The Effectiveness of Communication Mediums on Concussion Education

Jourdan Bennett-Begaye Fort Lewis College Exercise Science Department Senior Research Project April 17, 2013

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TABLE OF CONTENTS ABSTRACT ............................................................................................................ 4 CHAPTER 1 INTRODUCTION ............................................................................................... 6 Statement of the Problem ............................................................................ 7 Significance.................................................................................................. 7 Delimitations ............................................................................................... 7 Limitations .................................................................................................. 8 Assumptions ................................................................................................ 9 Hypothesis.................................................................................................... 9 Rationale for Hypothesis.............................................................................. 9 Definition of Terms and Abbreviations ...................................................... 10 2 LITERATURE REVIEW .................................................................................... 11 Introduction ................................................................................................ 11 Concussions ................................................................................................ 11 Generation Y in a Media-Rich Society....................................................... 14 Education & Technology ........................................................................... 15 Summary .................................................................................................... 17 3 METHODLOGY ................................................................................................ 19 Selection of Subjects ................................................................................... 19 Instruments .................................................................................................. 20 Methods and Procedures ............................................................................. 21 Statistical Analysis ...................................................................................... 22

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4 ANALYSIS OF DATA........................................................................................ 23 Subject Characteristics ................................................................................ 23 Results.......................................................................................................... 24 5 DISCUSSION....................................................................................................... 28 Summary....................................................................................................... 28 Findings........................................................................................................ 28 Conclusions.................................................................................................. 29 Implementations........................................................................................... 30 Recommendations........................................................................................ 31 REFERENCES ......................................................................................................... 32 APPENDIX A DEMOGRAPHICS .................................................................................. 35 B CONCUSSION KNOWLEDGE SURVEY ............................................. 37 C CONCUSSION PAMPHLET ................................................................... 41 D PODCAST SCRIPT .................................................................................. 44 E CONCUSSION VIDEO ............................................................................ 49

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ABSTRACT
Improving an athlete's knowledge of concussion signs and symptoms may play a huge part in prevention (Kaut, DePompei, Kerr, & Congeni, 2003). A "media-rich" society influences how an individual processes, perceives, and retains information (Lee, Cheng, Rai, & Depickere, 2005; Wessels & Steenkamp, 2009). This daily exposure to technology transfers to the classroom and may have a connection to how athletic trainers educate athletes about concussions (Wessels & Steenkamp, 2009). Multiple studies have been performed focusing on the level of awareness and knowledge of parents, coaches, and athletes, but the effectiveness of these materials needs to be studied (Gourley et al, 2010; Kaut et al., 2003). The goal of this study was to investigate the effectiveness of multiple communication mediums used for concussion education and if these mediums effect short- and long-term information retention. Thirty-three college-aged subjects were divided into five groups who completed three surveys (pre-test, immediate post-test, and month post-test). Four treatment groups were given one of four mediums on concussions (pamphlet, lecture, video, and online tutorial). Subjects took the immediate post-test, then the same subjects came back 24 to 51 days later to complete the month post-test. The control group just completed the surveys with no additional education. Concussion knowledge survey scores were submitted using the analysis of variance (ANOVA) with repeated measures. The ANOVA showed there was no significance (p>0.05) when comparing the pre-test, immediate post-test, and month post-test among the five groups (control, pamphlet, lecture, video, and online tutorial) (p = 0.911), therefore the hypothesis was rejected. The results of this study revealed no significance of using different communication mediums to educate people on concussions. The descriptive statistics did show that subjects for all of the education groups made a small improvement over time.

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Chapter 1: Introduction
Introduction Concussions are a growing concern in the sports atmosphere, especially for medical personnel. According to the Center for Disease Control and Prevention, about 1.6 to 3.8 million sports-and recreation-related traumatic brain injuries occur annually in the United States (CDC, 2009). Another study found higher rates of concussions in collegiate athletes than high school athletes Gessel, Fields, Collins, Dick, and Comstock, 2007). However, the concussions were much higher among the high school athletes alone (Gessel, Fields, Collins, Dick, & Comstock, 2007). Each athletic training room provides education for concussions to student-athletes, parents and coaches through a variety of communication mediums. However, not many athletes will take the time to stop and read a pamphlet or listen to a lecture about concussions. The only athletes reading posters or pamphlets are those receiving treatment or waiting to receive treatment. Educating athletes of signs and symptoms of a concussion will encourage them to report a possible concussion, therefore healthcare professionals can provide the best management. Society centers around technology for information and education. Any person born after 1982 has been exponentially exposed to media each day starting from the day internet was invented to the release of the iPhone 5. Classes use Smart Boards, instructional videos, PowerPoint Presentations, and many online resources. This exposure to technology has affected the way information is processed compared to the days of read, lecture and exam time. Students process and retain information differently now, and this study aimed to see if this change in learning styles had an influence on concussion education.

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Statement of the Problem To investigate the effectiveness of multiple communication mediums used for concussion education and if these mediums effect short-and long-term information retention. Significance Improving concussion education through an effective medium may improve the awareness of concussions among athletes and the general population. Each person has a different learning style and with modern technology evolving each day, learning styles are changing, thus the way we process information is changing as well. Generation Y has a need to multi-task, has a short attention span, prefers to learn from peers, and has "a need for immediacy of communications" (Baron & Maier, 2005). Personalities and learning styles are changing through these technological advances and have an influence in the classroom. Education is the key to concussion awareness and there are plenty of lectures, online tutorials, pamphlets, and educational toolkits that enhance that awareness (Gourley, Valovich McLeod, & Bay, 2010). Although, there are many ways to receive concussion education and numerous studies have focused on the level of awareness and knowledge of parents, coaches, and athletes, the specific medium that sends the message has not been investigated. Matching education to Generation Ys preferred learning style could increase the information retention (Wessels & Steemkamp, 2009). This may improve concussion awareness and the management of one. Delimitations The researcher went to classes asking for volunteers. Participants filled out a demographic sheet along with a date and time to meet for the study. Participants met in a classroom or computer lab. The principal investigator reserve the computer lab and classrooms.

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This study included 33 participants from the general population. Each person was randomly assigned to a medium by drawing names out of a hat. All 5 groups completed a demographic sheet and took the survey 3 times: pre-test, immediate post-test and post-test 24 to 51 days later. The pre-test and post-test questions were obtained from the CDC online tutorial and used the information presented in that tutorial to serve as a basis for what content needs to be included in each medium. The survey consists of 19 questions (9 true/false questions, 11 multiple-choice questions). The mediums used consisted of the latest NCAA concussion pamphlet, the Concussion Wise online education, which was free and was taken in a computer lab, an instructional video from the NCAA website, and a lecture (based on the CDC Concussion Podcast) from one of Fort Lewis Colleges certified athletic trainers. Limitations A few factors could limit the validity and reliability of the study. Consistency of information throughout the mediums is going to be difficult to control because each detail cannot be filtered. Keeping the content similar among the four mediums will be the ultimate challenge. The lecturers public speaking and communication abilities may also have influence due to the type of words used and the speakers eloquence and emotions (i.e. anxiety). The internet could delay or not work at the time so it may have some influence on the video and tutorial sessions. In relation to the video, there are hundreds of videos made for concussion education and choosing the proper instructional video that consists of similar content with the other mediums will be tough.

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Participants may also have know have prior knowledge of concussion from experience, family and/or friends, or may have been educated on concussions. Assumptions Throughout the study, a couple factors cannot be controlled so assumptions will need to be made. One assumption is each athlete will answer the survey and demographic sheet honestly and give forth their best effort. In addition, participants may ask health professionals or friends about concussions, thus improving. Hypothesis Different educational methods will result in varying levels of information retention, but the Concussion Wise online tutorial and the instructional video will be more effective in retaining knowledge of concussions. Rationale for Hypothesis Society is becoming a media-rich environment which influences the way Generation Y students is learning (Wessels & Steenkamp, 2009). These students process information differently that those who are used to lectures and chalkboards in the past (Wessels & Steenkamp, 2009). This generation is exposed to a different type of media each day whether its the radio, phone, or internet. Lecturers struggle with teaching Generation Y students who speak different languages which may hinder the educational experience (Wessels & Steenkamp, 2009). Lecturers now speak; expecting the students to retain information while reading and writing, then take an exam. On the other hand, one source argues that Generation Y students lack active reading habits that are essential to life-long learning and professional success (Milliron, 2008). Active reading habits could influence why students cannot read and retain the information for a

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long period of time. Multiple forms of learning need to exist so the information can be retained more efficiently. Definition of Terms Concussion - a type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes your head and brain to move rapidly back and forth (CDC, 2012). Generation Y student who have grown up using computers, video games, digital music players, cell phones, and almost all of the other toys and tools of the digital age and surrounded by the media they use every day (Wessels & Steenkamp, 2009). Abbreviations CATA Colorado Athletic Trainers Association CDC Center for Disease Control and Prevention FLC Fort Lewis College GX Generation X GY Generation Y NCAA National Collegiate Athletic Association TBI traumatic brain injury

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Chapter 2: Literature Review Examining the relationship between communication mediums and concussion education requires encompasses a variety of factors in complete different areas. The technological advancements in society and in classrooms directly affect our learning style and personalities. Generation Y prefers learning through videos and peer learning than the traditional readings, lectures and exams. These educational strategies can be transferred to educating athletes about concussions and determining what is the most effective way to do so. Content among various concussion education methods can all possess the same information, but the way a message is conveyed greatly influences how the receiver interprets, processes and retains the information. This is primarily due to the different learning styles and the media-based society that continues to advance each day. Concussions Getting your "bell rung" use to be part of the game, but with more concussion research being conducted, "seeing stars" after a hard hit can lead to serious consequences. Each year, approximately 1.6 million to 3.8 million people are affected by a traumatic brain injury (TBI) annually, which are related to sports and recreation (CDC, 2012). Approximately 300,000 sportrelated traumatic brain injuries happen each year in the United States alone (Gessel, Fields, Collins, Dick, and Comstock, 2007). Interestingly, sports is the second leading cause of traumatic brain injuries in people ages 15 to 24 following motor vehicle accidents (Gessel and Fields, 2007). Many definitions of a TBI and concussion exist, including the difference between the terms. For this research project, the CDC's definition of a concussion will be used. A concussion is "a type of traumatic brain injury caused by a bump, blow, or jolt to the head" changing how

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the brain works (2012). It can also be caused by an "impulsive force" on the body that is radiated to the head (Terrell, 2004). Severity of a concussion ranges from mild to severe depending on the mechanism of injury and symptoms present differently in each person (CDC and NCAA, 2012; Terrell, 2004). Symptoms include amnesia (retrograde and/or antegrade), confusion, headache, loss of consciousness (LOC), loss of balance, dizziness, double or fuzzy vision, sensitivity to light or noise, nausea, vomiting, feeling sluggish, foggy or groggy, irritability, concentration or memory problems and slowed reaction time (CDC and NCAA, 2012). Several symptoms need to be present and patients do not need to be unconscious in order to be diagnosed with a concussion (Terrell, 2004). Concussions are underreported for a variety of reasons, such as "underestimating the seriousness of the injury, not wanting to be withdrawn from competition, and not being aware of having suffered a concussion" (Gessel et al., 2007). There is also the possibility of athletes not making the connection between a concussion and some symptoms coming on days or weeks after the injury (Kaut et al., 2003). High school and college athletic trainers, team physicians, and other health professional face the challenges of properly managing a concussion when it is not reported by athletes (Kaut et al., 2003). Several authors performed a retrospective study on 461 collegiate athletes at the University of Akron (Kaut et al., 2003). They analyzed the prevalence of concussion symptoms in college athletes as well as the knowledge of head injuries and tendencies of athletes' behavior if they were concussed (Kaut et al., 2003). The researchers examined four aspects of this study, which were the incidence of concussions before entering college, the concussion symptoms experience and the athlete's behavior toward them, the athlete's knowledge of a head injury, and the difference of male and female athletes in reporting a concussion and occurrence of the injury (Kaut et al., 2004). The knowledge survey consisted of each athlete completing a 13-question

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survey of concussion symptoms that were later placed into four categories determined by the researchers (Kaut et al., 2003). They study showed over 30% of the athletes experiencing a direct blow to the head and having dizziness (Kaut et al., 2004) and 20% of the 461 athletes experienced a previous concussion (Kaut et al., 2004). As a result of these concussions, less than 5% experienced academic difficulties after the injury (Kaut et al., 2004). Consequences of a concussion range from temporary neurological impairments to longterm neurological and/or functional disabilities or death (Kaut, DePompei, Kerr, and Congeni, 2003). If a consequent brain injury happens while the athlete is symptomatic, second impact syndrome can occur (Sahler & Greenwald, 2012). Young athletes under 18 years old suffer from second impact syndrome most of the time due to the increase vulnerability of their brain (Guskiewicz et al., 2006; Gourley, Valvoich McLeod, & Bay, 2010). Since August 2011, 37 states implemented laws "requiring youth who sustain a sporting related brain injury be required to see a physician prior to returning to play" (Sahler and Greenwald, 2012). Colorado being one of those states who enacted the Jake Snakenberg Youth Concussion Act in 2012. It states that coaches working with any "youth athletic activity" involving athletes between the ages of 11 and 19 must annually complete a concussion education course (Jake Snakenberg Youth Concussion Act, 2012). The course must cover how recognized the signs and symptoms of a concussion, obtaining the proper medical attention for an individual suspected of a concussion, and the risks of concussions after an individual is concussed (Jake Snakenberg Youth Concussion Act, 2012). What about those athletes who are participating in a collegiate sport? Some universities or colleges provide a concussion education course for their athletes, some give a 5-minute lecture, some athletic training rooms have posters and pamphlets, and others do not provide any education whatsoever. The resources are available to the athlete,

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but it is the act of getting the athlete to read the material and remember the information so proper management can be done. Costs of a TBI versus preventing and/or managing one differ exponentially. In 2000, the CDC estimated that the total costs of a TBI in the United States, including direct medical and indirect costs, was about $76.5 billion (CDC, 2012). Preventing or managing a concussion can be easier with the free Heads Up: Concussion in Youth Sports toolkit provided by the CDC for athletes, parents, coaches, and health professionals. Generation Y in a Media-Rich Society Generation Y has grown up around computers, cell phones, video games and more that effects they way they think and process information differently from individuals who were not exposed to technology 24/7 (Wessels & Steenkamp, 2009). They are more "chaotic learners" (Baron & Maier, 2005) depicted as students who are "digitally literate; connected; social; prefer working in groups; achievement oriented; require structure and guidelines; crave interactivity; have short attention spans; are experiential, visual, kinaesthetic learners; and prefer working on things that matter" (Baron & Maier, 2005). Baron & Maier (2005) further identify this generation as: A strong sense of independence and autonomy; emotional and intellectual openness; greater social inclusion with technology; free expression and strong views; innovation and an expectation of constant change and the ability to build or construct experiences; a preoccupation with maturity; a need to understand the assumptions inherent in software and to feel empowered to change those assumptions; a need for immediacy of communications; and authentication of everything in order to establish trust. (p. 58)

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Generation Y students are especially fond of visual representation of information, such as images, because they grew up watching television, playing video games, and surfing the internet (Wessels & Steenkamp, 2009). Wessels & Steenkamp also state that Generation Y's learning preferences consist of a positive outlook of technology, an attraction toward images and not linear text, "a desire for customized experiences and choices; have low thresholds for boredom and an unwillingness to memorise text; prefer multi-tasking; and prefer active learning (even better when it is peer learning)" (2009). Education & Technology Educational technology continues to grow each day and is integrated into classrooms in order "to improve the delivery of learning" (Lee et al., 2005). It is said that a web-based education provides a better learning environment for students because of the change in delivery medium, content provider and subject matter (Lee et al., 2005). This media-based learning directly affects an individual's cognitive style (processing, perceiving, thinking and remember information) (Lee et al., 2005). Each person possesses a unique cognitive style - how they organize and process information - and an instructional preference (Sadler-Smith & Smith, 2004). Instructional strategies are developed in a way that assumes everyone shares one way of processing and organizing information when it comes to learning (Sadler-Smith & Smith, 2004). Educational options expand with the technological advances. These innovations provide more "flexible delivery" of information and this growth of flexible delivery enhances an individual's need (Sadler-Smith & Smith, 2004). Technology allows the students to develop their own learning paths, especially when all students do not share a similar cognitive style (Lee et al., 2005). Learning and information retention and retrieval are enhanced by expanding these educational avenues (Lee et al., 2005).

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Instructors simply provide the necessary tools for students to teach themselves and become critical learners (Wessels & Steenkamp, 2009). If the students can comprehend the main elements, it has a better practical use (Wessel & Steenkamp, 2009). Yadav et al. (2011) performed a study to investigate the cognitive and affective differences among text, video, and "video+text" using interviews, a survey, and a verbal protocol analysis (Yadav et al., 2011). They used three HIV/AIDS cases but delivered each case by text, video or "video+text" (Yadav, 2011). Participants found the video format to be an effective medium because it allowed them to focus their attention and emotions in the video (Yadav, 2011). Participants even expressed that video was more engaging that receiving the content through text (Yadav, 2011). After analyzing the cognitive differences between the different mediums, researchers found that all three mediums did not have an effect on cognitive processing and recall of information (Yadav, 2011).This may suppose the reason that Generation Y does not want all the coursework online, but they want the instructor to meet their learning style and preferences (Baron & Maier, 2005; Wessels & Steenkamp, 2009). Including technology into Generation Y's education increases the value of their learning (Baron & Maier, 2005). Wessels and Steenkamp (2009) found that 256 of their 319 participants (80.3 percent) use computers regularly while 77.7 percent had access to a computer at while growing up. Instructors must incorporate a variety of learning style strategies since students enter college with different skills, learning backgrounds, attitudes, and learning backgrounds (Wessels & Steenkamp, 2009). It is recommended that instructors fill their course with hands-on, interactive and in-class assignments incorporating teamwork and collaboration (Wessels & Steenkamp, 2009).

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Traditional lectures have been an instructional strategy used for many, many years. However, it is an ineffective teaching method for Generation Y students and now instructors are to cater to this generation's learning style (Wessel & Steenkamp, 2009). This shift from an authority-based learning (receiving a lecture and regurgitating the information) to discovery or experimental learning increases the understanding of the information for students (Wessels & Steenkamp, 2009). Although, the traditional style of readings and lectures should not be completely eliminated due to the fact all learning styles need to be addressed in the classroom (Wessels & Steenkamp, 2009). Summary A constantly changing society that is media-rich continues to influence how everyone thinks, processes, retrieves, and remembers information. This daily exposure to technology transfers to the classroom and it can be connected to how athletic trainers educate their athletes. Growing up with technology influenced our personality traits, such as the desire to interact with others, a desire for quick information , and a short attention span. Learning is an active process where the practice, facts and experience can be used for a variety of situations and problems (Wessels & Steenkamp, 2009). So how do we know if a 21-year-old now will sit down and listen to a lecture by the head athletic trainer? Facebook or Twitter could be catching his interest more than the vital information of managing a concussion; skills that could prevent a concussion or possibly save his life. Colleges and universities all over the nation express their concern and educate athletes through a variety of medium formats, such as a poster, lecture, videos or online tutorials. However, will any of these methods be enough for the athlete to learn and retain the information for the long run or will he continue to fix his attention on his SmartPhone?

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Multiple studies (Gourley, Valovich McLeod, & Bay, 2010) examine the concussion knowledge of coaches, parents and athletes through knowledge surveys or meta-analyses. However, even with the access to many educational programs, Kaut et al. state the effectiveness of these materials and behavior of athletes need to be studied (2003). In regards to this comment and a need to increase concussion education to Fort Lewis College varsity athletes, I attempted to assess the effectiveness of a variety of communication mediums for concussion education in relation to information retention.

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Chapter 3: Methodology The purpose of this study is to investigate the effectiveness of communication mediums on concussion education to athletes. Each athletic training room displays or distributes concussion information to all athletes, coaches and athletic training students. Colleges and universities go to great lengths to make sure their athletes are aware of concussion signs and symptoms often utilizing videos or lectures. Many studies have been done on concussion awareness among parents, coaches and athletes, and how information is received. However, no studies currently exist examining how the information is conveyed and if it has an effect on retention, education and awareness. Other studies show that technology greatly influences today's generation of processing and retaining information. Subjects volunteered from a variety of classes at Fort Lewis College, excluding varsity student-athletes and athletic training students in the professional phase. Thirty-three subjects completed three surveys (pre-test, immediate post-test, and month post-test). Subjects completed a demographic questionnaire and a pre-test. Aside from the control group, the four treatment groups were given one of four mediums on concussions (pamphlet, lecture, video, and online tutorial). Subjects took the immediate post-test, then the same subjects came back 24 to 51 days later to complete the month post-test. Selection of Subjects This study included 109 voluntary participants but ended with 33 subjects total for the entire study. Gender, educational background, a history of concussions, and club and intramural sport involvement did not play a factor in participation. Varsity student-athletes were excluded since they are more exposed to FLC certified athletic trainers and team physicians. Athletic training students in the professional phase of the FLC Athletic Training Education Program were

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also excluded from the study. A variety of students within different academic areas were used to give a broader spectrum and to make the sample more diverse. There were participants who did not know anything about concussions, who knww very little, already had knowledge of concussions, or sustained a concussion. The knowledge ranged throughout the study. There was one control group and four treatment groups (pamphlet, lecture, video, and online tutorial). The control group had six subjects, the pamphlet group had 7 subjects, the lecture group contained 7 subjects, the video group possessed 5 subjects, and the online tutorial group had 8 subjects (total n = 33). Instruments A demographic questionnaire was created for the researcher's purpose. The questionnaire helped in participant consistency and not skew the data. Refer to Appendix A for the demographic questionnaire. The CDC provides a concussion toolkit online for coaches in youth sports, but it can be used for anyone. The Heads Up toolkit includes an online tutorial with five scenarios and 19 questions about the information provided. A study investigated the effectiveness of the online tutorial and coaches showed positive results. A pre-test and post-test was created using the scenarios and questions used in the CDC Heads Up online tutorial. The same questions were used for the pre- and post-test, but the order of the questions change. The four communication mediums which were utilized in this study included: a sports concussion pamphlet created by The Brain and Behavior Clinic (see Appendix C); a lecture by an FLC certified athletic trainer using the concussion podcast script created by the CDC (see Appendix D); a 9-minute concussion video created by the National Academy of

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Neurophysiology, National Athletic Trainers' Association, CDC, NCAA and knowledgeable doctors and; the ConcussionWise online education program for athletes (see Appendix F). Methods and Procedures Professors of the classes and coaches of the varsity sports were asked for permission to solicit participation by their students or athletes. All 109 subjects were randomly assigned to a medium by drawing names out of a hat after filling out a demographic sheet in class. They were informed of several sessions to meet to take the pre-test, medium, and immediate post-test. After 24 to 51 days, subjects were contacted again to meet for the month post-test. Thirty-five subjects took the survey 3 times: pre-test, immediate post-test and post-test four weeks later. Two subjects incorrectly completed the surveys and were taken out of the study. Thirty-three subjects completed the entire study. The control group took a total time of 17 minutes: 2 minutes for the demographic sheet and contact information, 5 minutes for the pre-test, 5 minutes for the immediate post-test, and 5 minutes for the month post-test. The pamphlet group took a total of 20 minutes: 2 minutes for the demographic sheet and contact information, 5 minutes for the pre-test, 3 minutes to read the pamphlet, 5 minutes for the immediate post-test, and 5 minutes for the month post-test. The video group took a total of 26 minutes: 2 minutes for the demographic sheet and contact information, 5 minutes for the pre-test, 9 minutes to watch the video, 5 minutes for the immediate post-test, and 5 minutes for the month post-test. The online tutorial group took a total of 47 minutes: 2 minutes for the demographic sheet and contact information, 5 minutes for the pre-test, 30 minutes for the online course, 5 minutes for the immediate post-test, and 5 minutes for the month post-test.

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The lecture group took a total of 24 minutes: 2 minutes for the demographic sheet and contact information, 5 minutes for the pre-test, 7 minutes for the lecture, 5 minutes for the immediate post-test, and 5 minutes for the month post-test. The researcher kept the participant information locked in a cabinet away from public access for the entire study. The principal investigator reserved the computer labs and classrooms needed for all the groups in each trial. The month post-test was either taken in classroom or student common areas to accommodate each subject's schedule. Statistical Analysis The data collected for the study was analyzed using the repeated measure ANOVA because five groups are compared and tested three times to compare data resulting in 10 sample groups. The same participants were used for each group for both trials. The data will be zeropoint when analyzing the data.

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Chapter 4: Analysis of Data This study investigated how effective communication mediums are on concussion education in the general population. The hypothesis for this study suggested the instructional video and the Concussion Wise online tutorial would be more effective in retaining knowledge of concussions. Subject Characteristics One hundred and nine participants volunteered to participate in this study. Participants volunteered were from a variety of academic departments at FLC, such as the Exercise Science, Athletic Training, Psychology, Biology, and Theatre departments. Varsity athletes were excluded from this study. Varsity athletes work more closely with certified athletic trainers at FLC than the general population. Club sport athletes were able to participate in the study since they are not under the supervision of the certified athletic trainers at FLC. Each participant filled out a demographic sheet when the researcher recruited volunteers in classes. Thirty-seven participants completed all three surveys (pre-test, immediate post-test, and month post-test). Thirty-five participants completed the month post-test 24 to 51 days after the immediate post-test. Two participants incorrectly completed the surveys leaving the sample size to thirty-three participants total for the entire study. Each of the thirty-three participants were randomly chosen to be in one of the five groups (control, pamphlet, lecture, video, and online tutorial). Participants completed the pre-test, underwent one of the mediums, took the immediate post-test, and took the month post-test. The control group completed the pre-test and immediate post-test back to back. The survey consisted of 20 true/false and multiple-choice questions. The same questions were used for each survey but were mixed up to ensure the participants did not memorize the questions and answers.

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Results To assess the effectiveness of communication mediums on concussion education, the calculated knowledge scores from the participants for the pre-test, post-test, and month post-test were submitted to an ANOVA with repeated measures. This study utilized the ANOVA with repeated measures for the following reasons: there are five groups with the same participants in each group; each group was tested three times (pre-test, immediate post-test, and month posttest); two factors were being tested (time and group); and the average knowledge scores among the three surveys were compared between the five groups. The significance of the knowledge scores were observed between the groups. The ANOVA showed there was no statistical significant difference (p>0.05) when comparing the pre-test, immediate post-test, and month post-test among the five groups (control, pamphlet, lecture, video, and online tutorial) (p = 0.911) (See Table 1 and Figure 1).

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20.5000 20.0000 19.5000 19.0000 18.5000 18.0000 17.5000 17.0000 16.5000 16.0000
Pre-Test Immediate PostTest Month Post-Test

The descriptive statistics (See Table 2 and Figure 2) reveled the mean scores for each of the five groups for all three surveys. According to standard deviations in Table 2, each group's scores (excluding the control group) improved from the pre-test to immediate post-test: the pamphlet group decreased from a 2.699 to 2.116 (0.583 decrease); the lecture group improved from a 1.397 to 0.535 (0.862 decrease); the video group improved from a 0.894 to 0.447 (0.447 decrease); and the online tutorial group decreased from a 1.246 to 0.517 (0.729 decrease). The mean score from the control group remained the same for the pre-test and the immediate posttest (x = 18.667), and the standard deviation increased from 1.033 to 1.366 (0.333 increase). The average standard deviation for all five groups from pre-test to immediate post-test went from 1.641 to 1.293.

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20.5000 20.0000 19.5000 19.0000 Control 18.5000 18.0000 Pamphlet Lecture

17.5000
17.0000 16.5000 16.0000 Pre-Test Immediate Post-Test Month Post-Test

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The mean scores for all five groups showed an increase from the pre-test (x = 18.546) to the immediate post-test (x = 19.121). Mean scores for each group also shows a change: the control group pre-test was 18.667 and the immediate post-test was 18.667; the pamphlet group pre-test was 17.571 and the immediate post-test was 18.143; the lecture group pre-test was 18.429 and the immediate post-test was 19.429; the video group pre-test was 19.400 and the immediate post-test was 19.800; and the online tutorial group pre-test was 18.875 and the immediate post-test was 19.625. After 24 to 51 days, participants completed the month post-test. The changes for the standard deviation for each group are as follows: the control group immediate post-test was 1.366 and month post-test was 0.753; the pamphlet group immediate post-test was 2.116 and the month post-test was 1.718; the lecture group immediate post-test was 0.535 and month post-test was 0.900; the video group immediate post-test was 0.447 and month post-test was 0.548; and the online tutorial immediate post-test was 0.517 and month post-test was 1.126. As a whole going from the immediate post-test to the month test, the standard deviation changed from 1.293 to a 1.118. The mean scores for all five groups going from immediate post-test to the month post-test are as follows: control group immediate post-test was 18.667 and month post-test was 18.833; pamphlet group immediate post-test was 18.143 and month post-test was 18.429; lecture group immediate post-test was 19.429 and month post-test was 19.143; video group immediate posttest was 19.800 and month post-test was 19.600; and the online tutorial group immediate posttest was 19.625 and the month post-test was 1.126. The average mean score for all five groups from immediate post-test to month post-test went from 19.121 to 19.000.

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Chapter 5: Discussion Summary Concussions hit the mainstream media in the past few years, and journalists and broadcast journalists seem to not get enough of it. Consequences of concussions are being analyzed of certain sports at all levels of play. This study was implemented to investigate the effectiveness of communication mediums on concussion education. Education is the key to concussion awareness and many educational programs exist to enhance that awareness (Gourley, Valovich-McLeod, & Bay, 2010). Athletic trainers, physicians, and other health professionals try their best to inform student-athletes, parents, and coaches of the concussions. If athletes know the signs and symptoms of a concussion, it will encourage them to report one and health professionals can provide the best management (Kaut et al, 2003). The sports medicine team at colleges and universities educate people on concussions in a variety of ways but there is no study looking at what media platform is more effective in terms of memory retention (Kaut et al., 2003). Athletic trainers can lecture all they want, but are the athletes retaining the information that could save their life? Findings The results of this study revealed no statistical significant difference of using different communication mediums to educate athletes on concussions. Therefore, the hypothesis was rejected. However, the mean score for all five groups from pre-test to the immediate post-test improved from 18.546 to 19.121 including the standard deviation from 1.641 to 1.293. This accounts for the amount of information they learned in the short time span from the media platforms. When comparing the immediate post-test to the month test, the subjects did seem to retain the information. According the mean scores from immediate post-test to month post-test,

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the scores went from 19.121 to 19.000. The pre-test was a 18.546. This shows that there was a slight increase of knowledge and it shows on the surveys. The average standard deviation improved throughout all three surveys also improved going from 1.641 in the pre-test) to 1.293 in the immediate post-test, and to 1.118 in the month post-test. Another observation is comparing the control group mean scores and standard deviation to all four treatment groups in all three surveys. The control group mean score remained the same (x = 18.667) in the pre-test and immediate post-test, and slightly improved in the month post-test (x = 18.833). What is most important to notice is the pre-test and month post-test comparison because this reveals if there is a change in the subjects' knowledge over a long-term period. All four treatments groups mean scores and the standard deviations improved when comparing the pre-test and the month post-test. The improvement of the mean scores for the treatment groups ranged from 0.2 to 2.75 between the pre-test and month post-test. The control group mean score had a 0.166 change for the pre-test and month post-test. Overall, the online tutorial group had the greatest improvement when comparing the pre-test and month post-test mean scores with a 2.75 improvement. Conclusions The purpose of this study was to find an effective media platform to educate athletes of concussions relating to memory retention. It was hypothesized that the instructional video and Concussion Wise online tutorial would be more effective to educate people of concussions. This hypothesis was made in regard to Generation Y's chaotic learning style since they are more "digitally literate," visual learners, have short-attention spans, and have a "greater social inclusion with technology" (Baron & Maier, 2005). It was also based on the study performed by

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Yadav when his participants expressed videos were more engaging than content through text (2011). However, each treatment group slightly improved in the knowledge survey over time compared to the control group. This may suggest some education is better than no education. If athletes can comprehend the basic information of concussions and the consequences, it may have a better practical use (Wessel & Steenkamp, 2009). Studies suggested that concussions are underreported for many reasons, including underestimating a concussion, athletes did not want to be pulled from competition, and many did not know symptoms came on days or weeks after the initial incident (Gessel et al., 2007; Kaut et al, 2003). So it may be beneficial to have pamphlets lay around for athletes, in addition to providing a lecture or showing a video at the beginning of a season. Generation Y's learning style does need to be met with videos and online tutorials, but other learning styles should be addressed as well (Baron & Maier, 2005). Instructors are catering to this revolutionized learning style from the constant and sudden exposure to technology (Wessel & Steenkamp, 2009). Can health professionals, especially athletic trainers, cater to this learning style, too? Yadav's subjects even expressed they did not want all the coursework online, but to incorporate a variety of learning strategies (2011). These technological advances are just another way to provide a "flexible delivery" of information and a better learning environment (Sadler-Smith & Smith, 2004). Implementations Athletic trainers at all levels should consider implementing some sort of concussion education to athletes, parents, and coaches at the beginning of the competitive season. If at all possible, concussion education should be mandatory. Contact and non-contact sports should have

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this education. Athletic trainers can even pass out pamphlets, posters, and handouts so the athletes, parents, and coaches can hang them up. The awareness and understanding of concussions should be a priority. This education will provide a safer future for the athletes and improve the management of a concussion. Athletes should also be encouraged to report a possible concussion. It is better to be safe than sorry. Recommendations The CDC concussion quiz was a great starting point . However, constructing a concussion knowledge survey from scratch with input from athletic trainers and physicians could be better. In this study, the length of the correct answer in the multiple-choice portion was a giveaway. Keeping the content consistent between the different media platforms was difficult. It would be interesting to see if the content was exactly the same and conveyed a variety of ways. For example, a couple of the mediums in this study talked about consequences of a head injury if they did not see a health professional. Other mediums did not speak of the consequences. Another possibility for research is to do a similar study on high school athletes. High school athletes are more susceptible to Second Impact Syndrome due to the brain still developing. Last of all, time played a huge factor in this study. It would be interesting to see the memory retention of participants after a few months and not just a few weeks.

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Reference List Baron, J. & Maier, H. (2005). The challenge of maintaining the momentum. Proceedings of ascilite 2005: Balance, Fidelity, Mobility: maintaining the momentum?, 57-66. Center for Disease Control and Prevention. (2012). Concussion in Sports. Retrieved from http://www.cdc.gov/concussion/sports/index.html. Center for Disease Control and Prevention. (2012). Concussion. Retrieved from http://www.cdc.gov/concussion/. Center of Disease Control and Prevention. (2012). Concussion and mild TBI. Retrieved from http://www.cdc.gov/concussion/index.html. Center of Disease Control and Prevention. (2012). Traumatic brain injury statistics. Retrieved from http://www.cdc.gov/TraumaticBrainInjury/statistics.html Gessel, L.M., Fields, S.K., Collins, C.L., Dick, R. W., & Comstock, R.D. (2007). Concussions among United States high school and collegiate athletes. Journal of Athletic Training, 42(2), 495-503. Gourley, M.M., Valovich McLeod, T., & Bay, C. R. (2010). Awareness and recognition of concussion by youth athletes and their parents. Athletic Training & Sports Health Care: The Journal for the Practicing Clinician, 2(5), 208-218. Guskiewicz, K.M., Bruce, S.L., Cantu, R.C., Ferrara, M.S., Kelly, J.P., McCrea, M., Putukian, M., & Valovich McLeod, T.C. (2010). Research based recommendations on management of sport related concussion: Summary of the National Athletic Trainers' Association position statement. British Journal of Sports Medicine, 40, 6-10. doi: 10.1136/bjsm.2005.021683.

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Heads Up: Facts for Physicians About Mild Traumatic Brain Injury (MTBI). CDC. http://www.cdc.gov/concussion/headsup/pdf/facts_for_Physicians_booklet-a.pdf Herbert, P.C. & Lohrman, D.K. (2010). It's all in the delivery! An analysis of instructional strategies from effective health education curricula. Journal of School Health, 81, 258264. Kaut, K.P, DePompei, R., Kerr, J., & Congeni, J. (2003). Reports of head injury and symptom knowledge among college athletes: Implications for assessment and educational intervention. Clinical Journal of Sports Medicine, 13 (4), 213-221. Lee, C.H.M., Cheng, Y.W., Rai, S. & Depickere, A. (2005). What affect student cognitive style in the development of hypermedia learning system. Computers & Education, 45, 1-19. Milliron, V. C. (2008). Exploring millennial student values and societal trends: Accounting course selection preference. Issues in Accounting Education, 23(3), 405419. Moser, S., Brupacher, S.E., & Mosler, H.J. (2011). How people perceive and will cope with risks from the diffusion of ubiquitous information and communication technologies. Risk Analysis, 31(5), 832-846. NCAA. (2012). Concussions: Dont hide it, report it, take time to recover. http://s3.amazonaws.com/ncaa/web_video/health_and_safety/concussion/concussion.htm l Sadler-Smith, E. & Smith, P.J. (2004). Strategies for accommodating individuals' styles and preferences in flexible learning programmes. British Journal of Educational Technology, 35 (4), 395-412. Sahaler, C.S. & Greenwald, B.D. (2012). Traumatic brain injury in sports: a review. Rehabilitation Research and Practice, 2012. doi:10.1155/2012/659652

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Senate Bill. (2011, March 29). Jake Snakenberg Youth Concussion Act. Retrieved from http://knowconcussion.org/wp-content/uploads/2011/07/COLORADO.pdf Terrell, T.R. (2004). Concussion in athletes. Southern Medical Journal, 97 (9), 837-842. Wessels, P.L. & Steenkamp, L.P. (2009). Generation Y students: Appropriate learning styles and teaching approaches in the economic and management sciences faculty. South African Journal of Higher Education, 23(5), 1039-1058. Yadav, A., Phillips, M., Lundeberg, M. A., Koehler, M. J., Clouse, K., & Dirkin, K. H. (2011). If a picture is worth a thousand words is video worth a million? Differences in affective and cognitive processing of video and text cases. Journal of Computing in Higher Education, 1-35.

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Appendix A Demographic Questionnaire

Communication Mediums and Concussion Education 36 DEMOGRAPHICS Name: Phone number: Email:

Day & time to do follow-up survey in four weeks: Day: Age: Gender (circle): Male or Female Have you ever had a concussion? Time:

Yes No If yes, how many? 1-2 3-4 5+ How long ago? 2 weeks - 3 months 4 - 6 months 7 - 11 months 1 -2 years 3-5 years 5+ years

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Appendix B Concussion Knowledge Survey

Communication Mediums and Concussion Education 38 CDC Concussion Knowledge Survey Check True or False for each of the following statements:

1. A concussion is a brain injury. True False 2. Concussions can occur in any organized or unorganized recreational sport or activity. True False 3. You can't see a concussion and some athletes may not experience and/or report symptoms until hours or days after the injury. True False 4. Following a coach's rules for safety and the rules of the sport, practicing good sportsmanship at all times, and using the proper sports equipment are all ways that athletes can prevent a concussion. True False 5. Concussions can be caused by a fall or by a bump or blow to the head or body. True False 6. Concussion can happen even if the athlete hasn't been knocked out or lost consciousness. True False 7. Nausea, headaches, sensitivity to light or noise, and difficulty concentrating are some of the symptoms of a concussion. True False 8. Athletes who have a concussion should not return to play until they are symptom-free and have received approval from a doctor or health care professional. True False 9. A repeat concussion that occurs before the brain recovers from the first can slow recovery or increase the likelihood of having long-term problems. True

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False Circle the best answer for the following multiple choice statements/questions: 10. A concussion is a: A. type of traumatic brain injury (or TBI) caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. B. a brain bruise. C. loud sound heard from far away. 11. When can concussions occur? A. Only when playing full contact sports. B. Only when the individual who was hit or jolted loses consciousness. C. In any organized or unorganized recreational sport or activity and most occur without loss of consciousness. 12. How do you identify a concussion? A. By looking at CT or MRI scans of an individuals brain. B. By watching for different types of signs or symptoms, such as a change in the athletes behavior, thinking, or physical functioning. C. Asking an athlete if they had their bell rung in the last hit. 13. Which of the following are signs of a concussion that you as a coach may identify? A. The athlete appears stunned, is unsure of the game, score, or opponent, is confused about their assignment or position, and is answering questions slowly. B. The athlete follows the rules for safety and the rules of the sport, practices good sports- manship, and uses the proper equipment for the sport. C. The athlete looks pale, their tongue is white, and after gently pinching the skin, it does not immediately snap back into place. 14. Which of the following are symptoms of a concussion that an athlete may describe? A. The athlete complains of shoulder pain that radiates down the arm to a tingling feeling in the fingers. B. The athlete feels weak, tired, and has stopped sweating. C. The athlete states the lights hurt their eyes, they feel confused, not right, and complains of an odd headache with pressure in their head. 15. If an athlete has had a previous concussion they: A. are more likely to sustain another concussion, especially if the first concussion has not had time to heal. B. will never have another concussion. C. will not sustain another concussion from a similar blow or jolt. 16. What is the first thing you should do as a coach when one of your players has sustained a bump or blow to the head or body and isnt acting right?

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A. Immediately rush an athlete to the hospitaleven if none of the Danger Signs are present. B. Allow the athlete to finish out the quarter/period/half, etc. and then take the athlete for a medical examination. C. Remove the athlete from play and look for signs or symptoms of a concussion even those that may appear hours later. 17. Which of the following would be considered Danger Signs of a severe concussion and require rushing an athlete to the emergency department immediately? A. The athlete seems slightly off balance, complains of a headache, did not lose consciousness, but just isnt feeling right. B. The athlete lost consciousness, has slightly slurred speech, and seems to become increasing more confused and restless. C. The athlete complains of a headache and appears slightly dazed or stunned. 18. When can an athlete return to play after a concussion? A. As soon as they are feeling better. B. After being evaluated by a health care professional. C. After being cleared by a health care professional and after a five step process in which the athletes activity level is slowly increased over a period of days, weeks, or months depending on the athletes response to the increasingly challenging activities. 19. When should you talk to the athletes parents about the possible concussion he/she may have had? A. The evening of the event or the following day. B. Immediately following the game or practicebefore allowing the child to go home. Information should be given to the parents regarding the signs and symptoms of concussion, encouragement to see a health care professional, and follow-up with parents regarding the status of the athlete. C. Before the next game/match/event so as to make sure the child is cleared for play. 20. How can you help prevent concussions? A. By ensuring that all athletes wear properly fitted gear, play with good sportsmanship at all times, and obey the rules of safety. B. By working with parents, athletes, and school and club administrators to spread awareness about concussions all year: pre-season, during the season, and post season. C. Both A and B.

Center of Disease Control and Prevention (2012). Injury Prevention & Control: Traumatic Brain Injury. Retrieved from http://www.cdc.gov/concussion/HeadsUp/youth.html

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Appendix C The Brain and Behavior Clinic Concussion Pamphlet Information

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Appendix D CDC Concussion Podcast Script

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Lecturer Script Heads Up! Play it Safe When it Comes to Concussions Concussions are also known as a mild traumatic brain injuries, can be caused by a bump or blow to the head or body and it causes the brain to move about inside the skull. Concussion can change the way the brain normally works. And even a ding, or sometimes people say getting your bell rung, or what seems to be a mild bump or blow can be serious. Concussions can occur in any sport or recreational activity. There are lots of them and coaches or parents may observe many different signs that can indicate that an athlete has sustained a concussion. The athlete can appear dazed or confused. They can forget sports plays. They can be unsure of the score or who they are playing. They may stumble or move clumsily. They could answer the questions slowly. They could even lose consciousness (even briefly). Sometimes they show behavior or personality changes, and they may not recall events around the time of the hit or fall. And these are the signs. Symptoms can include headaches, blurred vision, and a whole host of different symptoms. Signs and symptoms of a concussion can last from several minutes to days, weeks, months, or even longer in some cases. So it is important to recognize the signs and symptoms and see a health care provider right away. Concussions are commonly reported injuries in children and adolescents who participate in sports and recreational activities. An estimated 135,000 sports- and recreation-related traumatic brain injuries (including concussions), are treated in U.S. hospital emergency departments each year in children ages 5 to 18 years.

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The greatest number of TBI-related emergency department visits for these children resulted from bicycling, football, basketball, playground activities, and soccer. But these are also common activities with many participants, so we cant say that they are the riskiest. We dont have participation information to directly compare activities, but we can compare the proportion of all injuries seen in emergency departments for an activity that are related to traumatic brain injury. For instance, one tenth of all injuries in horseback riding that were treated in the emergency department involved traumatic brain injury. Other activities with a high proportion of TBI among kids included ice skating, riding all-terrain vehicles, hockey, and tobogganing or sledding. An athlete with a concussion should not return to play until a health care professional with experience in evaluating for concussion says its OK. Athletes who return to play too soonwhile their brain is still healing from a concussionrisk having a second concussion. Second concussions can be very serious. They can cause permanent brain damage and affect a child for a lifetime. Traumatic brain injuries can cause a wide range of functional changes which can affect thinking, language, learning, emotions, behavior, and even how you feel things or sensations. Even relatively mild brain injuries can result in health consequences such as impaired thinking, memory problems, and emotional or behavioral changes. And again, athletes who return to play too soon put themselves at increased risk for very severe Second Impact Syndrome or a second concussion. Preventing a concussion can be a little different for every sport, but there are steps that can taken to protect youth from concussion. First, you want to ensure athletes follow their coachs rules for safety and the rules of the sport. You want to encourage athletes to practice

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good sportsmanship at all times. Make sure they wear the right protective equipment for their activity, (equipment such as helmets, padding, and eye and mouth guards can help). Protective equipment should fit properly, be well maintained, and be worn consistently and correctly. Finally, if you learn the signs and symptoms of a concussion that will help in ensuring that you will respond appropriately if someone sustains a concussion. CDCs National Center for Injury Prevention and Control has developed Heads Up: Concussion in Youth Sports. Its a free tool kit to help youth sports coaches, administrators, parents, and even the athletes recognize the signs and symptoms of a concussion and respond to concussions appropriately. The tool kit contains: a fact sheet for coaches and a specific fact sheet for athletes and for parents each in English and Spanish; it has clipboard with concussion facts right on the back so coaches can have it right at hand; and also a magnet with facts for coaches and parents. It has poster that coaches can use in their office or if they have concession stand anyplace where people can see it, and finally a quiz for anyone who is using the tool kit to test their concussion knowledge. Anyone can order the toolkit and it can be ordered by visiting CDCs website at: www.cdc.gov/ConcussionInYouthSports all one word. And all materials can also be directly downloaded in both English and Spanish directly from the website. The toolkit is free. More than 38 million boys and girls participate in organized youth sports in the U.S.A today. We know that youth sports coaches and administrators are eager to keep their athletes safe and healthy. That is why CDC wants to equip coaches and administrators with the Heads Up: Concussion in Youth Sports. Coaches are on the front line in the effort to identify and respond to concussions and they will play an important role in sharing this information with athletes and

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parents. Because of this we, we are sending these tool kits to youth sports administrators and organizations and urging them to order a kit for all the coaches in their leagues. To access the most accurate and relevant health information that affects you, your family and your community, please visit www.cdc.gov.

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Appendix E Concussions: Don't Hide It, Report It, Take Time to Recover http://www.youtube.com/watch?v=T3FLRDxbLXg