Beware the Classroom Costs of Sports Head Injuries

Students who suffer a concussion risk cognitive disabilities, poor academic performance and mood disorders. Jessica Rinaldi/Reuters

Molly Poletto, a University of Utah goalkeeper destined for stardom, was forced to cut her soccer career short after suffering eight concussions. Molly acknowledged that she did not give herself enough time to heal between injuries, behavior that ultimately resulted in years of speech and vision therapy, withdrawals from college courses and short-term memory loss.

Molly is not alone. Every year, thousands of student-athletes who suffer a concussion return to the field before they are fully healed, putting themselves at risk for serious cognitive disabilities. These disabilities can lead to poor academic performance and mood disorders—and can severely compromise life prospects after graduation.

Unfortunately, existing concussion protocols don't properly protect students. The National Collegiate Athletic Association, the organization that regulates college athletics, specifies the stages a student athlete must go through before returning to the field after a concussion. But the NCAA says very little about how to ensure a student's ability to return to the classroom.

That needs to change. A student unable to fruitfully engage in academics isn't ready for competitive athletics. Without a strong "return-to-learn" protocol alongside a "return-to-play" guideline, decision-making responsibility falls to those most reluctant to keep star athletes sidelined—the students themselves, their coaches and colleges where athletics is big business.

The NCAA should implement a specific, evidence-based strategy that ensures students that have suffered a concussion can return to learn.

Part of the problem with the return-to-play protocol is that it relies on subjective determinations and self-reported symptoms. Most of the time, students who suffer concussions look physically fine, so the health care team must base its evaluations on what students tell them.

But college athletes operate within a competitive culture that discourages reporting symptoms accurately or following proper injury-management protocols. Indeed, by one estimate, five in every six suspected college football concussions go unreported.

That figure is likely similar in other high-risk sports like lacrosse and soccer. In fact, over one in every five college athletes is unlikely to report concussions symptoms to a coach, according to a study by the American Academy of Neurology.

And many students lack the knowledge to recognize concussion symptoms. A survey of over 900 NCAA member institutions revealed that only about seven in 10 schools had an annual process for educating athletes about concussions. In some cases, this process consists of nothing more than passing out a one-page handout.

As a result, many students who look physically fine but are still struggling to regain full cognitive abilities return to play too early.

Even worse is the danger of another concussion suffered before a student-athlete has fully healed cognitively and physically from the previous one. The student may experience severe changes in behavior and the ability to process information. In some cases, multiple concussions can cause permanent brain damage.

To prevent these problems, the NCAA should implement a "return-to-learn" concussion protocol. This should include required medical assessments, such as neurologic exams and tests for vision and memory, designed to determine if a student-athlete has healed enough to return to the classroom.

It should also incorporate counseling and wellness services that ensure students are mentally prepared to reintegrate into modern university life—beyond college athletics.

The return-to-learn approach works. Consider the case of a student who suffered a concussion at our school, the New York Institute of Technology. Upon entering our Center for Sports Medicine, physicians assessed the student and assigned him a numerical score based on the severity of his symptoms. They also performed a comprehensive neurological exam, assessed vision and cognitive abilities, and provided physical therapy services for the student.

In performing these assessments, the members of the medical staff were able to identify the student's weak areas and tailor their treatments accordingly. Moreover, access to counseling and wellness services ensured the student was properly equipped to handle any mental symptoms—like anxiety or depression—that could arise after injury. Ultimately, he safely reintegrated back into the classroom—and to his team.

Such success would not have been possible without a holistic protocol involving medical and mental health experts focused on the student's well-being.

The NCAA should take similar steps to ensure students feel supported in their academic environment. Only then will student-athletes be able to return to their sports and classrooms ready to play and learn.

Hallie Zwibel is director of New York Institute of Technology Center for Sports Medicine, where Alice Heron-Burke is senior director of counseling and wellness.