injuries (MTBI).1 While all concussions are
MTBIs, not all MTBIs are concussions.1 Concussions are a
subset of mild traumatic brain injury on the less severe
end of the brain injury spectrum and are generally selflimited in duration and resolution.1

It is important to

examine this problem because the effects of a concussion
and or mild traumatic brain injury may impair an athlete
not only from an athletic standpoint but additionally can
interfere with academic success and activities of daily
living.2-4,6,8-9,8-10 Collaboration between the sports medicine
staff and OSD will provide a holistic approach to the

2
education, evaluation, treatment, and recovery from
concussions and MTBI.
Several key guidelines and return to play protocols
have been established by the 1st, 2nd, and 3rd International
Conferences on Concussions and the National Athletic
Trainers’ Association Position Statement: Management of
Sport-Related Concussion.2-4 However, an athletic trainer
(AT) can’t assume that these advances in concussion and
MTBI protocol are common knowledge among every professional
employed at a university. Having found little literature
and evidence on the current perceptions of OSD
professionals and the most commonly requested and approved
disability access accommodations provided for recovering
post-secondary student-athletes, there is a need for future
research.
Since sport medicine staffs and academic affairs have
a vested interest in a university’s student-athletes, it is
imperative that everyone involved is familiar with the
current concussion and/or MTBI protocols both from a return
to play standpoint as well as an academic one. By
evaluating the current perceptions and familiarity of a
university’s office of student disabilities with
concussions and/or MTBI, an AT could provide critical
information that would aid in a student-athlete’s recovery

3
and success both on and off the field.11-14 The AT could aid
in the manner that professionals working in the OSD are
educated in concussions and/or MTBI and their impairments
on cognitive functioning. Through this collaborating, the
AT would also learn what accommodations are available and
recommended/approved by the OSD for these recovering
student-athletes.
The goal of increasing rapport and communication
between these two sectors would allow for optimal care of
an injured student-athlete, along with enhancing the
knowledge base of both sectors.11 Athletic trainers (ATS)
could identify trends and areas that require further
education with the potential of creating a liaison position
between the two sectors.
The purpose of this study and survey was to identify
the current perceptions in the realm of concussions and
MTBI among professionals working in OSD. Identification of
areas for advancing education, gaining a better
understanding of disability access accommodations most
commonly requested and approved to the recovering studentathletes, and the creation of a synergistic collaboration
between the OSD and an AT staff are hopeful potential
outcomes of this study. Establishing an initial framework
for future research and communication between the two

4
sectors will enhance a university’s ability to holistically
meet the needs and challenges facing today’s post-secondary
student-athlete.

5
METHODS

The purpose of this study was to assess the current
perceptions and familiarity of student disability services
professionals in regards to concussions and/or MTBI and to
identify the most commonly requested and approved
disability academic access accommodations available to
post-secondary student-athletes. A survey was distributed
electronically among professionals working in the office of
student disabilities/student disability services at
collegiate institutions in the Mideast and Great Lake
regions. The Mideast and Great Lake regions were selected
using the National Center for Educational Statistics
CollegeNavigator Tool
(http://nces.ed.gov/collegenavigator/). CollegeNavigator is
a free tool for use in the public sector. The Mideast
region and Great Lakes region are comprised of the
following states: IL, IN, NY, NJ, PA, DC, DE, MD, MI, OH
and WI. The survey evaluated what academic disability
access accommodations are most commonly requested for and
approved for the recovering student athlete. Additionally,
the survey examined how the student disability service
professionals equated the two terms “concussion” and “mild
traumatic brain injury” when used to describe an injury,

6
the average number of concussions and/or MTBI seen each
year by the OSD from student-athletes, and the average
number of visits these student-athletes utilized to the OSD
during their recovery. This section will include the
following subsections: Research Design, Subjects,
Instruments, Procedures, Hypotheses, and Data Analysis.

Research Design

A descriptive study was utilized in the research design
with the Jakiel OSD Perceptions Concussions and/or MTBI
Survey distributed among 399 four-year universities with
men and women’s varsity athletics to current OSD
professionals working at their respective institution’s
post-secondary OSD.

The Jakiel OSD Perceptions Concussions

and/or MTBI Survey was generated through SurveyMonkey® and
distributed via email by the primary researcher. Variables
of the Jakiel OSD Perceptions Concussions and/or MTBI
Survey can be seen below (Table 1).

7
Table 1. Jakiel OSD Perceptions Concussions and/or MTBI
Survey Variables
Variables
Basic demographic information
Athletic governing body
Disability access accommodations most
commonly requested and approved
Number of concussions and/or MTBI by
student-athletes seen each year by OSD
What the OSD professional equated the severity
of the terms “concussions” and “MTBI”
If the OSD professional was familiar with
current Zurich concussion and/or MTBI protocols
Average number of visits a student-athlete
recovering from a concussion and/or MTBI
utilized the OSD
Number and employment status of all staff in OSD
If the OSD professional feels enough has been
done to educate on concussion and/or MTBI
If the OSD professional had direct contact with
their university’s athletic training staff
Had the OSD professional worked with an AT or
sports medicine staff member to develop concussion
and/or MTBI management and protocol for student-athletes
How often did the OSD professional have contact with their
university’s AT staff or sports medicine staff regarding
student-athletes who had been diagnosed with concussions
and/or MTBI
How comfortable was the OSD professional in managing and
directing a student-athlete suffering a sports related
concussion and/or MTBI from an OSD standpoint
If there was a liaison between the OSD and the
athletic training staff

Subjects

The subjects used in this study included 133 male and
female full-time OSD employees from Division I, II, III,
NAIA, and other athletic governing body affiliation
collegiate institutions within the Mideast and Great Lake

8
regions as defined by the Center for Educational Statistics
CollegeNavigator Tool. The Jakiel OSD Perceptions
Concussions and/or MTBI Survey was distributed
electronically to the OSD professionals currently employed
in the above mentioned athletic governing body
affiliations. The entire sample received an email with a
link and instructions on completing the survey. The first
page of the survey contained a cover letter informing the
participants (Appendix C3) of their role in the study and
their ability to end participation at any time.

The

subjects completed the survey electronically via the
Internet on SurveyMonkey®, and implied informed consent was
given upon completion and submission of the survey to the
researcher. The study was approved by the Institutional
Review Board (Appendix C2) at California University of PA.
Participation in the study was voluntary based upon
completion of the survey and subjects could choose to
terminate their participation in the study at any time.
Each participant’s identity remained confidential and was
not included in the study. The survey remained on a secure
password protected website (www.surveymonkey.com) and only
the researcher and research advisor have access to the
surveys.

9
Preliminary Research

A panel of experts reviewed the survey before any
research was conducted. The panel members, whom are faculty
members at California University of Pennsylvania (CAL U),
added to the content validity of the survey and made
suggestions for any necessary changes. The panel consisted
of certified athletic trainers and the director of the OSD
at CAL U with experience and knowledge of concussions
and/or MTBI and survey construction. The panel members were
sent a cover letter (Appendix C1) explaining the design and
the experts’ responsibilities in this study as well as the
researcher’s problem statement and a copy of the Jakiel OSD
Perceptions Concussion and/or MTBI Survey (Appendix C). The
panel members reviewed the survey instrument and added to
the content validity by making any recommendations for
improvement. After reviewing the survey, the panel members
provided critiques and changes that were reviewed for
revision. Necessary changes were made to the survey based
on critiques by panel of experts.
After the review by the experts, a preliminary
research study was administered to OSD professionals
working in the Pennsylvania State Athletic Conference to
test the effectiveness of the survey.

The surveys were

10
sent out electronically via email to the directors of each
institution’s OSD. The purpose of the preliminary study was
to establish reliability and validity of the survey.
However, an inadequate number of responses were gathered
from the preliminary study despite the efforts of the
researcher. Reminder emails and phone calls to the OSD for
each school were utilized to try to generate the necessary
responses, but failed to do so. Reliability and validity
were unable to be established. The time it took to complete
the survey was established at approximately five minutes.

Instruments

The Jakiel OSD Perceptions Concussion and/or MTBI
Survey (Appendix C1) was created by the researcher for the
purpose of evaluating the current perceptions professionals
in the OSD have on concussions and/or MTBI, along with
evaluating the most commonly requested and approved
disability access accommodations that are available to the
recovering student-athlete. The survey was created
electronically via www.SurveyMonkey.com. The subjects were
asked to complete demographic information including age,
gender, size and employment status of the staff working in
their respective OSD, if the OSD professional was employed

11
at the NCAA, NAIA, or other athletic governing body
affiliation. Subjects were also asked if they had
participated in a concussion and/or MTBI education training
sessions and their personal history of concussions and/or
MTBI. Additional questions were asked about how the subject
equates the terms “concussion” and “MTBI”, and if they were
familiar with the current universal concussion and/or MTBI
management protocol established by the Zurich conference.
Questions regarding if the subjects had worked with ATs to
develop concussion and/or MTBI management and protocols for
student-athletes, how often the subjects had contact with
their university’s AT staff regarding student-athletes who
had been diagnosed with concussions and/or MTBI, and how
comfortable the subjects were in managing and directing
student-athletes suffering from a sports related concussion
and/or MTBI from an OSD standpoint were also examined. The
survey took approximately five minutes for participants to
complete.

Procedures

The study was granted approval by the California
University of Pennsylvania Institutional Review Board
(IRB). Following approval, an email containing a link to

12
the Jakiel OSD Perceptions Concussions and/or MTBI Survey
was sent to all OSD professionals with a current email
account in the Mideast and Great Lake region. The first
page of the survey contained a cover letter (Appendix C3)
explaining the purpose and significance of the study. A
link in the email provided the OSD professionals with
direct access to begin the survey. Informed consent was
implied when the subjects clicked on the link at the bottom
of the email. An additional email was sent out one week
after the initial email as a reminder to complete the
survey. There was no obligation of the subjects to
participate. All subjects who completed the survey remained
anonymous with no way to trace answers back to one subject.
The risk was minimal in this study. The possible risk of
harm associated with this knowledge research was
psychological and dignitary in nature. Since the responses
of each individual are confidential, the risk posed was
small. Gathered data were analyzed and tested against the
hypotheses developed by the researcher.

13
Hypotheses

The following hypotheses were based on previous
research and the researcher’s intuition based on a review
of the literature.
1.

Division I OSD professionals will have worked
more frequently with an athletic trainer or
sports medicine staff member to develop a
concussion and/or mild traumatic brain injury
management protocol for student-athletes when
compared to OSD professionals from NCAA Division
II, III, NAIA, or other athletic governing body
affiliation.

2.

Division I OSD professionals will be
more comfortable in managing and directing a
student-athlete suffering a sports related
concussion and/or mild traumatic brain injury
from an OSD standpoint than OSD professionals
from NCAA Division II, III, NAIA, or other
athletic governing body affiliation.

14
Data Analysis

All data were analyzed utilizing SPSS Version 18.0 for
Windows at an alpha level of 0.05 (α ≤ 0.05). A Pearson Chi
Square test was used to analyze Hypothesis 1 to determine
if NCAA Division I OSD professionals have worked more
frequently with AT staff in the development of concussion
and/or MTBI management protocol when compared to their
Division II, III, NAIA, or other athletic governing body
affiliation counterparts. A Pearson Chi Square test was
used to analyze Hypothesis 2. This test was utilized to
determine if NCAA Division I OSD professionals are more
comfortable managing and directing a student-athlete
suffering from a concussion and/or MTBI from an OSD
standpoint than OSD professionals from Division II, III,
NAIA, or other athletic governing body affiliation.

15

RESULTS

The purpose of this study was to examine the current
perceptions of professionals working in the OSD in regards
to concussions and/or MTBI, and the most commonly requested
and approved disability access accommodations provided by a
university’s OSD for student-athletes recovering from a
mild traumatic brain injury. The following section contains
the data collected in the study and is divided into three
subsections: Preliminary Results, Demographic Information,
Hypothesis Testing and Additional Findings.

Preliminary Results

The preliminary study was conducted in the
Pennsylvania State Athletic Conference (PSAC). The Jakiel
OSD Perceptions Concussions and/or MTBI Survey was emailed
to 15 universities in the PSAC. California University of
Pennsylvania was not used in the study because the director
of the OSD was used during the creation of the survey and
served on the panel of experts. A reminder email was sent
out a week later asking for the OSD professional to retake
the survey to establish validity and reliability.

16
There were no issues reported navigating the Jakiel
OSD Perceptions Concussions and/or MTBI Survey during the
preliminary study. The time of completion was also
established during the preliminary study. Eighty-eight
point nine percent (88.9%) of participants stated the
survey took approximately 5 minutes. A total of 10
responses were collected with 9 completed surveys.

After

contacting the OSD for each institution by phone and email
to request participation, an adequate amount of responses
was not collected for the second round of surveying.
Reliability and validity were not able to be established.

Demographic Information

The Jakiel OSD Perceptions Concussions and/or MTBI
Survey was sent out to 399 OSD contacts from the Mideast
and Great Lake Regions. The Mideast and Great Lake Regions
are comprised of the following states: IL, IN, NY, NJ, PA,
DC, DE, MD, MI, OH and WI as classified by the
CollegeNaviator Tool from the National Center for
Educational Statistics. A total of 133 surveys were
returned (33.33%) with 118 fully completed (29.57%). There
are currently approximately 1,300-1,500 NCAA and NAIA
member institutions in the United States. The sample size

17
surveyed made up approximately 26.60%-30.68% of all NCAA
and NAIA member institutions. Eight point eighty-six
percent (8.86%) to ten point twenty-three percent (10.23%)
of all NCAA and NAIA member institutions responded with
seven point eighty-seven percent (7.87%) to nine point
eight percent (9.08%) fully completed the Jakiel OSD
Perceptions Concussions and/or MTBI Survey. The sample
consisted of OSD professionals from the following
collegiate affiliations: NCAA Division I (28), NCAA
Division II (23), NCAA Division III (57), NAIA (6), and
other athletic governing body affiliation (11). A frequency
table of demographics is shown in Table 2.
Table 2. Frequency Table of Demographic
Athletic
Number of
Percent
Governing Respondents
Body
I
28
22.4
II
23
18.4
III
57
45.6
NAIA
6
4.8
Other
11
8.8
Total
125
100.0
All participants were 18 years of age or older. Out of the
133 surveys collected, 125 reported their gender, 8 chose
to omit to answer. Table 3 represents the gender of the
participants.

18
Table 3. Frequency Table of Participant Gender
Gender
Frequency
Percent
Male
20
16
Female
105
84

Information was gathered regarding the size of each
respondent’s staff in the OSD and the employment status of
the staff. A frequency table of the size of the OSD staff
and their employment statuses are represented by Table 4
and Table 5.

Table 4. Frequency Table of Staff Size
Staff
Number of
Percent
Size
Respondents
1
2-3
4-5
5+
Total

44
48
17
16
125

35.2
38.4
13.6
12.8
100

Table 5. Frequency Table of Employment Status
Employment
Number of
Percent
Status
Responses
Full-time
Staff
Part-time
Staff
Full-time
Faculty
Part-time
Faculty

113

90.4

64

51.2

21

16.8

15

12.0

19
Hypothesis Testing

The following hypotheses were tested in this study.
All hypotheses were tested with a level of significance set
at α ≤ 0.05.
Hypothesis 1: Division I OSD professionals will have
worked more frequently with an athletic trainer or sports
medicine staff member to develop a concussion and/or mild
traumatic brain injury (MTBI) management protocol for
student-athletes when compared to OSD professionals from
NCAA Division II, III, NAIA, or other athletic governing
body affiliation.
Conclusion: A Pearson’s Chi-Square test of
independence was performed to examine the potential
relationship between the athletic governing body collegiate
setting of the OSD professional and how often that
professional had contact with his/her university’s athletic
training staff or sports medicine staff regarding studentathletes who have been diagnosed with concussions and/or
mild traumatic brain injuries. The relation between these
variables was statistically significant, (Χ 2(16)=27.403,
p=.037). Office of student disabilities professionals at
the NCAA Division I level were more likely to frequently
contact their athletic training staff than OSD

20
professionals at the Division II, Division III, NAIA, or
other athletic governing body affiliation.
Hypothesis 2: Division I OSD professionals will be
more comfortable in managing and directing a studentathlete suffering a sports related concussion and/MTBI from
an OSD standpoint than OSD professionals from NCAA Division
II, III, NAIA, or other athletic governing body
affiliation.
Conclusion: A Pearson’s Chi-Square test of
independence was performed to examine the potential
relationship between the athletic governing body collegiate
setting of the OSD professional and how comfortable the OSD
professional was in managing and directing a studentathlete suffering from a sports related concussion and/or
mild traumatic brain injury from an OSD standpoint. The
relationship between these variables was not statistically
significant, (Χ2(16)=8.001, p=.949). Collegiate setting and
comfort level appear to be independent events (Table 6).

21
Table 6. Contact and Comfort
Athletic
Contact with
Governing
AT
Body
(Mean, SD)
I
4.39 (1.227)
II
4.43 (1.502)
III
4.73 (1.380)
NAIA
5.50 (.837)
Other
Constant
(omitted)

Means
Comfort
(Mean, SD)
3.64
3.61
3.47
3.33
3.22

(1.062)
(0.988)
(1.034)
(1.366)
(1.202)

Contact with AT: 1= Daily, 2= Once a week, 3= Once a month, 4= Once a semester, 5= Once a
year, 6= Never
Comfort: 1= Very Uncomfortable 2= Uncomfortable, 3= Neither Comfortable or Uncomfortable,
4= Comfortable, 5= Very Comfortable

Additional Findings

Additional findings of the study showed what disability
access accommodations are most commonly requested and
approved. Office of student disability professionals were
asked to selected all the accommodations that they normally
requested approval for a student-athlete recovering from a
sports related concussion/and or MTBI (Table 7).

22
Table 7. Disability Access
Accommodations Most Commonly
Requested and Approved
Accommodation
Percent of OSD
Requested/Approved
Extra Testing
(95.0%)
Time
Quiet Testing
(86.6%)
Environments
Extended
(52.1%)
Deadlines
Recorded
(44.5%)
Lectures
Other
(28.6%)
Power Point
(26.9%)
lectures
No Initial
(14.3%)
Cognitive
Activity

In the other category, note takers were mentioned by
20 of the OSD professionals surveyed. If the study were to
be conducted again, the primary researcher would add note
takers as a potential choice due to its prevalence in this
study.
Additional findings of the studied examined the OSD
professional’s familiarity with concussions/and or MTBI, if
they themselves had previous sustained a concussion/and or
MTBI, if they were familiar with the current Zurich
guidelines and protocols for the management of concussion/
and or MTBI, and if they had collaborated in the past with
their university’s athletic training staff in regards to
their institution’s concussion/and or MTBI management

23
protocol. Table 8 represents the frequency of OSD
professionals’ responses.
Table 8. Frequency Table of Familiarity,
Previous Medical History, Familiar with
Zurich Guidelines, & ATS Collaboration for
Protocols with Concussions/MTBI
Question
Yes
No
Familiarity
199 (97.5%)
3
(2.5%)
Previous
26 (21.3%)
96 (78.7%)
Medical History
of a
Concussion/MTBI
Familiar with
41 (33.6%)
81 (66.4%)
Zurich
ATS
44 (36.1%)
78 (63.9%)
Collaboration
for Protocols

Comparison of the two terms “Concussion” and “MTBI”
were utilized in the study to see if there was a difference
in how the OSD professional equated the severity of the
injury when to the two terms were used to describe an
injury. Table 9 represents the frequency of the responses
based upon the current perceptions OSD professionals had
when presented with the two terms qualifying a sportsrelated head injury. The majority (74.4%) of the OSD
professionals perceived concussions as a “moderate” injury.
Similarly, the majority (67.2%) of the OSD professionals
surveyed perceived MTBI as a “moderate” injury.

24

Table 9. Frequency Table of
Concussion Vs. MTBI
Perception
Concussion
of
Severity
Mild
37
Injury
(30.6%)
Moderate
90
Injury
(74.4%)
Severe
67
Injury
(55.4%)
Getting
6
Dinged
(5%)
Getting
11
your Bell
(9.1%)
Rung
No Opinion
10
(8.3%)

Terms
MTBI

39
(32.8%)
80
(67.2%)
34
(28.6%)
7
(5.9%)
9
(7.6%)
12
(10.1%)

The average number of concussion/and or MTBI cases
seen each year by the OSD was recorded (Table 10) along
with the average number of visits student-athletes
recovering from a sports related head injury utilized their
OSD (Table 11). From the collected data 66.1% of surveyed
OSD professionals reported an average of 1-5
concussion/MTBI cases seen each year by their respective
OSD. Of the reported cases, 53.7% of OSD professionals
reported that student-athletes recovering from a sportsrelated head injury utilized the OSD on an average of 1-4
visits.

25

Table 10. Frequency Table of Yearly
Average of Concussion/MTBI cases
Number of
Responses
Percent
Cases
0
11
9.1
1-5
80
66.1
6-10
17
14.0
11-15
6
5.0
15+
7
5.8

Table 11. Frequency Table of Average
Visits to OSD.
Visits
Responses
Percent
0
1-4
5-9
10+

33
65
16
7

27.3
53.7
13.2
5.8

Identification of a liaison between the OSD and the
athletic training staffs at a university was also measured
(Table 12). Of the 121 collected responses, only 43(35.5%)
reported that there was a liaison between the OSD and
athletic training staff. Current perceptions if enough was
being done in regards to educating individuals on the
disability and impairment of concussions/and or MTBI was
measured (Table 13). Out of the 119 responses collected
only 25 (21%) reported that they felt enough was being done
in regards to education on concussions/MTBI.

26

Table 12. Frequency Table of Liaison
Between OSD and ATS
Liaison
Responses
Percent
Yes
No

43
78

35.5
64.5

Table 13. Frequency Table of Perception
if Enough is Being Done in Regards to
Education on Concussions/MTBI?
Is enough
Responses
Percent
being
done?
Yes
25
21.0
No
94
79.0

The perceptions of OSD professionals in regards to a
need for enhanced and increased communication between the
OSD and the athletic training departments were measured
(Table 14). Seventy (59.3%) of respondents reported the
need for an increase in communication between the two
departments.
Table 14. Frequency Table on
Need for Enhanced Communication
Between OSD and Athletic
Training Department
Yes
No
70
(59.3%)

48
(40.7%)

Previous attendance and interest in attending future
educational lectures on Concussions/MTBI was recorded

27
(Table 15). Only 19 (16.0%) of respondents reported that
they had previously attended an educational lecture on
concussions/MTBI. However 99 (83.2%) of OSD professionals
surveyed reported that they had an interest in attending
these educational lectures.
Table 15. Frequency Table of Attendance
and Interest in Attending Educational
Lectures on Concussions/MTBI
Question
Yes
No
Have you
Attended?
Are you
interested
in
attending?

19
(16.0%)
99
(83.2%)

100
(84.0%)
20
(16.8%)

The influence of financial cost on the likelihood of
an OSD professional’s attendance to educational lectures on
concussions/MTBI was measured and collected (Table 16).
This was an interesting finding considering 66.7% of OSD
professionals who reported they had interest in attending
educational lectures reported that they attendance would be
influenced by finical cost.

28
Table 16. Frequency Table of Influence
of Finical Cost on Attendance to
Educational Lectures
Question
Yes
No
Would your
attendance
change if
you had to
pay?

66
(66.7%)

33
(33.3%)

The extent and willingness of an OSD professional to
attend an educational lecture on concussions/MTBI based
upon finical cost was recorded (Table 17). Over half
(56.9%) of OSD professionals surveyed reported that they
were most likely to attend an educational lecture is the
finical cost was between $0-$25.
Table 17. Frequency Table of
Cost and Willingness to
Attend Educational Lectures
Total Cost
Would Attend
$0-$25
$26-$50
$51-$75
$76-$100
$100+

37(56.9%)
12(18.5%)
7 (10.8%)
7 (10.8%)
2 ( 3.1%)

29

DISCUSSION

The focus of this study was to determine if the
athletic governing body collegiate affiliation that the OSD
professional was in employed in influenced their
perceptions on concussions and/or MTBI. Differences in
interactions with their university’s athletic training
staff or sports medicine staff in regards to studentathletes that had sustained a mild traumatic brain injury
and/or concussion from a sports related standpoint was also
evaluated. The study also examined if the athletic
governing body collegiate affiliation that the OSD
professional was employed at influenced the OSD
professional’s comfort level in properly managing and
directing a student-athlete suffering a sports related
concussion and/or mild traumatic brain injury from an OSD
standpoint. It’s important to note that reliability and
validity of the Jakiel OSD Perceptions Concussions and/or
MTBI Survey was not established during the preliminary
study that was conducted in the Pennsylvania State Athletic
Conference (PSAC).
The following section is divided into four
subsections: Discussion of Results, Recommendations for

30
Future Research, Implications to the Profession, and
Conclusions.

Discussion of Results

This study examined whether the athletic governing
body affiliation the OSD professional was employed in
influenced their interactions with their university’s
athletic training staff or sports medicine staff in regards
to student-athletes that had sustained a mild traumatic
brain injury and/or concussion from a sports related
standpoint. The study also examined if the athletic
governing body affiliation the OSD professional was
employed at influenced the OSD professional’s comfort level
in properly managing and directing a student-athlete
suffering a sports related concussion and/or mild traumatic
brain injury from an OSD standpoint.
Hypothesis 1 stated NCAA Division I OSD professionals
will have worked more frequently with an athletic trainer
or sports medicine staff member to develop a concussion
and/or mild traumatic brain injury (MTBI) management
protocol for student-athletes when compared to OSD
professionals from NCAA Division II, NCAA Division III,
NAIA, or other athletic governing body affiliations. There

31
was no previous research published or identified on the
influence of the athletic governing body affiliation of an
OSD professional on the frequency in which they had contact
with their university’s athletic training staff or athletic
training department. Based on the researcher’s intuition,
it was thought that OSD professionals working at the NCAA
Division I level would have more frequent contact as
opposed to OSD professionals working at NCAA Division II,
NCAA Division III, NAIA, or other athletic governing body
affiliation. This assumption was made because the
researcher believed that NCAA Division I OSD professionals
who have larger staffs and more resources to their disposal
when compared to OSD professionals at the NCAA Division II,
NCAA Division III, NAIA, or other athletic governing body
affiliation. With the potential for larger staffs due to
increased budgets the researcher believed that the cases
seen by OSD professionals would be more evenly distributed
among the employed staff and allows a greater amount of
attention to be dedicated to each individual case. This
assumption is based upon the researcher’s previous
experience at the Junior College level where only one OSD
professional was employed to handle the needs of the
institution. The relation between these variables was
statistically significant and supported this hypothesis.

32
Responses from the survey showed that Division I OSD
professionals were the most likely to maintain frequent
contact when compared to OSD professionals at the other
NCAA Division or colligate affiliation.
Hypothesis 2 stated that Division I OSD professionals
would be more comfortable in managing and directing a
student-athlete suffering a sports related concussion
and/MTBI from an OSD standpoint than OSD professionals from
NCAA Division II, III, NAIA, or other affiliation. The
researcher hypothesized that Division I OSD professional
would be more comfortable due to their increased resources
when compared to the lower NCAA divisions and other
athletic governing body affiliations. The relationship
between these variables was not statistically significant
and did not support the original hypothesis. OSD
professionals from each NCAA division and collegiate
affiliation reported similar levels of comfort when
managing and directing a student-athlete suffering a sports
related concussion and/MTBI from an OSD standpoint.
Office of student disabilities professionals expressed
an interest in increasing their current knowledge base in
regards to concussions/and or MTBI. A way to potential meet
this demand would be to utilize social media sites, such as
Facebook to hold open discussions and forms. Ahmed et al15

33
studied postings on Facebook groups related to concussions.
Individuals utilized the Facebook groups to relate personal
experiences of concussions, seek advice, or offer advice in
regards to concussions.15 Office of student disabilities
professionals and ATs could utilize a similar format to
provide educational opportunities and create effective
communication between both departments when questions arise
about the management of post-secondary student-athletes
recovering from a sports related concussion.
The findings of the perception of severity of the
terms concussion vs. mild traumatic brain injury do not
reflect previously conducted research. Research conducted
by Weber and Edwards16 determined the influence of the terms
concussion, MTBI, and minor head injury.16 Subjects utilized
in the study conducted at the University of Birmingham
found that terminology significantly influenced both the
expected injury outcome and familiarity. Outcome
expectations were reliably more negative for the term MTBI
than concussion or minor head injury.16 Responses from the
Jakiel OSD Perceptions Concussions and/or MTBI Survey
showed that OSD professionals rated the term concussion a
severe injury (55.4%) compared to MTBI (28.6%).
The recommended disability access accommodation for
recovering post-secondary student-athletes supports

34
previous findings and literature. The need for potential
academic alterations or accommodations for the symptomatic
athlete are strongly supported by the guidelines set forth
by Kirkwood et al17 when reintroducing the student athlete
back into the school environment.17 Protecting the rights of
the student-athletes must also be taken into consideration
considering that the inclusion of a 504 plan is not an
option at the collegiate level. Section 504 protects
individuals with disabilities from discrimination and
ensures that children with disabilities have equal access
to an education.17 Typically students who need only an
accommodation-but not specialized direct instruction-are
provided those accommodations under a 504 plan.17

Recommendations for Future Research

The purpose of this study was to assess the current
perceptions and familiarity of student disability services
professionals in regards to concussions and/or MTBI and to
identify the most commonly requested and approved
disability academic access accommodations available to
post-secondary student-athletes. The study also examined if
collegiate setting and athletic governing body affiliation
impacted the OSD professional’s comfort level in managing

35
care and academic accommodations for a recovering studentathlete and if the frequency that the OSD professional
communicated with their athletic training staff was also
influenced.
After reviewing the results and finding of the study,
one recommendation would be to increase the overall
response rate. Utilizing the CollegeNavigator tool, the
regions that were not selected for this study could be
included to identify any differences in responses based on
region. Another method to obtain a larger sample size could
be accomplished through gaining approval for distribution
of a survey through an organization such as the Association
on Higher Education and Disability (AHEAD). Distribution to
OSD professionals that hold membership in AHEAD could
examine responses from a global perspective to identify if
there are significant differences between countries and
cultures in the manner that concussions and/or mild
traumatic brain injuries are managed.
The inclusion of an incentive or reward for
participation in the survey could also increase the overall
response and completion rate. Utilizing OSD professionals
who work with non-student-athletes along with the OSD
professionals surveyed in this study could also increase
overall response rates.

36
The survey identified that 59.3% of the OSD
professionals felt there was a need to enhance
communication between the office of student disabilities
and athletic training departments. The creation of a
liaison position or holding regular staff meetings with
professionals from both departments could address this
need. How often these meetings should occur could be
determined by surveying professionals in both departments.

Implications to the Profession

One of the biggest implications to both the athletic
training and office of student disability professions is
the need for increased communication between the two
sectors. Although NCAA Division I OSD professionals
communicated on a more frequent basis than their
counterparts, communication from NCAA Division I OSD
professionals was roughly a little less than once a
semester (Table 5). In order to provide a more holistic
approach to care for collegiate student-athletes, a greater
emphasis should be placed on increasing the frequency of
communication.
The comfort level reported by the OSD professionals
surveyed in this study showed that a potential increase in

37
education and educational opportunities could aid in
meeting the needs of collegiate student-athletes recovering
from a concussion and/or MTBI. NCAA Division I
professionals reported a comfort level of 3.64, NCAA
Division II professionals reported at 3.61, NCAA Division
III professionals reported at 3.47, NAIA professionals
reported at 3.33, and professionals from other athletic
governing bodies reported at 3.22.
With amendments to current concussion/MTBI return to
play protocol, keeping OSD professionals updated with
current literature and practices could aid in increasing
their overall comfort levels in handling recovering postsecondary student-athletes from an OSD standpoint. The
creation of educational opportunities to further advance
awareness and knowledge of concussion and/or MTBI
management could contributed to a holistic approach towards
meeting the needs of recovering student-athletes.

Conclusions

Based on the results of this study, we can conclude
that there is a need to increase communication between the
office of student disabilities and athletic trainers in
regards to provide care from a holistic standpoint for

38
recovering student-athletes that have sustained a
concussion/and or MTBI. Regarding the potential
relationship between the athletic governing body collegiate
setting of the OSD professional and how often that
professional had contact with their university’s athletic
training staff or sports medicine staff regarding studentathletes who have been diagnosed with concussions and/or
mild traumatic brain injuries. The relation between these
variables was statistically significant (Table 6).

Fifty-

Nine point three percent (59.3%) of OSD professionals
surveyed agreed that there is a need to enhance
communication between both the OSD and athletic training
sectors of a university.
When considering relationship between the athletic
governing body collegiate setting of the OSD professional
and how comfortable the OSD professional was in managing
and directing a student-athlete suffering from a sports
related concussion and/or mild traumatic brain injury from
an OSD standpoint. The relationship between these variables
was not statistically significant. Exploring why this was
the case by asking the level of experience or number of
years working as an OSD professional at the post-secondary
setting could be explored in a future study to determine
why comfort levels of OSD professionals were not

39
significant based upon employment setting. Identifying if
the university where the OSD professional is employed at
has an athletic training education program could also be
evaluated to see if the presence of certified athletic
trainers influenced the comfort level of the OSD
professional when handling sport-related concussion/ and or
MTBI cases.
There also appears to be a need for increasing the
educational opportunities for OSD professionals as 83.2% of
the respondents reported that they had an interest in
attending educational seminars on concussions and/or MTBI.
However it should also be noted that 66.7% of the
respondents reported that attendance to these lectures
would change if they had to pay out of their own pockets.
Over half (56.9%) of OSD professionals responded that they
would be willing pay between $0-$25, 18.5% were willing to
pay $26-50, 10.8% were willing to pay between $51-75, 10.8%
were willing to pay $76-$100, and only 3.1% would be
willing to pay $100+ out of pocket to attend such lectures
and educational opportunities (Table 17).

40
Table 17. Frequency Table of Cost and Willingness
to Attend Educational Lectures
Total Cost
Would Attend
$0-$25
$26-$50
$51-$75
$76-$100
$100+

37(56.9%)
12(18.5%)
7 (10.8%)
7 (10.8%)
2 ( 3.1%)

Indicating that there is a need to provide more
economically affordable educational opportunities for OSD
professionals and other members of the student services
department that have an interest in increase their
knowledge base and expertise on concussions/MTBI.

41
REFERENCES

1.

Harmon, KG, Drezner, J, Gammons, M. American medical
society for sports medicine position statement:
concussion in sport. Clin J Sport Med [serial online].
January 2013; 23(1):1-18. Available from: SPORTDiscus
with Full Text, Ipswich, MA. Accessed May 6, 2013.

2.

Logan K. Cognitive rest means I can't do
what?!. ATSHC[serial online]. November 2009;1(6):251252. Available from: SPORTDiscus with Full Text,
Ipswich, MA. Accessed June 22, 2012.

3.

McLeod T, Gioia G. Cognitive rest: the often neglected
aspect of concussion management. Athl Ther Today
[serial online]. March 2010;15(2):1-3. Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed June
22, 2012.

4.

McClincy M, Lovell M, Pardini J, Collins M, Spore M.
Recovery from sports concussion in high school and
collegiate athletes. Brain Inj: [BI][serial online].
January 2006;20(1):33-39. Available from: MEDLINE with
Full Text, Ipswich, MA. Accessed June 22, 2012.

5.

Kwok F, Lee T, Leung C, Poon W. Changes of cognitive
functioning following mild traumatic brain injury over
a 3-month period. Brain Inj: [BI] [serial online].
September 2008;22(10):740-751. Available from: MEDLINE
with Full Text, Ipswich, MA. Accessed June 25, 2012.

6.

Broglio S, Macciocchi S, Ferrara M. Neurocognitive
performance of concussed athletes when symptom free. J
Athl Train [serial online]. October 2007;42(4):504508. Available from: SPORTDiscus with Full Text,
Ipswich, MA. Accessed June 22, 2012.

7.

McClincy M, Lovell M, Pardini J, Collins M, Spore M.
Recovery from sports concussion in high school and
collegiate athletes. Brain Inj: [BI][serial online].

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January 2006;20(1):33-39. Available from: MEDLINE with
Full Text, Ipswich, MA. Accessed June 22, 2012.
8.

Mccrory P, Johnston K, Schamasch P, et al. Summary and
agreement statement of the 2nd International
Conference on Concussion in Sport, Prague 2004. Br J
Sports Med [serial online]. April 2005;39(4):196-204.
Available from: SPORTDiscus with Full Text, Ipswich,
MA. Accessed June 22, 2012.

9.

McCrory P, Meeuwisse W, Cantu R, et al. Consensus
Statement on Concussion in Sport: The 3rd
International Conference on Concussion in Sport Held
in Zurich, November 2008. J Athl Train. [serial
online]. July 2009;44(4):434-444. Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed June
22, 2012.

10.

Guskiewicz K, Bruce S, Valovich McLeod T, et al.
National Athletic Trainers' Association position
statement: management of sport-related concussion. /
management of sport-related concussion. J Athl Train.
[serial online]. July 2004;39(3):280-297. Available
from: SPORTDiscus with Full Text, Ipswich, MA.
Accessed June 22, 2012.

11.

Gagnon I, Swaine B, Champagne F, Lefebvre H.
Perspectives of adolescents and their parents
regarding service needs following a mild traumatic
brain injury. Brain Inj: [BI] [serial online].
February 2008; 22(2):161-173 Available from: MEDLINE
with Full Text, Ipswich, MA. Accessed June 25, 2012.

12.

Gessel L, Fields S, Collins C, Dick R, Comstock R.
Concussions among United States high school and
collegiate athletes. J Athl Train. [serial online].
October 2007;42(4):495-503. Available from:
SPORTDiscus with Full Text, Ipswich, MA. Accessed June
22, 2012.

13.

Covassin T, Swanik CB, Sachs ML. Sex differences and
the incidence of concussions among collegiate
athletes. J Athl Train. [serial online]. July
2003;38(3):238-244. Available from: SPORTDiscus with
Full Text, Ipswich, MA. Accessed June 25, 2012.

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Covassin T, Swanik C, Sachs M. Epidemiological
considerations of concussions among intercollegiate
athletes. Appl Neuropsychol. [serial online]. March
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MA. Accessed June 22, 2012.

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Ahmed O, Sullivan S, Schneiders A, Mccrory P.
iSupport: do social networking sites have a role to
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Accessed June 22, 2012.

16.

Weber M, Edwards M. The effect of brain injury
terminology on university athletes’ expected outcome
form injury, familiarity and actual symptom report.
Brain Inj: [BI] [serial online]. 2010;24(11):13641371. Available from: MEDLINE with Full Text, Ipswich,
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Duff M. Management of sports-related concussion in
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44

APPENDICES

45

APPENDIX A
Review of Literature

46

REVIEW OF LITERATURE

More frequently we are hearing and reading about
concussions and mild traumatic brain injuries (MTBI) in the
media. From Pee Wee football to the NFL, organizations are
taking an active approach in providing the correct services
and treatments to athletes recovering from an MTBI.
Although much progress has been made in regards to
improving the evaluation, treatment, and education of these
injuries, those outside of the medical community may still
be lacking knowledge of these issues.

Current Protocols and Statements for
Concussions and MTBI

As medical technology and practices have advanced in
the 21st century we have seen a drastic change in the manner
health care professionals evaluate, diagnosis, treat, and
rehabilitate head injuries. A byproduct of these
advancements and collaborations has led to the development
of a universally accepted protocol in regards to the
removal from play of an athlete with a suspected MTBI and

47
their transition back to sport specific activities
throughout their recovery. The 1st International Conference
on Concussion in Sports developed the initial framework for
the current Zurich guidelines that are followed today. A 2nd
and 3rd conference were deemed necessary to amend the
initial protocol, provide additional clarification of
certain topics, and to ensure the Vienna guidelines were
clearly defined and understood by all medical
professionals.
The intentions of the 2nd International Conference on
Concussion in Sports were to revise and update the
guidelines and universal protocols that were developed at
the 1st conference in 2001. A 2nd conference was deemed
necessary to update the current agreement position,
evaluations, and treatments strategies of concussions to
reflect the changes in literature and findings regarding
MTBI.1 The conference also stressed the importance of
developing guidelines for pediatric and adolescent athletes
with MTBI as the first conference’s recommendations were
originally designed for the management of adult sporting
concussions.1 The 2nd conference continued to evaluate and
revise current practices in regards to classifications of
concussions, signs and symptoms, pre-season and baseline
testing procedures, acute management of MTBI, and the

48
universal return to play guidelines developed at the 2001
Vienna conference.1
A 3rd International Conference on Concussion in Sports
was held in Zurich in 2008. The Zurich Consensus Statement
is designed to build on the principles outlined in the
original Vienna and Prague conferences and to develop
further conceptual understanding of this problem using a
formal consensus based approach.2 This was a continuation of
the guidelines set forth at the 1st International
Conference on Concussion in Sports in Vienna and the 2nd
International Conference in Prague. Further need for
research and clarification was identified in several topics
including acute simple concussion, return to play issues,
complex concussion and long term issues, pediatric
concussion, and future directions in concussion assessment
and management.2 No universal changes were made to the
previously stated protocol however new questions and
aspects concerning the incidence, prevalence, prevention,
and treatment of concussions were identify for further
research and analysis.2
Universal guidelines set forth by these conferences
also resulted in the changing and alternations of several
organizations’ mission and position statements when dealing
with concussions and MTBI. The National Athletic Trainers’

49
Association was one of many organizations that took these
findings to heart and reevaluated the manner in which
athletic trainers educate, evaluate, and manage concussions
and MTBI on a case-by-case basis.
The current position statement of the National
Athletic Trainers’ Association on the management of sportrelated concussion identifies key aspects of concussion
management. These key aspects include the recognition of
concussions, return to play decisions, current assessment
tools, referral to a treating physicians, special
conditions for younger athletes, disqualifying an athlete
from returning to a contest or practice, care for the
athlete at home and away from the field/AT, and enforcement
of proper equipment use during practices and contests.3 No
new evidence or methods were presented, however, a detailed
analysis of neuropsychological tools was referenced in
their importance of measuring the recovery of an athlete
who has sustained a MTBI. The 2004 position statement is
founded on and supported by the findings and guidelines set
forth from the 2001 Vienna International Conference on
Concussion in Sport.3

50
Incidence and Reporting of MTBI

It is seemingly almost impossible to attend a sporting
event or to watch an athletic contest on television and not
hear at least one person mention concussions or MTBI. We
are seemingly seeing a greater increase in these injuries
because today’s athletes are bigger, stronger, and faster
than their predecessors. But one can’t truly say that
today’s athletes are sustaining more head injuries than
what athletes did 10 to 20 years ago due to the potential
increase in media coverage and social networking.27 With
almost everyone having access to the Internet via tablets,
computers, and smart phones is it safe to say that we are
simply living in a time where more injuries are being
reported and made public? Regardless of what the true
underlying factor to the current epidemic of MTBI, we can
safely say that improved evaluation and diagnostic methods
are allowing today’s health professionals to identify
concussions and MTBI that may have gone undiagnosed in
years past.
Gessel et al4 investigated and compared the
epidemiology of concussions of high school athletes to
collegiate athletes. The subjects were sampled from 100 US
high schools and 180 US colleges.4 Data collected were

51
analyzed to calculate rates, patterns, and potential risk
factors for sport related concussions. Results of the study
showed that concussions accounted for 8.9% of all high
school athletic injuries and 5.8% of all collegiate
athletic injuries.4 The highest incidence of concussions was
in football and soccer for both high school and college
athletes.4 In high school sports, female athletes sustained
a higher rate of concussion than their male counterparts.4
Collegiate athletes also showed a higher rate of
concussions when compared to the high school level.4 Results
of the study show an increase in need for the development
of sport related concussion preventive measures along with
increasing overall knowledge of rates, patterns, and risk
factors.4
As seen from Gessel et al4 the competitive environment
in which an athlete is competing in may have some direct
influence with the risk of sustaining a MTBI. Another key
variable that Gessel et al evaluated was the gender of the
athlete and its direct correlation to the risk of
sustaining a MTBI and its incidence.
Covassin et al5 explored the gender differences
regarding the incidence of concussion from 1997-2000.
Subjects were both male and female collegiate athletes from
soccer, lacrosse, basketball, softball, baseball, and

52
gymnastics programs.5 Weekly injury and athlete exposure
data was collected from the first day of preseason to the
final postseason contest for each respected sport. Results
of the study showed that out of the 14591 reported
injuries, 5.9% were classified as concussions.5 Female
athletes sustained 167 concussions during practices and 305
during games compared to 148 during practices and 254
during games for males.5 From the data collected in this
sample size we can see that female athletes were sustaining
a higher rate of MTBI both during practices and during
athletic competitions. Identifying and evaluating this
trend may better dictate where an understaffed sports
medicine staff is to determine their physical presence if
multiple practices or athletic contests are occurring at
the same time. By placing their staff in strategic and the
highest risk locations, an AT can ensure that the safety
and health of all student-athletes is being maintained and
allow them to be onsite if or when a head injury should
occur. The highest rate of incidence among all of the
sports was seen in women’s soccer and men’s lacrosse.5
Conclusions of the study showed that female athletes
sustained a higher percentage of concussions during games
than male athletes.5

53
As we have seen in the two previous studies both the
level in which an athlete is competing along with the
gender of an athlete may factor in to which athletes are at
greater risk for sustaining concussions and MTBI. By
identifying these at risk athletes we can better utilize
our current resources and practices to minimize their risk
of injury, implement possible preventive measures, and work
with educating athletes, parents, and coaches to identify
the signs and symptoms of a concussion and or MTBI and
promptly remove that athlete from play. Another interesting
variable that has been studied has been whether there are
certain sports that because of their physical nature and
technical demands place athletes in greater risk for
sustaining a MTBI.
Covassin et al6 examined the epidemiological trends of
concussions among 15 different intercollegiate sports from
1997-2000.6 Data was collected through the National
Collegiate Athletic Association Injury Surveillance System
and a total of 40547 injuries were reported during the 3
year study.6 Concussions accounted for 6.2% of the reported
injuries with women’s lacrosse (13.9%) reporting the
highest percentage of suffering a concussion during an
athletic contest.6 Female athletes from all 7 sports were
found to have a lower risk of suffering concussions during

54
practice than the 8 male sports studied.6 This is
interesting because it conflicts the earlier findings of
Covassin et al who had found that female athletes were at a
higher risk of suffering concussion both during practices
and games. Female athletes, however, were found to have a
greater risk of suffering a concussion during games than
male athletes which was mentioned earlier in Covassin’s
study. Injury trends indicated an increase in incidence for
football, men’s soccer, and both men’s and women’s
basketball.6 Again we can see the importance of ensuring
coverage of these at risk sports, especially in
environments where there may only be one AT on staff or at
the event.

Management and Reporting

The manner in which a MTBI is managed has also evolved
as information and protocols have been validated through
continuing research. Health care professionals no longer
refer to an athlete as being “dinged” or “having their bell
rung” when they have sustained a concussion or MTBI. It is
also my hope that we start to refer to all concussions as
MTBI so their severity is not misinterpreted or undermined
and they are treated with the respect and caution their

55
condition merits. Medical professionals now understand and
see the potential consequences of mishandling a MTBI and
the potential long-term affects it can have on an athlete’s
quality of life both from an athletic and non-athletic
standpoint. However this is not common knowledge among the
general populous and an increase in educating members
outside of the medical profession is of high priority.
McLeod et al7 stressed the importance of incorporating
health-related quality of life assessments to better
understand the effects a concussion has on aspects of a
student’s life that are outside the realm of returning to
their specific sport or activity. The subject that was used
in their study was a 14 year old female soccer player that
had sustained a MTBI 4 weeks prior and was still
symptomatic.7 Tools such as the SF-36, PedsQL, HIT-6, MIDAS,
PedMIDAS, BDI-II, PedsQL MFS, POMS, GSS, and RPCSQ were
mentioned and evaluated for their importance in identifying
potential challenges and issues facing the patient and care
provider in managing the effects of a concussion on quality
of life.7 The authors stressed the use of both clinical
based diagnostic tools and patient self-inquiry tools when
considering the health related quality of life aspects of
an athlete recovering from a concussion.7 Recent literature
suggests that each concussed athlete be managed

56
individually because the effects of concussion on physical,
cognitive, emotional, social, school, and family issues
will differ across individuals. Outcome-based instruments
can help clinicians better evaluate the effects of
concussion and MTBI on all these areas, leading to better
and more complete management.7
One of the best and often overlooked aspects of the
human body is its ability to heal itself. We can see this
process clearly when an individual sustains a cut or
laceration. If left alone the wound will scab over, lay
down new tissue, and outside of leaving a scar, return to
normal as if the injury hadn’t occurred at all. When
dealing with concussions and MTBI, the same principle
applies. However there is often confusion as to how we
should let the brain rest because one can’t see the healing
process occur with the naked eye and often is relying on
the reporting of the injured athlete to determine if they
are no longer experiencing symptoms and should be allowed
to resume any type of physical activity.
Logan states the importance of complete cognitive rest
from an academic, social, and physical aspect when an
athlete is symptomatic during the acute phase of a
concussion.8 Contacting school officials and letting them
know about the athlete’s situation is also a vital aspect

57
of this processes in getting course work and examinations
postponed or altered through the use of a 504 plan to
ensure the athlete isn’t being put in a position to fail.
Limiting other stimuli from a physical and social aspect
will ensure that the student athlete isn’t manifesting
symptoms or claiming to be symptomatic to simply get out of
their academic responsibilities.8 Having the athlete learn
to identify triggers that cause an increase or exacerbation
of symptoms is also an important step in recovery and
allows an athletic trainer to see if the athlete is
progressing in their recovery or if more cognitive rest is
required.8
McLeod also recognizes the importance and need for
cognitive rest and how it should be incorporated with the
current treatment strategies in concussion management.
Although it is impossible to limit cognitive activities
completely, the goal of cognitive rest should be to limit
activity where there isn’t an exacerbation or reemergence
of symptoms.9 Use of tools such as a school’s version of the
ACE Care Plan can ensure that each MTBI are being handled
on a case by case basis and that the proper adjustments to
a student’s time and intensity of cognitive tasks are made
to accommodate their current level of tolerance. When
considering a student athlete’s return to sport specific

58
activities, a student’s performance in the classroom should
return to pre-injury levels before any exertional or
functional testing is implemented.9
If the athlete is allowed proper time to rest while
limiting their exposure to sensory stimuli, the recovery
process is much smoother and unnecessary strain isn’t
placed on the recovering athlete. However, simply because
an athlete is no longer symptomatic doesn’t mean that they
have completely recovered nor are they functioning at preinjury cognitive levels.9
McClincy et al10 examined the cognitive performance of
concussed athletes at baseline, 2, 7, and 14 days postinjury using the ImPACT testing programing. The subjects of
the study consisted of 104 high school and collegiate
athletes who had experienced a concussion during an
athletic event.10 Variables such as verbal memory composite,
visual memory composite, processing speed composite,
reaction time composite, and post-concussion symptoms were
all measured during the 4 stages of testing.10 Results of
the study showed that differences were seen for all ImPACT
composites and total symptom score between baseline and day
2 post-injury testing. At day 7 poorer performances was
seen in verbal memory, visual memory, reaction time, and
total symptom score.10 At day 14 only verbal memory scores

59
were significantly different from baseline measurements.10
Conclusions from the study showed that cognitive
performance deficits in concussed athletes may persist up
to 14 days post-injury in some cases.10 The importance of
incorporating cognitive testing such as the ImPACT program
are required because the self-reporting of an athlete or
use of symptom scores may not provide an accurate
assessment of the student athlete’s recovery when used
alone. It’s feasible that an athlete may feel fine or
completely recovered but without neurological testing if
allowed to resume full activities both in and out of the
classroom; the athlete would be placed in a position to
fail, exacerbate previous symptoms or possibly sustain a
potentially fatal injury.
A meta-analysis by Broglio and Puetz11 systematically
reviewed and quantified the effect of sport concussion on
each assessment measure when administered immediately postinjury and 2 weeks following the injury. 39 articles were
selected for the meta-analysis via PubMed and PsychINFO
databases.11 Variables extracted from the studies included
study design, type of neurocognitive technique used for
assessment, time the post-concussion assessment was
administered following injury, and number of follow-up
assessments post-concussion.11 Results of the meta-analysis

60
found that sport concussions had a large negative effect on
neurocognitive functioning. Conclusions of the metaanalysis supported that the assessment of neurocognitive
functioning, self-report symptoms, and postural control all
warrant inclusion and should be used synergistically during
the evaluation process of a concussion.11

Changes in Cognitive Functions Following MTBI

The management of a MTBI must encompass a holistic
approach to the health and wellbeing of the athlete. As the
brain begins the process of healing it is the
responsibility of the health care professional to create
and enforce an environment that is conducive to this
healing process. Unlike an ankle sprain or muscle strain, a
MTBI must be fully healed before an athlete will be cleared
to fully return to their respective sport. The previous
articles have stressed the importance of cognitive rest
before any physical stresses are to be placed on the
recovering athlete. To place an athlete who has not
regained their cognitive ability to process the multitude
of information and stimuli they experience during athletics
would be negligent and potentially catastrophic.

61
Kowk et al12 evaluated the cognitive functioning of
MTBI patients immediately post injury, 1 month, and 3
months post injury. 31 adult subjects (25 male and 6
female) were selected for the study and were between the
ages of 18-65 years old.12 A control group of 32 subjects
(19 males and 13 females) was used to compare the findings
from the two groups.12 Kowk et al measured cognitive
function by evaluating attention (Stroop Word-Color Test,
Digit Vigilance Test, Symbol Digit Modalities Test), memory
(Chinese Auditory Verbal Learning Test, Benton Visual
Retention Test) and executive functions (Verbal Fluency
Test).12 Kowk et al found that the MTBI patients performed
significantly worse in all three aspects of cognitive
functioning immediately post-injury.12 1 month post injury
there was significant improvement in cognitive functioning
of the MTBI group but there was still a significant
difference from the control group.12 3 months post injury
there were similarities in results between the MTBI and
control groups in all aspects of cognitive functioning
except for attention where the MTBI group continued to
perform worse.12
The impact and impairment that a single MTBI has on an
athlete is well supported in the previously mentioned
literature. Variations on the level of impairment are

62
dependent on the situation and individual. These
impairments can encompass the physical, mental, and
emotional aspects of a student-athlete’s life. When an
athlete has sustained multiple MTBI the affects and
consequences can be severe and debilitating. If not treated
correctly, complete disqualification from participation in
athletics and long-term neurocognitive impairments may
result in certain cases.
Iverson et al13 examined the possibility that athletes
with multiple concussions show cumulative effects of
injury.13 Subjects consisted of high school and college
athletes, 19 with a history of three or more concussions
and 19 with no prior concussions. Athletes from both groups
were carefully matched by gender, age, education and sport
and completed ImPACT testing at preseason and then within 5
days of sustaining a concussion. At baseline athletes with
multiple concussions reported more symptoms than athletes
with no history of concussion.13 At approximately 2 days
post-injury athletes with multiple concussions scored
significantly lower on memory testing than athletes with a
single concussion.13 This study provides preliminary
evidence to suggest that athletes who have sustained
multiple concussions may suffer from cumulative effects.

63
Whether an athlete sustains a single occurrence or
multiple episodes of MTBI the athlete has an increased
risked of neurocognitive impairment. When an athlete is
symptomatic it is easier for a medical professional to
identify these impairments and recommend the necessary care
to minimize the external stimuli exposure and expedite the
athlete’s recovery. However when an athlete is no longer
reporting as symptomatic the medical professional has to
utilize diagnostic testing to ensure a full recovery has
been achieved.
Broglio S, Macciocchi S, and Ferrara M14 evaluated the
presence of neurocognitive decrements in concussed athletes
no longer reporting concussion related symptoms. Subjects
were 21 NCAA DI collegiate athletes (16 males and 5
females).14 ImPACT concussion assessment test was
administered to concussed athletes at baseline, when
symptomatic, and when asymptomatic. Index scores of verbal
memory, visual memory, visual-motor speed, reaction time,
and concussion related symptoms were recorded at each
session.14 When assessed within 72 hours of concussion, 81%
of athletes showed deficits on at least 1 ImPACT variable.14
When asymptomatic, 38% of the concussed athletes continued
to demonstrate impairment on at least 1 ImPACT variable.14
Conclusions of the study advocate neurocognitive decrements

64
may persist when athletes no longer report concussion
related symptoms.14
With the potential for neurocognitive impairment from
a MTBI the performance of the student athlete both on the
field and in the classroom must be taken into
consideration. A correlation between multiple MTBI and
learning impairments must be evaluated further.
Collins15 assessed the relationship between concussion
history and learning disability, the association of these
variables with neuropsychological performance and to
evaluate post-concussion recovery. Subjects were 393
athletes from 4 university 4 football programs.15 Variables
studied included clinical interviews, 8 neuropsychological
measures, and concussion symptom scale ratings at baseline
and after concussion.15 Results showed a significant
interaction between learning disability and history of
multiple concussions and learning disability on 2
neuropsychological measures (Trial-Making Test and Symbol
Digit Modalities Test).15 Conclusions of the study showed
that both history of multiple concussions and learning
disabilities are associated with reduced cognitive
performance.15
The number of concussive episodes experienced by the
student-athlete may also play a role in post-concussive

65
functioning and symptom severity. Utilizing diagnostic
tools like ImPACT allow medical professionals to evaluate
the recovering student-athlete from all aspects of recovery
and can potential identify impairments that would go undiagnosed by outdated assessment measures.
Covassin T, Stearne D, Elbin III R16 evaluated the
relationship between concussion history and post-concussion
neurocognitive performance and symptoms in collegiate
athletes. Subjects for the study were 57 concussed
collegiate athletes (36 without concussion history, 21 with
a history of 2 or more concussions).16 All subjects were
administered ImPACT testing and those who sustained a
concussion were administered 2 follow up tests at days 1
and 5 post injury.16 Independent variables in the study were
history of concussion and when the ImPACT test was
implemented. Results found that athletes with a concussion
history performed significantly worse on verbal memory and
reaction time at day 5 post-concussion compared to athletes
with no previous history.16 Conclusions of the study stated
concussed collegiate athletes with a history of 2 or more
concussions took longer to recover verbal memory and
reaction time.16

66
Neuropsychological Differences and Challenges
Following a MTBI

College students with learning disabilities and those
with a history of MTBI are two groups whose learning
problems are not adequately addressed or understood by all.
Beers S, Goldstein G, Katz L17 gathered subjects for a study
which consisted of 35 students with learning disabilities,
25 with mild head injuries, and a control group of 22. Six
neuropsychological and psychoeducational test variables
produced statistically significant differences among the
three groups. Results found that students with learning
disabilities performed poorly on linguistically oriented
psychoeducational tests, whereas students with MHI showed
cognitive deficits in visual-spatial skills and in areas of
attention, memory, and problem solving.17 Findings of the
study support the development of unique interventions and
treatment protocols when addressing the needs and deficits
of each group.17
Bay and Donder’s18 research determined the extent to
which pre-injury psychosocial factors, injury-related
variables and post-injury litigation, perceived stress,
fatigue, pain, and information processing speed contributed
to depressive symptoms after a MTBI. Subjects included 84

67
adults recruited from outpatient clinics.18 Results of the
study found that perceived stress, pain, and litigation
status made independent contributions to the level of
depressive symptoms.18 The findings suggest a need for
earlier identification of as well as preventative education
for those who are stress-vulnerable.18
Mainwaring L, Bisschop S, Richards D, et al19 compared
emotional functioning of college athletes with MTBI to that
of uninjured teammates and undergraduates. Participants in
this study were three groups of students from the
University of Toronto: Concussed athletes (12 males, 4
females), uninjured teammates (211 males, 114 females) and
healthy, physically active undergraduates (8 males, 20
females). Pre and post-injury emotional response were
assessed with the short version of the Profile of Mood
States which consisted of 40 adjectives organized into
seven subscales (tension, depression, anger, vigor,
fatigue, confusions, and self-esteem).19 Each adjective was
rated on a 5-point Likert scale from 0 (not at all) to 4
(extremely). Analysis revealed a significant acute postconcussion spike for POMS ratings of depression, confusion,
and aggregate total mood disturbance.19 Conclusions of the
study showed that concussed athletes were not emotionally
different from their peers before injury, but they were

68
more depressed and confused than their non-injured peers
after sustaining MTBI.19

Post Concussive Syndrome and Issues

Although the majority of athletes will have a complete
recovery after suffering a MTBI, there are still cases
where impairment may continue to linger. The development of
post concussive syndrome (PCS) can vary from case to case
but often will result in some aspect of chronic impairment
and a reoccurrence of certain symptoms. Identifying which
athletes may be at risk of developing some form of PCS is
still an imperfect science at this point, but there have
been several studies conducted to try to identify certain
markers that may give us a better understanding of why PCS
occurs.
Stalnacke et al20 looked at 88 patients (53 male and 35
female) immediately after sustaining a MTBI. Blood samples
were taken and S-100B and neurone-specific enolase were
measured to see if there was a correlation between
evaluated levels of these two factors and the presence and
severity of brain tissue damage. The inclusion criteria for
the study included individuals who had sustained blunt head
trauma, were over the age of 18 years old, and had a rating

69
between 13-15 on the Glasgow Coma Scale.20 69 of the
patients participated fully in the follow up study that was
conducted 15 months later (+/- 4 months).20 The findings of
the follow up showed that 31 patients suffered from 1 or
more post concussive symptoms (Rivermead Post Concussion
Symptoms), 33 patients suffered from 1 or more disabilities
(Rivermead Head Injury Follow Up), and only 55% of the
patients reported that they were very satisfied or
satisfied with life as a whole following their MTBI (LiSat11).20 Stalnacke et al20 also found that the presence of S100B and neurone-specific enolase shortly after trauma are
better predictors of potential disability rather than
symptoms following a MTBI.20
The identifying markers of S-100B and neurone-specific
enolase have shown promise in aiding to identify at risk
patients who have sustained a MTBI and may be at risk of
developing PCS.20 However the use of these tests in a small
school setting or in an environment without the necessary
resources to conduct such testing isn’t feasible. The use
of neurocognitive testing such as ImPACT may provide
insight into athletes who are still feeling the effects of
a concussion even if they are adamantly denying symptoms.
Fazio et al21 examined the differences in
neurocognitive performance between symptomatic concussed

70
athletes, concussed athletes with no subjective symptoms,
and a non-concussed control group of athletes.21 Concussed
athletes were evaluated within one week of injury using the
ImPACT computerized test. Results indicated that concussed
athletes who denied subjective symptoms demonstrated poorer
performance than control subjects on all four composite
scores of the ImPACT test (Verbal Memory, Visual Memory,
Reaction Time, and Processing Speed).21 However the
asymptomatic group performed significantly better than the
symptomatic group. Results of the study supported that
concussed athletes who did not report subjective symptoms
were not fully recovered based on neurocognitive testing.21
Fazio’s findings underscores the importance of
neurocognitive testing in the assessment of concussions.21
Although the presence of certain physiological markers
may determine why an athlete develops PCS, it is also
imperative that other internal and external stimuli be
evaluated for their potential influence in the development
of symptoms.
Hou et al22 investigated the contributions of
cognitive, emotional, behavioral and social factors to the
development of PCS. One hundred seven MTBI patients
participated in a cohort study with measurements at 2 weeks
post injury and follow up questionnaires at 3 months and 6

71
months.22 Variables were measured using the Brief Illness
Perception Questionnaire (BIPQ), Behavioral Response to
Illness Questionnaire (BRIQ), Hospital Anxiety and
Depression Scale (HADS), Brief Social Support Questionnaire
(SSQ), and Rivermead Post Concussion Symptoms Questionnaire
(RPQ).22 24 patients met the criteria for PCS at 3 months
and 22 at 6 months post-injury.22 Negative MTBI perceptions,
stress, anxiety, depression and all or nothing behavior
were associated with the risk of PCS.22 Conclusions of the
study support that a patient’s perceptions of their head
injury and their behavioral responses play important roles
in the development of PCS.22
An exploratory study by Greiffenstein and Baker23
examined the relationship between proven academic
performances and present neuropsychological test scores in
neurologically intact late PCS subjects. In this study
final cumulative grade point average was regressed on to
Halstead-Reitan Battery (HRB), IQ and other
neuropsychological test scores in 60 non-malingering postconcussive subjects and 17 subjects with moderate-severe
closed head injury.23 The findings of the study suggest the
quality of premorbid academic performance also provides an
important context in which to view present
neuropsychological performance. Marginal premorbid

72
achievement may be a risk factor for late developing PCS
and litigation.23
Logan24 reviewed and discussed current methods in
recognition and management of PCS. There were no subjects
studied directly and the article follows more of a
literature review format. Key subtopics of the article
included diagnosing PCS, the importance of cognitive and
physical rest in PCS treatment, medications in PCS
treatment, sleep problems, and neuropsychological
problems.24 PCS is a complex problem that AT and therapists
need to understand. Prompt recognition of PCS can initiate
treatment that will decrease symptoms and enhance the
athlete’s quality of life during the recovery period.24
A retrospective cohort design conducted Majerske C,
Mihalik J, Wagner A, et al25 was to examine the role postinjury activity levels play in PCS and performance on
neurocognitive tests. Ninety-five student athletes (80
males, 15 females) were selected as subjects for the
study.25 PCS scores and neurocognitive scores served as the
primary outcomes. Independent variables included age,
gender, concussion grade, self-reported history of
concussions, return to play status, type of sport in which
concussion occurred, level of post-injury activity, and
time of evaluation (in days).25 Level of exertion was

73
significantly related to all outcome variables and remained
significant with respect to visual memory and reaction
time. Conclusions from the study showed that activity
levels after concussion affected symptoms and
neurocognitive recovery.25

Perception of MTBI and Services Required

Members outside of the medical community still may
attach certain stigmas to athletes that have sustained a
MTBI. There are some who may feel that the athlete is
faking the symptoms to gain an unfair advantage in the
classroom or have alternative motives. Others may simply
not understand the severity and complexity of a MTBI and
the recovery process. Many questions still remain in
regards to what services should be provided to the
recovering student-athlete and how long these services need
to be provided. Often confusion and differences in opinion
for what services are needed can be seen between the
injured athlete and the parents or family members that are
also impacted by these injuries.
Gagnon et al26 explored the specific service needs of
adolescents (12-18 years old) after a MTBI. Subjects
included 15 adolescents and their parents. They were

74
interviewed separately on the following themes: the impact
of a MTBI on the various spheres of the adolescent’s life,
needs following a MTBI, quality of services received since
their injury, and any additional services they wish they
had received to ensure optimal recovery.26 Information
regarding the injury was also extracted from the
adolescent’s medical file and included initial Glasgow Coma
Scale Score, duration of loss of consciousness and post
traumatic amnesia, initial symptoms, and cause of injury.26
Results of the study found that all adolescents and parents
expressed the need to receive information about the injury,
its expected recovery and when to return to activities.
Many adolescents reported wanting to be seen rapidly by
professionals who genuinely care about them and who
acknowledge that they have specific needs.26 Conclusions
from the study suggest that professionals involved in the
management of adolescents with MTBI should be aware of
their needs in order to provide optimal services.26
Social media has become an influential aspect of
today’s society. Ideas, thoughts, news, and other
information can easily be shared and accessed by anyone
with access to the Internet. Creations of electronic social
media sites such as Facebook and MySpace have provided
people with similar interests, issues, and concerns the

75
ability to connect with one another with the mere click of
a mouse.
Ahmed et al27 used content analysis to scrutinize
postings on Facebook groups related to concussion and
examine the purpose of these postings. Four hundred and
seventy-two Facebook groups related to concussions were
screened in the study and 17 groups were selected for
having met the inclusion criteria of the study.27
Demographic information and the purpose of the posting were
the main variables evaluated in the study. Results showed
that the predominant demographic group was North American
males.27 Individuals utilized the Facebook groups to relate
personal experiences of concussions, seek advice, or offer
advice in regards to concussions.27 The evolving nature of
healthcare support in the 21st century and the rich
information present relating to concussions and MTBI on
social networking sites such as Facebook have provided a
new wrinkle in increasing public awareness of the
challenges and impairments facing those recovering from
these injuries.
The use or misuse of terms can also influence the
perceptions and feeling one has towards a topic. If a term
is used that is not well understood by the general
population, confusion and an inaccurate response to the

76
term is a likely outcome. However interchangeable and
similar terms can be used to measure the response they
generate when they are presented to a certain demographic.
Research conducted by Weber and Edwards28 determined
the influence of the terms concussion, MTBI, and minor head
injury on expected injury outcome, term-related familiarity
and actual symptom reporting. Subjects were 224 university
student athletes from the University of Birmingham.28
Participants rated injury outcome statements for their
truthfulness, specified term familiarity and completed
measures on PCS, anxiety, depression, pain, and
affectivity.28 Results of the questionnaire showed that
terminology significantly influenced both expected injury
outcome and familiarity. Outcome expectations were reliably
more negative for the term MTBI than concussion or minor
head injury.28 The data showed that the use of terminology
affected athlete’s injury outcome expectations and
familiarity.28

Academic Support and Accommodations

Kirkwood et al29 proposed a clinical management model
aimed at the non-acute clinical care of pediatric MTBI
focused on both evaluation and intervention from the time

77
of injury through recovery. Variables consisted of four
relevant domains: the individual youth, family, school, and
athletics.29 Subjects referenced in the article were
pediatric or adolescent in age. Findings showed that a lack
of sufficient data to derive evidenced-based management
recommendations for children and adolescents exists.29
Conclusions of the study showed that clinical management
has primary value in its potential to speed recovery,
minimize distress during recovery, and reduced the number
of youth who experience longer-lasting post-concussive
problems.29 However pediatric MTBI management must still
rely heavily on indirect empirical data from adult and more
severely injured pediatric populations.29
McGrath30 looked to provide a framework for AT when
advising colleagues about the health and academic needs of
student-athletes suffering from MTBI. Issues such as
concussion education, preseason baseline testing, post
injury testing, academic accommodations, and return to play
must all be given equal consideration when dealing with
MTBI.30 Particularly in the realm of academic accommodations
there are several steps or alternations that can be made
depending on the severity of symptoms and subsequent
disability that a student athlete may be suffering from.
Along with the importance of making the connection that

78
recovery from a MTBI is just as easily influenced by
cognitive stresses as the physical ones.30
Duff31 mentions the numerous challenges health care
professionals and academic institutions face when dealing
with concussions in the pediatric and adolescent
population. Understanding the impact of age, previous
history of head injuries, and the current guidelines
established by the 2001 Vienna conference are instrumental
in providing the proper care and accommodations to
recovering young athletes.31 The need for potential academic
alterations or accommodations for the symptomatic athlete
are strongly supported by the guidelines set forth by
Kirkwood et al when reintroducing the student athlete back
into the school environment.31 Protecting the rights of a
student athlete who has sustained a MTBI must also be taken
into considering and is protected under Section 504 of the
Rehabilitation Act.31 Incorporating all members of an
institution from the athletic trainers to speech language
pathologist must be considered when a student athlete is
recovering from a MTBI.31
Laubscher et al32 studied the effects of very mild
traumatic brain injuries (vMTBI) and MTBI on academic
performance in secondary school male rugby players. Fortyfive subjects were used in the study and separated into

79
three groups: vMTBI (26 subjects), MTBI (nine subjects),
and a control group that was not involved with athletics
(ten subjects).32 All subjects were from the 11th and 12th
grade, were males, and attended the same school and partook
in the same academic courses. The findings of Laubscher et
al showed a significant decrease in academic performance of
the two concussion groups compared to the control group
when tested in the subject of Afrikanns.32 There was no
significant decrease in the three other courses measured
(Math, Science, and English) and challenges regarding the
small sample size were also noted for a need of future
research into the subject matter.32

80

Summary

After reviewing the current literature on MTBI and
concussions there is a plethora of information available to
AT and other health care providers. However, this knowledge
and information may seem commonplace among health care
providers but due to obscure and foreign terminology may
confuse other professional faculty and staff at a
university. An AT may need to reach out to other sectors of
a university to educate on the current recovery protocols
and impairments that a student athlete suffers from after
sustaining a MTBI.
The descriptive study and survey the researcher
generated provided a glimpse at the current knowledge base
of one of these other sectors at a university, the OSD. The
goal of this study was to gain a better understanding of
the current knowledge base and familiarity of these
professionals while addressing future needs for research
and educate. With this information a more holistic approach
between the two sectors could be formulated to meet the
demands and needs of post-secondary student-athletes.

81

APPENDIX B
The Problem

82
STATEMENT OF THE PROBLEM

The purpose of the study was to examine the current
perceptions professionals working in the OSD have in
regards to concussions and or MTBI. The study also examined
and the most commonly requested and approved disability
access accommodations provided by a university’s OSD for
post-secondary student athletes recovering from a
concussion/MTBI. It is important to examine this problem
because the effects of a concussion/MTBI may impair an
athlete not only from an athletic standpoint but also
interfere with academic success and activities of daily
living. Collaborating between the sports medicine staff and
OSD will provide a holistic approach to the education,
evaluation, treatment, and recovery from concussions/MTBI.

Definition of Terms
The following definitions of terms were defined for
this study:
1)

Concussion/Mild Traumatic Brain Injury– ‘‘A complex
pathophysiological process affecting the brain,
induced by traumatic biomechanical forces’’.2

2)

Disability access accommodations- Academic
accommodations recommended by the Office of Student

83
Disabilities to students recovering from a mild
traumatic brain injury.

Basic Assumptions
The following are basic assumptions of this study:
1)

The subjects will be honest when they complete their
survey.

2)

The subjects will answer all questions completely and
to the best of their ability.

3)

The subjects will complete and submit the survey
during the requested submission deadline.

4)

The sample obtained for this research was a
representation of the population.

4)

The survey had content validity after being reviewed
by a panel of experts.

5)

All subjects had access to technology and were able to
access the SurveyMonkey® survey.

6)

Subjects were representative of OSD professionals.

Limitations of the Study
The following were possible limitations of the study:
1)

There were no current research studies specifically
regarding this topic.

84
2)

OSD professionals who were not in the Mideast or Great
Lake regions as classified by the National Center for
Educational Statistics CollegeNavigator Tool will not
have access to the survey.

3)

The validity and reliability of the instrument has not
been established. A preliminary study was conducted in
the Pennsylvania State Athletic Conference (PSAC), but
an adequate number of responses weren’t received.

4)

The survey was completed online and there was no
supervision by the primary research to ensure that the
survey was completed in its entirety.

5)

Only OSD professionals with a valid email address
received the survey.

Delimitations of the Study
The following was a possible delimitations of the study:
1)

The subjects utilized in this study were from only the
Mideast and Great Lake Regions.

Significance of the Study
The significance of this study identified the current
perceptions of professionals in the OSD on concussions and
MTBI. The study also determined the most commonly requested
and approved disability access accommodations for

85
recovering post-secondary student-athletes. This initial
research and information will allow ATs and university
administration to examine areas where an increase in
communication between the two sectors can be enhanced and
to ensure the professionals in the OSD are update with the
latest protocol and management techniques for MTBI.
Identifying the most commonly requested and approved
disability access accommodations will also give ATs a
better understanding of what services can be provided and
that a holistic approach of treatment is established
between the AT and the OSD.

86

APPENDIX C
Additional Methods

87

APPENDIX C1
Informed Consent Form

88

April 1, 2013
Dear Office of Student Disabilities Professional:
My name is Andrew Jakiel and I am currently a graduate student at California University
of Pennsylvania pursing a Master of Science in Athletic Training. Part of the graduate
study curriculum is to complete a research thesis through conducting research. I am
conducting survey research to determine the current perceptions of the office of student
disabilities (OSD) professionals on concussions and or mild traumatic brain injuries. The
survey will also identify which disability access accommodations are most commonly
requested and approved for the recovering post-secondary student-athlete. The survey
will be generated through SurveyMonkey.com and will be distributed to current
professionals working full-time in a university’s OSD by the primary research to the
Mideast and Great Lake regions as defined by the National Center for Education
Statistics College Navigator Tool. The Mideast and Great Lake regions will be composed
of the following states: IL, IN, NY, NJ, PA, DC, DE, MD, MI, OH and WI. The survey
will be distributed to only four year universities that currently have Men’s and Women’s
Varsity and Junior Varsity Athletic Teams.
Your participation is voluntary and you do have the right to choose not to participate.
You also have the right to discontinue participation at any time during the survey
completion process at which time your data will be discarded. The California University
of Pennsylvania Institutional Review Board has reviewed and approved this project. The
approval is effective 02/04/13 and expires 02/03/14.
All survey responses are anonymous and will be kept confidential, and informed consent
to use the data collected will be assumed upon return of the survey. Aggregate survey
responses will be housed in a password protected file on the CalU campus. Minimal risk
is posed by participating as a subject in this study. I ask that you please take this survey
at your earliest convenience. If you have any questions regarding this project, please feel
free to contact the primary researcher Andrew Jakiel at JAK5070@calu.edu. You can
also contact the faculty advisor for this research (Ellen J. West, EdD, ATC, LAT, 724938-4356, west_e@calu.edu). Thanks in advance for your participation. Please click the
following link to access the survey

(https://www.surveymonkey.com/s/FWGQNW2

89

Thank you for taking the time to take part in my thesis research. I greatly appreciate your
time and effort put into this task.
Sincerely,
Andrew Jakiel LAT, ATC, PES
Primary Researcher
California University of Pennsylvania
250 University Ave
California, PA 15419

90

APPENDIX C2
Institutional Review Board –
California University of Pennsylvania

91
Institutional Review Board
California University of Pennsylvania
Morgan Hall, Room 310
250 University Avenue
California, PA 15419
instreviewboard@calu.edu
Robert Skwarecki, Ph.D., CCC-SLP,Chair

Dear Dear Mr. Andrew James Jakiel:
Please consider this email as official notification that your proposal titled
" Survey of student disabilities services current perceptions on
concussions and/or mild traumatic brain injuries and current disability
access accommodations available to recovering collegiate athletes”
(Proposal #12-036) has been approved by the California University of
Pennsylvania Institutional Review Board as submitted.
The effective date of the approval is 2-4-2013 and the expiration date is 2-32014. These dates must appear on the consent form .
Please note that Federal Policy requires that you notify the IRB promptly
regarding any of the following:
(1) Any additions or changes in procedures you might wish for your
study (additions or changes must be approved by the IRB before
they are implemented)
(2) Any events that affect the safety or well-being of subjects
(3) Any modifications of your study or other responses that are
necessitated by any events reported in (2).
(4) To continue your research beyond the approval expiration date of
2-3-2014 you must file additional information to be considered for
continuing review. Please contactinstreviewboard@calu.edu
Please notify the Board when data collection is complete.
Regards,
Robert Skwarecki, Ph.D., CCC-SLP
Chair, Institutional Review Board

92

APPENDIX C3
Panel of Experts Letter

93

November 29, 2012
Dear______,
I am a graduate athletic training student at California University of
Pennsylvania pursuing a Master of Science degree in athletic training. To fulfill
the thesis requirement for this program, I am conducting a descriptive study.
The objective of this study is to determine the perceptions professionals
working in the Office of Student Disabilities have in regards to mild traumatic
brain injuries. The survey will also identify which disability access
accommodations are typically recommended for post-secondary student
athletes recovering from a mild traumatic brain injury.
In order to increase the content validity of the instrument, a panel of experts
has been chosen to review the survey. You have been selected as one of the
three professionals to be on this panel. Your feedback is vital to the success of
this study. The information obtained by this panel of experts review will be
used to make revisions and create the final survey to be distributed to the
population sample. Your responses are voluntary and will be confidential.
Please answer the following questions based on the attached survey and make
any other additional comments you deem appropriate. Please return your
comments and revisions via email no later than December 5th 2012. If you
have any questions or concerns, please do not hesitate to contact me at
JAK5070@calu.edu.
1. Are the questions appropriate, valid, and understandable? Please Explain.
2. Comment on the overall presentation of the survey.
3. Which questions, if any, should be restated from the survey? Why? What
suggestions would you make?

94

4. Which questions, if any, should be added to the survey? Why? What
suggestions would you make?
Very Respectfully,
Andrew James Jakiel ATC, LAT
CAL U
Graduate Assistant
Cross Country, Track & Field, Tennis

95

APPENDIX C4
Email to Participants

96
Hello,
My name is Andrew Jakiel and I am a graduate student at California University of Pennsylvania. I
am conducting a research study for my Masters thesis about the current perceptions of Office of
Student Disabilities professionals on concussions/and or mild traumatic brain injuries and
the accommodations recommended for recovering student athletes. I have obtained IRB approval
for my study and the survey should only takes 5 minutes of your time. Below is a link that will
take you directly to the survey describing your role as a participant. Thank you for your
participation.

https://www.surveymonkey.com/s/FWGQNW
2
Very Respectfully,
Andrew James Jakiel LAT, ATC, PES
CAL U
Graduate Assistant
Cross Country, Tennis, Track and Field

97

APPENDIX C5
Jakiel OSD Perceptions Concussion and/or MTBI Survey

98

99

100

101

102

103

104

105

106

107

108

109
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ABSTRACT
TITLE:

SURVEY OF STUDENT DISABILITIES SERVICES
CURRENT PERCEPTIONS ON CONCUSSIONS AND/OR
MILD TRAUMATIC BRAIN INJURIES AND CURRENT
DISABILITY ACCESS ACCOMMODATIONS AVAILABLE
TO RECOVERING COLLEGIATE ATHLETES

RESEARCHER:

Andrew James Jakiel, LAT, ATC, PES

ADVISOR:

Ellen J. West, EdD LAT, ATC

DATE:

MAY 2013

PURPOSE:

The purpose of this study is to assess the
current perceptions and familiarity of
student disability services professionals in
regards to concussions and/or MTBI and to
identify the most commonly requested and
approved disability academic access
accommodations available to post-secondary
student-athletes.

DESIGN:

Descriptive Survey

SETTINGS:

Population-Based Survey

PARTICIPANTS:

Three hundred ninety-nine OSD professionals
working at the collegiate setting in the
Great Lakes and Mideast Regions (N=399). The
final response rate was 118 completed
surveys (n=118).

INTERVENTIONS: The variables of the study can be found in
the Jakiel OSD Perceptions Concussions
and/or MTBI Survey. There were no identified
independent or dependent variable.
RESULTS:

Hypothesis 1 was statistically significant,
indicating that NCAA Division I OSD
professionals were more likely to engage in
contact in a more frequent manner with their
university’s athletic training staff when
compared to the other NCAA Divisions or
collegiate affiliations surveyed. In
addition NCAA Division or collegiate

116
affiliation does not significantly impact an
OSD professional’s comfort level in managing
a recovering student-athlete from an OSD
standpoint.
CONCLUSIONS:

Based on the results of this study there is
a need to increase communication between the
office of student disabilities and athletic
trainers in regards to providing care from a
holistic standpoint for recovering studentathletes that have sustained a
concussion/and or MTBI.