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Season 1, Episode 8: Concussion in School Sports

September 4, 2023

In this episode we discuss concussion education programs for school sports.

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Episode Guests

Daniel DaneshvarDaniel Daneshvar, MD, PhD conducts research on the long-term effects of moderate-severe traumatic brain injury, concussion, and repetitive head impacts, including chronic traumatic encephalopathy (CTE). Dr. Daneshvar's work has been published in the Journal of the American Medical Association, Annals of Neurology, and Brain, and has been featured broadly including in the New York Times, the Wall Street Journal, NPR, and ESPN. He also founded Team Up Against Concussions, the first scientifically validated concussion education program for kids. He is the Director of the Institute for Brain Research and Innovation at TeachAids, which created CrashCourse: a free, scientifically validated virtual reality and computer-based concussion education program. He received his S.B. from MIT and completed his MD/PhD at the BU CTE Center. His research resulted in the first dissertation in history to study CTE. He completed residency at Stanford University before joining the faculty at Harvard Medical School.

Esther LovettEsther Lovett is an analyst at Guidepost Growth Equity. She joins us in this episode because of her experience as an advocate for post-concussion syndrome. As an eighth grader in 2013, she experienced her first concussion while playing soccer. Over the next few years, Esther, who was an avid athlete playing soccer, hockey, and tennis, experienced a total of five diagnosed concussions. She shares her experiences to support others with insights, suggestions, and information on various platforms, including her own website, Headstrong.

Episode Resources

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If you are interested in one of the articles highlighted on the show, but are having trouble accessing it, please reach out to us at


Shonali Gaudino, OT, Host, Producer, Co-Creator

Chuck Clough, Editor

This production is a collaboration between, and partially funded by, the Rehabilitation Outcomes Center at Spaulding and our Model Systems: the Boston-Harvard Burn Injury Model System (NIDILRR Award #90DPBU0008), the Spaulding-Harvard Traumatic Brain Injury Model System (NIDILRR Award #90DPTB0027-01-01), and the Spaulding New England Regional Spinal Cord Injury Model System Center (NIDILRR Award #90SIM0017-01-00).

Transcript of Episode 8

Esther: 00:04

I was playing a soccer game and took a pretty hard ball sort of to the side of my head. And, remember feeling kind of immediately pretty dizzy - a little bit off. And I know, I know people recognize that I'd gotten hit like I know my dad on the sideline. Kinda they give me the thumbs up, thumbs down and I gave him the thumbs up and kind of similar with at least one of my teammates, but I think in that case, I just wasn't in a place where I could really recognize I did myself, just because I, you know, had just had a concussion.

Shonali: 00:50

Welcome to Finding Strength. The Spaulding Rehabilitation Podcast, where we'll try to connect the dots between rehabilitation research and the people who are most impacted. This production is a collaboration between the model systems and the Rehabilitation Outcomes Center at Spaulding. I'm your host, Shonali Gaudino and today we’re talking about school-age concussions and education programs. 

The voice you heard at the top of the episode was Esther Lovett. Esther is an advocate for post-concussion syndrome after managing the effects of multiple concussions in grade school. She has an impressive track record of speaking out through her own blog, website, and in partnership with the Concussion Legacy Foundation. You can even watch her TED talk.

We’re also joined today by Dr. Daniel Daneshvar who has been doing concussion research for over a decade. In the episode resource links, you’ll find a couple of his articles evaluating the effectiveness of concussion education programs. Dr. Daneshvar is Chief of the Division of Brain Injury at Spaulding, Assistant Professor at Harvard Medical School, Director of the TeachAids Institute for Brain Research and Innovation, and is the Director of Training at our own Rehabilitation Outcomes Center at Spaulding. So given that this episode is releasing in September, and school is starting back up, let’s jump back into Esther’s story.

Esther: 02:06

As a youth athlete, I played soccer and hockey. And ended up having two serious concussions that really sent me on a long path of getting better and having post-concussion syndrome for years. So, I had a few bad concussions, stop playing sports, but at this point, graduated from Georgetown in 2022. And now I'm working full time, moved back to Boston, and, you know, still have some lingering symptoms. But, I'm so much improved. And so, hope that, that other people know that, that things get better. And sometimes it just takes time. I think, knowing what we know now, hopefully those teammates or even my dad probably would have handled it differently of, you know, sort of insisting that, that I come out and get checked out.

Dr. Daneshvar: 03:02

So, one of the things that we realize now is with concussions, getting proper rest and recovery is critically important. We know that one of the things that can most prolong your symptoms of a concussion is a subsequent head injury. And we also know that a second head impact of lesser magnitude than what would normally give you a concussion, could give you a concussion. And so that's why it's so important to make sure that you get rest and recovery. And one of the things we also tell the athletes is if you have a concussion, you're not only at higher risk of getting a second concussion, you're also at higher risk of getting an ACL tear, or you know hurting another part of your body. And that makes sense. Because if your reaction time is off, if your proprioception or your ability to know where you are in space, if that’s off. If you're not able to think the same way as quickly as you normally can. You're gonna be at risk of hurting yourself.

Esther: 04:10

I just couldn't really recognize it in myself at the moment, even though I felt like I had had decent education about concussions and, you know, typically would have been able to recognize the signs and symptoms just sort of in that moment. So out of it. I didn't I didn't take myself out.

Shonali: 04:25

Yeah. You said you had had some kind of education before that?

Esther: 04:29

Yeah, I remember, at my school, we did impact testing, and sort of the, the educational piece that comes along with that. And then I also played on a club soccer team, where I think, I mean, I think their coaching staff did a pretty good job, frankly, talking about concussion and making us feel like we should self-report or we should speak up if teammates of ours had had concussions or, you know, we noticed something on the field. But I think all of the education that I had had, concussions were a very short-term injury. And I had had a concussion myself before that one in 2013, where I missed one game, and I felt fine after, you know, maybe a couple of days and was sort of held out as a precaution. And that's exactly what I had seen teammates go through as well, sort of the, you miss a week, and then everything's fine. I guess we're sort of some of the education failed me a little bit was more, as I sort of got further down the bell curve, and had post-concussion syndrome. And I'd never, I've never, I'd never heard those words before being diagnosed with it. And that was never a component of any of the concussion training. And it seems like there's a place for both obviously want people to understand the short-term effects and how to recognize symptoms in a teammate. And, you know, help them get off the field in the short term, but also understanding that sometimes you don't recover in a few days or a week. And so, people have this long tail of recovery. And that, you know, other people experienced that as well.

Shonali: 06:01

Talk more about impact testing, either one of you, because I don't know anything about impact testing.

Esther: 06:05

I remember doing it in the computer lab at school, and sort of running through a series of memory tests, you know, shapes and colors, pattern recognition, things like that. And then I remember taking it after having a concussion, and it being so hard, and then immediately telling me to go see a doctor after seeing my results on it. And remember taking it a few times after that, but yeah, at least for me, that was a that was a quick red flag.

Dr. Daneshvar: 06:36

The idea is that it can be so hard to know whether someone has a concussion because unlike, you know, an injury to the rest of your body, you don't know for sure - that there's no x-ray, or even advanced imaging, no MRI, that tells you whether or not someone's concussed. And we're all so different. So, some people might have better memory than others, just starting off the bat. So, what impact testing does is it allows every athlete to get a baseline test. So, you can figure out how someone's functioning before a potential injury. And then if you're concerned that they have one, you test them and see whether or not they might have a concussion. The problem with impact testing though is some athletes will intentionally what's called sandbag their baseline test, so that it'll be harder to determine whether they had a concussion in the future. And so, and we know that that happens, and that's why this isn't a black and white way of assessing concussions, it's just another tool in the toolbox. But when you’re talking about knowing what concussions were, and even knowing that you're supposed to speak up for your teammates like that those are two critically important things.

Shonali: 07:53

Had you ever heard of impact testing? I hadn’t. I wondered if it was mandated across all school sports in the country.

Dr. Daneshvar: 08:01

The impact testing is not mandated. But the majority of high schools and almost all colleges do some form of neuropsychiatric testing at baseline so that they can then follow it up, whether that be impact or something else. Now, when we're talking about concussion education, every state has a requirement. So, the first state to pass a law mandating concussion education was the state of Washington, and it was following a catastrophic injury that occurred to a high school student by name is Zack Lystedt . And so, the first law then was Lystedt Law in, in Washington, which is I think, in 2007. And then, basically, every state has since followed suit with a similar law. But there isn't a lot of standardization of what counts as convention education. So, for some teams, that's just putting a flyer up on the wall. For other teams are much more robust in their concussion education. there's also no real enforcement mechanism for making sure that this takes place. There's no one monitoring in most states, and then there's no one penalizing for the teams that don't do it properly. So that really sets up a system where you know, it's the Wild West.

Shonali: 09:34

I graduated high school in 2003. So, thinking back to sort of like, what, I don't think we I mean, I was a swimmer, so it wasn't really a contact sport. So, we didn't have to, didn't have to go through that. But I don't think we had really much of this in New Jersey in 2000. In the early 2000s

Dr. Daneshvar: 09:50

Our knowledge of concussions has changed so much right when I started doing this work 15 years ago, what we thought of as concussions, that they're different than what they are now. We now know that a lot of the things that we would previously called ‘dings’, or ‘bell ringers’ , those are concussions. And so, part of the task with concussion education programs over the last 15 years has been trying to bridge that knowledge gap that it's not just a knowledge gap from scientists to providers, it's a knowledge gap from the scientists to patients to families. It’s not just educating people about what a concussion is, which is critically important. But it's also about imparting a attitude change, a behavior change, a belief change, because you might know what a concussion is. But if you don't think it's serious enough to report, or if you don't feel that your coaches and your teammates would respect you for reporting them, then you're not going to report them. And that is something that every educational program needs to really take into account. And so part of what we learn from when implementing new education programs is building on the robust literature that frankly, comes from a lot of the stuff that didn't work like the DARE program of the 80s and 90s. There's a robust literature around that intervention change, and what worked for and what didn't largely what didn't work. And so when we, you know, created new concussion education programs, and then looked to validate them, we base it really on that, that scientific literature.

Shonali: 11:38

What kinds of things did not work about the DARE program? Because now I think back in, I think people used to joke about the DARE program, like when I was in school, like you were not the cool kid, if you like, really believed that the DARE program.

Dr. Daneshvar: 11:50

And that's what we learned so that there's a of Planned Behavior that was first proposed in the early 90s. But it basically says that you need changes to certain constructs to actually change someone's behavior and one of those is the perceived norms. What the other people in your situation would do. That influences what you would do. So, the DARE program it was just largely about imparting information. But if you don't, if you think that your friends would think it's dorky to not do drugs, then you You're gonna feel it's dorky to not do drugs. Similarly, if you think that your teammates would not report their concussion, then you're less likely to report your concussion. If you think that your coaches would look down on you for reporting a concussion then you, similarly, will look down on yourself for potential recording question. And so that's where the perceived norms are, it's one of the key constructs in imparting behavioral change.

Dr. Daneshvar: 12:25

One of the other constructs of the theory of planned behavior, is to have what's called Perceived Behavioral Control. The idea that you know what to do in the case of wanting to make that behavior change, what I mean is, in the example of concussions, if you know how you would go through the mechanism of reporting, you for yourself or for your friend, you're more likely to actually do it when when it comes down to brass tax it's a lot harder to minute navigate that space, if you're a person who has a brain injury, which is what a concussion is. And to figure it out for the first time, if you haven't already mentally gone through what it would be like to, to report.

Shonali: 13:48

So if we want to improve prevention and early treatment of concussion in schools, it’s not enough just to deliver facts and figures. We have to acknowledge and address the very human aspects of our behavior – as Dan says, perceived norms, and perceived behavioral control. Shift the cultural attitudes and make a concussion action plan. Question is – how are school concussion education programs integrating these lessons so far? I asked Dan to describe a couple of the programs that exist today.

Dr. Daneshvar: 14:23

Yeah, so the most commonly used one is a video-based concussion education program. That's actually a both written and video based English education program. And so, they'll sometimes some schools will just use the written materials, most schools will require the learners to watch like a 14-minute video or something along those lines.

The second most commonly used concussion education programs, something actually I helped to develop, but it also has a VR option. which is called Crash Course. You are put in the situation of someone who experiencing concussion, and then you basically have to decide am I going to report this concussion or not, and then you're led down the path - like a choose your own adventure type thing, know that path of what happens based on your choice. That aspect is one of the things that we want to study from a research perspective, we want to see to what extent having ownership over that decision in impacts your beliefs, and attitudes and the other constructs related to behavior change around concussion reporting.

Shonali: 15:29

Yeah, from someone who has a background in education. The idea that like any training, let alone an hour or less can impact a cultural shift is like a serious challenge. But that game, gamification idea, right, is more engaging. So, any more on the research on sort of what that has shown?

Dr. Daneshvar: 15:48

Yeah, that was one of the things we also found when we studied is that something about having multiple different education programs, in series substantially improves metrics related to concussion reporting. So, to your point, it's, it might not be enough for just a one-time point education to really change views related to concussion that you might need regular, or at least repeated concussion education interventions, to really impact changing behavior. There's also ways to kind of build the community surrounding Concussion Awareness and Education. So, for example, there's another program called The Concussion Story Wall. An online collection of people's stories related to concussion most of them had persistent post-concussion symptoms and, and so they had prolonged recovery. So, one of the problems with getting diagnosed with a concussion is that it's an isolating experience. You feel like nobody else is going through that, or nobody else has gone through that. And that's for the most part, it's, again, because it's an invisible injury. And so, what tools like the Story Wall can provide in terms of education is access to other people who have experienced similar problems, and, and the knowledge that they recover? Because that can also be very scary for people when they're taking a longer time to recover than their peers might have.

Shonali: 17:28

Yeah, similar for what you were Yeah. what you went through, right, that isolating experience? Yeah. Did you know about was it? Did it exist when you were going through this that the story?

Esther: 17:36

Not that I knew of.

Dr. Daneshvar: 17:38

That was launched in in 2019.

Esther: 17:40

I mean, for me, I even got to a point where the doc the concussion doctor, I was seeing, told me that he'd never had a patient who had symptoms for as long as I had. And so that's, that's sort of a scary territory to enter when it's like, not only do I not know anybody who who's had symptoms for this long, but my doctor who's an expert in his field hasn't had a patient who's experienced symptoms for this long. And so that's, that's certainly very isolating.

Shonali: 18:08

Talk a little bit about maybe team up against concussions? Is that something that is like ancient history for you? Now? I don't know how long ago that was

Dr. Daneshvar: 18:12

Ancient history. So, Team Up Against Concussions was the first scientifically validated concussion education program. It's the way that I actually originally met Esther. So that was 10 years ago, eight years ago?

Esther: 18:30

Something like that, yeah.

Dr. Daneshvar: 18:31

And so this is a program that was launched in 2009. And its model was basically to help impart concussion education information by directly talking to kids with your near peers, so you know, maybe five years older or so. And it ended up proving to be successful in terms of changing knowledge and attitudes about concussion. But the problem is that it doesn't really scale very well. And so, we educated, you know, almost 40,000 kids. But that's a drop in the bucket when you're talking about, you know, 3 million football players in this country every year. There are actually more than that, sorry, almost 3.97 million. Over 60% of all people playing football in this country are playing before high school. Right? It's like a 30% or so are playing at high school level. And that's just football, right? You're talking about all these other sports, if you if the best estimate said say that there are a couple million concussions from sports every year in this country. And so if you're educating people, 30 - 40,000 people at a time, that doesn't really address the problem. And so that was where the need for a more scalable solution came from.

Shonali: 19:55

Which lead to Crash Course. Because it's like a package that you, but that's part of the thing, right is at the end of the day, like one of the things that can have the biggest impact is like people talking with people. So, if you can integrate the both, yeah, with each other.

Dr. Daneshvar: 20:308

And so, The Concussion Legacy Foundation actually launched a initiative called Team Up, Speak Up. And the idea here is perceived norms. So, this idea that your teammates would report a concussion that makes you more likely to report a concussion. Well, what Team Up Speak Up is, is it's a basically a pledge that is said before, a game by a team, in unison, they are basically all reading a statement, which basically says that, you know, I agree to look out for concussion symptoms in myself or my teammates, but something about the act of saying it as a community. The thought there is that that can help move the needle when it comes to changing the perceived norms.

Shonali: 20:54

Who was actually delivering these education programs, it's the coaches and the like, like the gym teachers in school?

Dr. Daneshvar: 20:57

The problem is that there's no standardization. You can have programs that have athletic trainers, delivering it, those actually based on some other research tend to be the best ways of delivering cash education. But you can have many programs that don't even have athletic trainers, in particular at the youth level. Parents have a front row seat and know their kids better than anybody else. And they can often be the first to sense that there's something wrong and escalate their kid to get the care they need. But unfortunately, most of these concussion allegations, they're not given to parents at all. And so that's part of what we're also learning is really important is that you need to the parents need to be involved in the education too, because if they don't know what to be looking for them, they're not going to look for it.]

Shonali: 21:53

Were there people in your life that were like, something's not right with you, Esther?

Esther: 21:59

Yeah, for sure. I mean, it was my dad, who was really the only one who noticed that I got hit on the field, I think one of my teammates said something. But you know, he was sort of the first person because the parents are the ones who are probably watching their kids specifically on the field the most. But it was definitely my parents who identified it even sort of later that day, the next day, once I had sort of all the symptoms come on. And certainly, were also the ones to escalate things. Cause I don't I don't know that I would have known to do that and been in the right state of mind to do that.

Shonali: 22:35

And do we know anything about which sports are more dangerous than others? 

Dr. Daneshvar: 22:39

The problem with assigning risk to sports, when it comes to concussion is that you don't want to discount the fact that your brain doesn't care what hits it. I've seen some horrible concussions that come from things like cheerleading where they're doing those incredibly technical tosses over very hard surfaces. I've also seen a really bad concussions in things that you wouldn't necessarily consider contact sports like swimming it when people are doing those turns at the edge of the pool. Skiing, of course, you see really bad brain injuries in general tend to not be as frequent with concussions. But I mean, you know, if I were to say the single sport that’s the worst when it comes to concussion, it's got to be boxing. Right because the goal of that sport is to give someone a concussion, right? That's what knocking them out is. So, the that's probably the worst. But fortunately, we don't have for the last seventy years, we don't have that many middle schoolers doing it. But it used to be in middle schools used to be a normal thing,

Shonali: 23:41

I have to go back and ask my husband was a was a boxer in school, like grade school. So, I have to ask, when that started, whether it was high school or even earlier, but even a high schooler doing boxing is like a terrifying concept to me. But they're pretty prevalent, right? High School boxing teams?

Shonali: 24:00

Quick disclaimer that I don’t know much about boxing, probably have no right nor reason to be judging school-aged boxing, and I wouldn’t be surprised if the physical and mental health benefits of boxing outweighed the risks! But let’s continue.

Dr. Daneshvar: 24:14

One of my colleagues actually pulled the video of this, it's like from the 50s. And it is basically a bunch of like moms cheering on their middle school aged boxing, kids, and it looks barbaric. But you know, really, I think any of these activities that are putting nine-year-olds at risk of concussion, I don't think that those are necessarily the best thing.

Shonali: 24:43

Esther, the other thing that I just did want to touch on, you talk somewhere about how cognitive behavioral therapy really helped you.

Esther: 24:50

Yeah, I did cognitive therapy after my second bad concussion, where I think I experienced a lot more memory problems and things like that than the first. And with that second concussion actually missed a whole year of school. And so it was during that year, that I was trying a lot of different things, seeing what worked and cognitive therapy was one of them, of just improving my memory, executive functioning, all of those skills that had just gotten a little bit hurt by the concussion. And it definitely was one of the best treatments that I that I had, and I think really made me a lot more comfortable and feel prepared to then go back to school, and feel like I was a lot more back to my, my old self in terms of my memory and just knowing that I could do the work in school. And I think those skills really translated and helped a lot with my memory and just sort of general work. Really since then.

Shonali: 25:56

Was it because your memory got better? And or I suppose, like you learned how to, like techniques to compensate or help get yourself through are there?

Esther: 26:03

Yeah, it was both. I mean, part of it was, you know, I've recovered a lot over those months, and really that year, but a lot of it was just figuring out how to make things work. Like I no longer had quite as sharp a memory as I did. And it was about like, you know, preparing early for tests or things like that, and, you know, learning vocab words, studying Spanish in school, like was always something that was really easy for me. And then suddenly that became a lot harder. And so, figuring out other ways to study and just sort of the, the slow and steady was always sort of what I took of just preparing early and like, frankly, that's a skill that I think helped a lot just throughout life and in college, even when I was no longer suffering as much as I was in high school, you know, didn't have the kind of memory problems. Starting to study for exams earlier is just like, a great thing to do. And then you know, what questions you have, you have time to go see your professor and office hours. So, things like that, that even when, maybe I didn't need them to compensate for the memory issues that I had acutely post-concussion. Like we're just great skills for life, frankly, and that I have sort of carried it with me.

Shonali: 27:19

Sounds helpful.

Dr. Daneshvar: 27:20

Seems like I need some cognitive therapy.

Shonali: 27:23

Anything with sleep that you had impacts with after?

Esther: 27:28

Yeah, I remember having like disrupted sleep, right after in a lot of ways. I mean, part of it was just like being in a lot of pain with headaches. Sometimes it's hard to go to sleep with a headache, just feeling so fatigued after my concussions. Both of those bad ones just like wanting to sleep a lot after them. I don't know what the research is about this, but like after my concussion in 2013 I stopped remembering dreams for like many years like I only very recently started to ever remember them. I know there's been some different, like, ideas about that or some research but I've always thought that was kind of interesting because I used to always remember my dreams growing up and that was like very quickly stopped. So...

Shonali: 28:14

You got anything for us on that Dan?

Dr. Daneshvar: 28:16

Well, part of what the areas of the brain are responsible for encoding memory. So, we're basically translating something from working memory to more long-term memory, something that you might remember longer, are the same regions of the brain that are structurally, where you'd expect the brain to be most impacted, with a hit. Near bone or near other structures. And so, it's not surprising that there might be some changes in memory and coding that could translate into problems with remembering dreams. But I don't know of any specific research about it.

Shonali: 28:54

Do you ever watch the movie Inside Out? No, neither one of you. Oh, that's like homework. It's like my favorite. It's one of my I think I saw it like three times in the theaters. And for an adult, to watch a Pixar movie three times in theaters is somewhat embarrassing, but I mean, my background is in cognitive science. So, they just do a really nice job of sort of depicting what it's like to create memories and to like, manage your different emotions, and how important it is to have sort of like a whole brain. So highly recommend inside out.

Shonali: 29:22

So, after you got your concussions, one of the things you talked about is having like a huge part of your identity being associated with sports, and you talk about, I had to totally reinvent myself and find other things.

Esther: 29:38

Yeah, it was a mix of both like viewing myself as an athlete caring about sports, but also just how much the team aspect meant to me, and just how many friends I had you know, I played at school, but I also played on a club team, I played on a town team. And so, I had a lot of friends who I really only interacted with through sports. And so that was a big loss even relationships with, with coaches. But it's also just something that I spent a lot of time doing and so figuring out what else was I going to do for extracurriculars, if I wasn't playing soccer wasn't playing hockey. And you know, that became a bunch of different things in high school and you know, certainly things that are more applicable now, I guess, then, then playing soccer might be. But I started playing golf in high school, I'm still not very good, but good lifelong sport that’s what my doctor told me.

Shonali: 30:31

Probably good in finance too. It’s where a lot of business gets done.

Esther: 30:33

Yeah, I should be a lot better golf, I think. For now, we're working on that. Or even just, you know, playing more tennis, which is something that you know, I enjoy doing, I played with my dad this Saturday. And I started when I was in high school, I started writing for the school newspaper, which I probably wouldn't have had time to do if I was if I was playing three seasons of sports. And then really, the big one was getting involved on the advocacy side around concussion, and doing work with Boston Children's Hospital with The Concussion Legacy Foundation, sort of a series of, of things, they're just trying to, to help other people feel like they weren't alone and that other people had gone through something similar. So that really became a huge a huge focus of mine in high school and beyond. Because it just felt like all the things that I didn't know and my family didn't know. Hopefully we could pass some of those on so other people could maybe do it do it a little bit better than then we had and not have to learn the hard way on so many of those things.

Shonali: 31:40

One of the articles looks at outcomes after one month. Do we have any evidence about these education programs and their longer? Longer term outcomes?

Dr. Daneshvar: 31:51

Yeah, the there are some studies looking at the programs up to a year out, including a study that I'm writing up now. But you I think you bring up an important point that, you know, it's hard, no one's really looking at these things and the long term. And part of that is because the decision to report a concussion is so multifactorial, so you don't know whether someone's decision to either report or not report is based on the education they received, or based on a whole bunch of other factors.

Dr. Daneshvar: 32:23

The State of North Carolina has implemented the Crash Course Program by mandate across the state. And as part of that program, the North Carolina high school athletic Association has worked with us on a research study to see what does that look like? And so, it's actually the likely to be the largest study of concussion education ever. Because we've had at this point, over 40,000 respondents over three years, and so we're basically going to get a really good sense of, of, you know, what concussion education looks like now in terms of efficacy, and what we can do to improve it.

Shonali: 33:14

Yeah, I feel like as humans, we're great at implementing programs, but not always out, like deciding whether they actually work or have any good impact.

Dr. Daneshvar: 33:23

Well, it’s a whole lot more straightforward just to implement it. And the actual tracking, I mean, forget about programs, right, that's like the entire outcome center is, you know, well, I have a patient in front of me, I treated them and you know, some get a lot better, and some get a little better. How much of it has to do with what I did, like, tracking that is a lot harder than just treating that patient in the next patient.

Shonali: 33:51

It takes so much time.

Dr. Daneshvar: 33:54

But that's where we learn. I mean, so for example, you know, 10 years ago, the idea if you had a concussion, was to rest completely. You'd wait until you're completely asymptomatic. If you wouldn't do anything before, then, then you'd slowly introduce activities. And if any symptoms came back, where you went back to the earlier step, and so you'd slowly build up to returning to sport. And what we realized now that's that was a standard practice. And, you know, no one was really studying it that closely.

Shonali: 34:29

I'm not gonna lie, that's kind of what I would have thought today's treatment was.

Dr. Daneshvar: 34:32

But what we realize now is, okay, so if my headache gets a little worse, because I'm exercising, that's not causing damage to my brain tissue. So, there's no problem with that. In fact, to the extent we understand the concussions are problems of metabolic mismatch, and so, ability, inability of the brain to clear toxic metabolites and get nutrients where they need to be increasing your heart rate, would actually help with that. And so now when we actually when they've done the studies, they found that people who have participation activities that increase our heart rate without putting them at risk for subsequent Head Impact. They do better. So, you know, again, tracking these outcomes, it's so important.

Esther: 35:23

Yeah, I was I was part of the dark room crowd, the very slow return to stuff. And, yeah, it was, I think, also, it's like, it's very isolating to do that. Because you're just at home, you're out of school, you're not really seeing anybody because you're resting all the time. And so, I'm sure there's, you know, benefits to sort of the social and sort of continuous learning aspects as well probably that you don't get if you're completely shut down.

Dr. Daneshvar: 35:50

And the other part of it is, if you're not doing anything else, you have nothing to do but perseverate on your symptoms. And so, if you were hanging out with your friends, you might not notice that you have a bit of a headache. But if you're sitting in a room, you're not allowed to look at your phone, you're not allowed to look at the TV not allowed to look at the computer, you're just sitting. You got nothing to do but think about how much your head hurts. And so that that's what the science actually says now.

Shonali: 36:20

Good to know. 

With a potential conflict of interest disclosure that Dan helped create and is a director for the program, I want to emphasize that anyone can go to the CrashCourse website, linked in our episode resources, and download their concussion education toolkits, of which there are many, so you can find the program that works for you and your needs. Big thank you to Esther and Dan for sharing. 

If you've enjoyed this podcast, please know that liking, subscribing and sharing is essential to sustaining our work. We release episodes the first Monday of each month... or try to... so stay tuned for more stories.

The Finding Strength production is a collaboration between the Rehabilitation Outcomes Center at Spaulding and our Model Systems: the Spaulding-Harvard Traumatic Brain Injury Model System, the Boston-Harvard Burn Injury Model System, and the Spaulding New England Regional Spinal Cord Injury Model System Center, all funded by the National Institute on Disability Independent Living and Rehabilitation Research. The material presented here is for general informational purposes only.

Shonali: 37:31

Dan, you played some sports? What did you play?

Dr. Daneshvar: 37:33

I wrestled in, in high school in college, and I played football in high school. I wasn't very good at football. But we won the state championship, but not because of me. And yeah, so. So, I actually didn't know that I'd had concussions until I started doing research in concussion.

Shonali: 37:49

And now you can like look back and say, oh, that was definitely a concussion.

Dr. Daneshvar: 37:52

Oh, yeah. I've definitely had concussions. There are a few specific ones that really stand out. And I was fortunate enough to not have any significant problems associated with them that I can tell at this point. But you know, it's just you know, how much the science is or how much our understanding of concussion has changed in 20 years since I was participating those activities. It's remarkable.

Shonali: 38:17

So now it'd be able to look at my husband differently and like blame things on the boxing when he was when he was in high school.

Dr. Daneshvar: 38:23

Of course. You have my express professional opinion.

Can’t remove without hearing the cut.