Effect of RISE Bundle implementation on school adoption of a student-centered return-to-learn program in Washington state.

BACKGROUND: Appropriate concussion care in school is vital for full recovery, but school return-to-learn (RTL) programs are lacking and vary in quality. Establishing student-centered RTL programs may reduce disparities in RTL care. OBJECTIVE: To examine the effect of RISE Bundle (Return to Learn Implementation Bundle for Schools) implementation on high school adoption of a student-centered RTL program. METHODS: A convenience sample of fourteen (4 rural and 10 urban) small and large Washington (WA) State public high schools were enrolled in a stepped-wedge study with baseline, end of study, and monthly measures over the 2021-2022 academic year. Schools identified an RTL champion who led RISE Bundle implementation in 6-week steps. Concussion knowledge and impact of RTL program on concussion care were examined. RESULTS: Ten schools (71.4%) successfully completed RISE Bundle implementation and established a functional RTL program. Self-reported concussion knowledge from RTL Champions increased post intervention. Establishing RTL programs facilitated provision of tailored accommodations, and perceived variation and inequities in RTL care were reduced. CONCLUSION: RISE Bundle implementation proved feasible, supported the establishment of a functional RTL program, and perceived to reduce disparities in concussion care in rural and urban WA State public high schools of varying sizes.

Concussion evaluation methods among Washington State high school football coaches and athletic trainers.

OBJECTIVE: To evaluate awareness of concussion assessment methods and to determine whether there are differences among Washington State high school football coaches and athletic trainers in urban versus rural school districts. DESIGN: A Catalyst WebQ survey link was randomly sent by e-mail to varsity head football coaches, athletic trainers, and athletic directors in Washington State school districts. PARTICIPANTS: Survey participants were high school varsity head football coaches and athletic trainers from a total of 106 Washington State high schools. METHODS: A 12-item questionnaire on Catalyst WebQ was distributed via e-mail. The survey inquired about use of the methods of concussion assessment, both on the field and for follow-up; participants' concussion education training; and familiarity with Washington State's Zackery Lystedt Law. MAIN OUTCOME MEASUREMENTS: The survey examined differences in concussion management practices between rural and urban school districts and also between coaches and athletic trainers in Washington State, specifically regarding the use of the Standardized Concussion Assessment Tool 2 (SCAT2) and neurocognitive testing (NCT). RESULTS: Twenty-seven of 48 respondents (56%) used the SCAT2 for on-the-field assessment; urban respondents were significantly more likely to use SCAT2 (P < .05). The difference between coaches and athletic trainers with respect to SCAT2 use was not significant (P = .08). NCT was used by 18 of 58 respondents (31%). This was more commonly used by those in urban districts (P < .01) and by athletic trainers (P < .01). Eleven of these 18 individuals (61%) reported that a neuropsychologist interpreted the results; the rest used other providers not specifically trained in neuropsychology. There was no statistically significant correlation between years of experience and use of the SCAT2, but those with more than 10 years of experience were less likely to use NCT (P < .01). All respondents reported being familiar with Washington State's Zackery Lystedt Law, but only 44.1% reported that the law changed their concussion management. CONCLUSIONS: There were statistically significant differences between SCAT2 and NCT use for respondents from urban and rural districts, and also between coaches and athletic trainers, as well as NCT use among respondents with varying years of experience. Further understanding and identification of barriers that limit identification and management of concussions in high school athletes are crucial to prevent serious permanent injury. Additional education is necessary to ensure that athletic trainers and coaches are aware of current recommendations within the medical literature for the evaluation and management of concussions.

Use of neuropsychological evaluations.

Neuropsychological or neurocognitive tests provide information regarding the cognitive and emotional status of the concussed athlete. The development and availability of computerized testing platforms has allowed the application of baseline and follow-up testing models, and provide a more precise measurement of reaction time and processing speed. A combination of computerized assessment and a more expanded battery of tests may be a better approach to understanding the nature of the cognitive impact of sports concussion in youth athletes. This approach may be especially important for athletes with general risk factors and other potential modifiers or influencers on the cognitive performance data.

Attention deficit hyperactivity disorder and the athlete: an American Medical Society for Sports Medicine position statement.

Attention deficit hyperactivity disorder (ADHD) is an important issue for the physician taking care of athletes since ADHD is common in the athletic population, and comorbid issues affect athletes of all ages. The health care provider taking care of athletes should be familiar with making the diagnosis of ADHD, the management of ADHD, and how treatment medications impact exercise and performance. In this statement, the term "Team Physician" is used in reference to all healthcare providers that take care of athletes. These providers should understand the side effects of medications, regulatory issues regarding stimulant medications, and indications for additional testing. This position statement is not intended to be a comprehensive review of ADHD, but rather a directed review of the core issues related to the athlete with ADHD.

Neurocognitive correlates of positive and negative perfectionism.

The present study examined the neurocognitive correlates of positive and negative perfectionism. A clinical sample of 160 patients undergoing standard neuropsychological testing was administered the Positive and Negative Perfectionism Scale (PANPS), a 40-item questionnaire measure of positive and negative perfectionism. The main question addressed in the study was how individual differences in positive and negative perfectionism relate to differences in neurocognitive performance. The general hypotheses to be tested were that positive perfectionism would be associated primarily with tests that relied on mental and physical "effort," while negative perfectionism would be associated with tests involving both "speed and accuracy." The results of the study provided general support for these hypotheses. Implications for the perfectionism literature and sports psychology are briefly discussed.