This article reviews the essential components of a practical, evidenced-based approach to the management of sport-related concussion in an ambulatory care setting. The model presented is based on the core philosophy that concussion assessment and management be approached from the biopsychosocial perspective, which recognizes the medical/physiological, psychological, and sociological factors that influence recovery and outcome following concussion. Based on the biopsychosocial paradigm, we outline a care delivery model that emphasizes an interdisciplinary approach in which the clinical neuropsychologist is a key participant. We discuss the importance of nonmedical, psychoeducational interventions introduced during the acute phase to facilitate recovery after sport-related concussion. Finally, using the local experience of our “Concussion Clinic” as a backdrop, we offer two separate case studies that demonstrate the value of this model in evaluating and managing athletes after sport-related concussion. The overall objective of this paper is to provide an adaptable template that neuropsychologists and other healthcare providers can use to improve the overall care of athletes with sport-related concussion and civilians with mild traumatic brain injury.
Michael McCrea and Matthew R. Powell
Lynda Mainwaring, Michael Hutchison, Paul Camper, and Doug Richards
Depression, fatigue, irritability, confusion, and general mood disturbance are frequently reported after cerebral concussion in sport. Recent trends in research point to the importance of examining postconcussive emotional disturbances more thoroughly, empirically, and clinically. An overview of the complexity of human emotion and its study is provided herein, followed by a review of emotional correlates identified in the existing sparse literature. The significance and clinical implications of identifying emotional correlates of concussion in sport and athletics are discussed.
Lynda Mainwaring and Max Trenerry
This current special issue of the Journal of Clinical Sport Psychology was conceived and developed to provide a resource for clinicians who have contact with athletes who are at risk for or have sustained a concussion during sport participation. The special issue is part of an exciting two-issue series. This first installment contains papers from leaders in the field of sport concussion who review the frequency and mechanisms of concussion, models for managing concussion, the emotional aspects of concussion in sport, practical examples from a model sport concussion clinic, and the importance of sport concussion education and prevention. As Guest Editors, we hope that this timely and unique special series will be used by clinicians who help care for athletes and their families who have experienced concussion in their sport life.
Paul Comper, Michael Hutchison, Doug Richards, and Lynda Mainwaring
Along with the ever growing awareness among the scientific community and the general public that concussion is a serious health care issue at all levels of sport, with potentially devastating long term health effects, the number of concussion surveillance clinical monitoring programs has significantly increased internationally over the past 10–15 years. An effective concussion program (a “best practice” model) is clinically prudent and evidence-based, one that is an interdisciplinary model involving health professionals who manage, educate, and provide psychosocial support to athletes. The integration of neuropsychological assessment is a component of many present day programs, and therefore, the neuropsychologist is an integral member of the concussion management team. The University of Toronto Concussion Program, operational since 1999, integrates best practices and current evidence into a working model of concussion management for university athletes. The model uses an interdisciplinary approach to monitor and assess athletes with concussions, as well as to educate its athletes, coaches, and administrators. A research component is also integral to the program.
Charles H. Tator
There has been a remarkable increase in the past 10 years in the awareness of concussion in the sports and recreation communities. Just as sport participants, their families, coaches, trainers, and sports organizations now know more about concussions, health care professionals are also better prepared to diagnose and manage concussions. As has been stated in the formal articles in this special issue on sport-related concussion, education about concussion is one of the most important aspects of concussion prevention, with the others being data collection, program evaluation, improved engineering, and introduction and enforcement of rules. Unfortunately, the incidence of concussion appears to be rising in many sports and thus, additional sports-specific strategies are required to reduce the incidence, short-term effects, and long term consequences of concussion. Enhanced educational strategies are required to ensure that individual participants, sports organizations, and health care professionals recognize concussions and manage them proficiently according to internationally recognized guidelines. Therefore, this paper serves as a “brief report” on a few important aspects of concussion education and prevention.
Robert J. Schinke, Randy C. Battochio, Timothy V. Dube, Ronnie Lidor, Gershon Tenenbaum, and Andrew M. Lane
Sport researchers have considered the processes that elite athletes undergo to achieve positive psychological adaptation during significant chronic stressors throughout sport careers and also, acute stressors within important competitions. This review contains a description of competitive and organizational stressors that can hamper an elite athlete’s pursuit of adaptation within the aforementioned circumstances, followed by an identification of the responses that together can foster the desired outcome of adaptation. The authors propose that there are four parts that contribute to an elite athlete’s positive psychological adaptation, presented as parts of a process: (a) the appraisal of stressors, (b) coping strategies, (c) self-regulation strategies, and (d) a consolidated adaptation response. Subsequently, athlete adaptation is considered through examples taken from anecdotal literature and formal research studies pertaining to elite athlete adaptation. Implications are discussed for sport psychologists, mental training consultants, sport scientists, coaches, and athletes.
María Sol Alvarez, Isabel Balaguer, Isabel Castillo, and Joan L. Duda
Drawing from the theories of self-determination (SDT; Ryan & Deci, 2000) achievement goals (AGT; Nicholls, 1989), and, in particular, Vallerand’s four-stage casual sequence embedded in his hierarchical model of intrinsic and extrinsic motivation (HMIEM; Vallerand, 1997, 2001), this study tested a motivational model in the sport context via structural equation modeling (SEM). Based on the responses of 370 young male soccer players (M age = 14.77), the path analysis results offered overall support for the proposed model. A perceived task-involving climate emerged as a positive predictor of the satisfaction of the three psychological needs, while a perceived ego-involving climate was a negative predictor of related-ness satisfaction. The results also support positive paths between satisfaction of the three psychological needs and intrinsic motivation, while intrinsic motivation was positively linked to subjective vitality and future intention to participate. The implications of the coach-created motivational climate are discussed in the light of its implications for the quality and potential maintenance of sport involvement among young athletes.
Craig Lodis, Sandra T. Sigmon, Amber Martinson, Julia Craner, Morgan McGillicuddy, and Bruce Hale
This study investigated seasonality in male and female college athletes and nonathletes. Given the literature on activity level and its positive impact on mood, it was predicted that athletes would benefit more than nonathletes with regards to seasonal symptoms. Participants completed measures of seasonality, depression, and cognitive processes during a winter month. Multiple measures of seasonality were administered to distinguish seasonal depression symptoms from nonseasonal symptoms. Results indicated that nonathletes reported more seasonal symptoms, seasonal attitudes, and rumination, gained more weight, socialized the least, and slept more than athletes. Female nonathletes reported the most impact from the changing seasons and more negative thoughts about the changing seasons. These results indicate that engaging in collegiate athletics may serve as a protective factor in seasonal depression.
Paul R. Appleton and Andrew P. Hill
This study investigated whether motivation regulations mediate the relationship between socially prescribed and self-oriented dimensions of perfectionism and athlete burnout. Two-hundred and thirty-one (N = 231) elite junior athletes completed the Child and Adolescent Perfectionism Scale (Flett, Hewitt, Boucher, Davidson, & Munro, 2000), the Sport Motivation Scale (Pelletier, Fortier, Valle-rand, Tuson, & Blais, 1995), and the Athlete Burnout Questionnaire (Raedeke & Smith, 2009). Multiple mediator regression analyses revealed that amotivation mediated the relationship between socially prescribed perfectionism and burnout symptoms. Amotivation and intrinsic motivation emerged as significant mediators of the relationship between self-oriented perfectionism and burnout symptoms. The findings suggest that patterns of motivation regulations are important factors in the perfectionism-athlete burnout relationship.
Yusuke Tabei, David Fletcher, and Kate Goodger
This study investigated the relationship between organizational stressors in sport and athlete burnout and involved a cross-cultural comparison of English and Japanese soccer players. Ninety-eight male players completed the Athlete Burnout Questionnaire (Raedeke & Smith, 2001) to determine levels of perceived burnout. Based on data reported in previous research, and the thresholds developed by Hodge, Lonsdale, and Ng (2008), 22 of the players were identified as exhibiting higher levels of perceived burnout. Nine members of this subsample (4 English and 5 Japanese players) were subsequently interviewed to explore the relationship between their experiences of burnout and the organizational stressors they encountered. Results revealed multiple demands linked to the dimensions of athlete burnout and identified specific organizational-related issues that players associated with the incidence of burnout. Cultural differences between English and Japanese players in terms of the prevalence and organizational stressors associated with burnout were also identified, with the main differences being the relationship with senior teammates and the coaching style.