My life has been surrounded by sports since I can remember walking. I tried playing everything imaginable when I was in elementary and middle school, finding myself loving the competition and finesse of little league games. Field hockey stole my heart quickly, as I found myself dedicating most of my time to training during the week, weekends and sometimes (I could swear), in my sleep. In fact, I played field hockey in college, meaning I dedicated my college career not only to academics, but to my team, my coach and my school.
As soon as I graduated college, I no longer had the opportunity to play, and living in Hawaii has put boundaries on my love for the sport — there isn’t much field hockey in the middle of the Pacific Ocean. As every graduate student may understand as well, I don’t have much time outside of academics to enjoy field hockey like I used to.
But then I began studying concussions, and I found my love for athletics and competition again in the willingness of players recovering from concussions sustained while playing sports. The study also revealed my own connection, as a collegiate athlete getting head-butted during a heated competition and losing consciousness for a few seconds, to then find myself suffering a concussion for weeks. I laugh at some of my experiences, like when I fell asleep on my front porch after I forgot my house keys or when I would cry whenever I forgot where I had put my keys. In other instances, I shake my head about all the things I wish I could take back, like trying to participate in class when I could barely keep my eyes open or continuing to play in the same game I lost consciousness.
While I recovered from my concussion, I could have sworn I remembered the six-step return-to-play program in my sleep, dreaming of the day I could play field hockey again. My athletic trainer pushed me to be honest and monitored me carefully while recovering to physical activity and contact practice. The following are the steps recommended in several studies, as well as from the NCAA:
- Light aerobic exercise — For example, I rode a stationary bike for 20 minutes. If I didn’t show any signs of symptoms of a concussion, I moved onto the next step.
- Duration and intensity-dependent exercising — In this portion, the athletic trainers had me ride a bike for a longer period of time (say an hour, since field hockey is considered an endurance sport and demands the ability to run for a long amount of time).
- Activity specific to sport with no contact — In practice, I participated in passing drills where there was no contact with another person, but I slowly was guided back into the intensity of the game.
- Non-contact drills and continuing resistance training — Along with practice, our team lifted five days a week. During this step, I was able to participate in drills where there was no physical contact, such as shooting drills as well as beginning the lifting regimen the rest of the team followed.
- Full Practice — Finally, a full practice to prove that all symptoms of the concussion are gone. This includes contact and noncontact drills.
- Game Ready — Once the player has been able to do steps 1–5 without any symptoms of a concussion, they are allowed to participate in games again with an OK from a physician. In my experience, my coach slowly let me back in games as to be incredibly cautious getting me back into the typical full-game routine I was so used to. I swear by the third game, my teammates could hear me whisper “put me in coach … ”
For any symptoms shown throughout the increments, the player would digress to the step prior. For example, the first time I tried riding the bike I felt my head hurting again and had to return to rest the next day. The step-by-step aspects of returning to play are efficient and organized, and although there are guidelines and recommendations, there is no step-by-step program in recovering to academics.
I personally discovered this issue after returning to class from a concussion sustained a few days before midterms. At this point, I was not even attempting the six-step program to return to play, because I still had symptoms such as a consistent headache, irritability and tiredness. Yes, I stupidly attempted to take my midterm (I like to think my executive functioning aka decision making was affected also). And yes, I failed miserably. My team’s athletic trainer was focused on my recovery, but I was still lacking the carryover to academics.
According to research regarding academic recovery, the following is recommended by the American Medical Society for Sports Medicine: “Students will require cognitive rest and may require academic accommodations such as reduced workload and extended time for tests while recovering from a concussion.”
Although this is recommended and I had a whole group of people supporting me in my recovery, I didn’t have a designated person to help me understand the cognitive deficiencies associated with concussions. In fact, my injury affected my test scores and academic abilities following the three weeks after my concussion because of my inability to concentrate and remember small details, while I also fatigued incredibly fast throughout the day. Looking back now, I wish an SLP could have helped me understand the small incremental steps in returning to academics that coaches, athletic trainers, academic advisors and professors may not understand as thoroughly. I felt that I understood the steps returning to play, but no one had the knowledge of regaining the ability to work again like SLPs do.
Maybe in the future, there will be SLPs assigned to work with college or professional athletes returning to daily living and academics in order to promote the recovery process. In my opinion, another specialist on the team for recovery could do no harm, but provide greater support to a person with mTBI. The scope of our practice may be broad, but no one knows those aspects quite like we do. Although I did not recover to academics appropriately when I sustained my concussion, I feel as if I have learned through personal experience, and have grown to be an advocate for a healthy brain.
Giza, C. C., Kutcher, J. S., Ashwal, S., Barth, J., Getchius, T. S. D., Gioia, G. A., … Zafonte, R. (2013). Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology.Neurology, 80(24), 2250–2257. http://doi.org/10.1212/WNL.0b013e31828d57dd
Harmon K.G., Drezner J.A., Gammons M., et al. (2013). American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med, 47, 15–26. doi:10.1136/bjsports-2012-091941