Understanding concussion in para athletes with vision impairment

Abstract

Sports-related concussions occur in para sport as they do in able-bodied sport. There is evidence to suggest athletes with vision impairment (VI) may be more likely to sustain concussion injuries compared to athletes with other impairment types. However, there is limited understanding of best practices in concussion assessment and management for athletes with VI. Symptoms intrinsic to pre-existing conditions in para athletes are also commonly seen in athletes suffering from a concussion, which makes the assessment and management of concussion more challenging in the para athlete population. Perspectives and experiences of VI para sport athletes and coaches with concussion are also poorly understood. The purpose of this project was to understand how concussions are currently assessed and managed in elite para athletes with vision impairment, to move toward establishing clinical practice guidelines and critical research priorities in concussion management for elite athletes with VI. The secondary objective of this thesis was to understand the perspectives, experiences, and knowledge of elite athletes with VI and coaches concerning concussion in VI para sport. A two-round Delphi study was conducted to solicit the opinions of healthcare professionals, researchers, and administrators in VI para sport concerning concussion assessment and management practices. Eight out of the nine interested participants completed the first-round survey; seven of those completed the second-round survey. Five out of eight participants were sports medicine physicians, and the remaining three participants had a background in physical therapy. Experts identified that VI athletes may exhibit different observable signs of concussion (e.g., lack of blank look, balance issues at baseline, etc.) compared to able-bodied athletes. Experts unanimously agreed that pre-season baseline testing is necessary for para athletes with VI. While most experts (86%) agreed the SCAT5 currently represents the most effective assessment tool available for the evaluation of suspected concussion, one expert disagreed and explained that the SCAT5 is too complex for regular sideline use. Some experts suggested prescribing a longer period of initial rest or doubling the time between return-to-sport steps for athletes with VI. Experts came to a unanimous consensus that there is a lack of after-care in VI para sport in addition to the lack of on-site specially trained medical support. Elite para athletes with VI and coaches were invited to participate in a single-round survey study. The survey questions covered the following topics: Demographics; Concussion incidence, recognition, response, assessment, and management; Return-to-sport; and Education. Analysis consisted of categorizing written responses and analyzing response frequencies. A total of 8 participants (athletes (n = 4); coaches (n = 4)) from elite VI para sport took part. Athletes were found to have less awareness of medics at sidelines, assessment tools, how decisions are made to investigate for concussion, and the need for concussion assessments than coaches. Athletes were also more likely to not report incidents with reasons for not reporting including “don’t think it’s serious”, “time and money”, and “misdiagnosis because of underlying conditions”. Coaches are not considering athlete involvement in return-to-play decisions. Athletes and coaches agreed that it is important for medical professionals to have concussion education but differ on the need for education of athletes and guides. Athletes reported having little and poor quality concussion education. Future investment in the provision of specially trained on-site medical support is needed to ensure the safety and well-being of VI para athletes. Education strategies should prioritize informing para athletes of the potential long-term consequences of concussion, so they understand the significance of failing to report concussion symptoms and of neglecting concussion injury protocol.