The Coach’s Role in Sport Concussion Care: Developing High School and Youth Coaches through the Concepts of Deliberate Practice

Submitted by Brandon D. Spradley1, EdD*, Fred Cromartie2, EdD*

1* Acting Director of Continuing Education at the United States Sports Academy, Daphne, Alabama 36526

2* Director of Doctoral Studies at the United States Sports Academy, Daphne, Alabama, 36526

Dr. Brandon Spradley is the Acting Director of Continuing Education at the United States Sports Academy. Dr. Fred Cromartie is the Director of Doctoral Studies at the United States Sports Academy.

ABSTRACT

Sport coaches have a significant role in providing concussion care to young athletes. The foundations of expert coaching and elite performance that is so often cited in scholarly literature can be used to develop coaches in the area of sport-related concussion care. There are two essential components to providing optimal sports concussion care: understanding athletes and the sports they play and understanding the neurology of the injury (Kutcher, 2011). Research shows that detecting early signs of concussion can improve outcomes (Lovell, 2009); therefore, there is a need for a rapid screening test to assess athletes who may have a concussion (Galetta et al., 2011). The King-Devick Test is a concussion screening test that could meet this need and is based on measuring the speed participants complete rapid number naming test cards. The King-Devick Test has been consistently published in research as an accurate and reliable method of identifying athletes with head trauma. Using the concepts and applications of deliberate practice, high school and youth sport coaches can implement easy-to-use assessments such as the King-Devick Test into their sport programs to develop competency in protecting athletes from the effects of concussion.

Key Words: sport-related concussions, King-Devick Test, expertise, deliberate practice

INTRODUCTION

The role of deliberate practice in the development of elite performers and experts has clearly had a profound impact in the area of sport psychology and sport coaching. Much of the scholarly literature defines deliberate practice by the 10,000 hour rule. Although there has been widespread adoption of the concept of deliberate practice as a guiding framework for the development of expertise, many researchers are still seeking clear guidelines for how to apply deliberate practice in the context of sport coaching (Gilbert, 2013). The development of elite performance in the context of expert coaching can be applied in a variety of ways. In this paper, the development of elite performance and the definition of expert coaching will be specifically applied to the role of the coach in concussion care. Coaches should demonstrate leadership qualities in multiple facets of the sport, including the overall physical and mental care of athletes.

It is well understood that professional and many college coaches have athletic personnel such as athletic trainers, sport medicine physicians, and sport psychologists to aid in the care of sport-related injuries such as concussion. That is why this paper will focus more on the impact of high school and youth coaches and their role in providing optimal care for athletes. The concepts of expert coaching and elite performance that is so often cited in scholarly literature can be used to develop coaches in the area of sport concussion care. This does not mean that coaches will gain enough knowledge and develop sufficient skills to become ‘experts’ in sport concussion care; but rather to implement a widely accepted thesis that helps high school and youth coaches develop the necessary knowledge, skills, and application to better protect athletes from concussion.

The sport coach must play a significant role in providing optimal concussion care to young athletes. A brief commentary article by Jeffrey Kutcher discusses sport-related concussions and argues that concussion expertise requires integrating complementary viewpoints from a variety of professions. Kutcher (2011) states that a diverse roster of physicians, physician assistants, nurses, nurse practitioners, athletic trainers, and neuropsychologists tend to concussed athletes. Each of these professions requires a unique skill set that has a stake in taking care of this type of injury (Kutcher, 2011). Most sport medicine professionals would agree with Kutcher’s argument, although from a prevention and management standpoint, coaches should be added as well. There are two essential components to providing optimal sports concussion care: understanding athletes and the sports they play and understanding the neurology of the injury (Kutcher, 2011). Kutcher explains that mastering one component without the other implies only partial expertise and leaves an incomplete view of the concussed athlete. Adding coaches to the concussion team is certainly beneficial for high school and youth sports being that a considerable amount of public schools in the United States do not employ certified athletic trainers. It is time for sports medicine professionals to realize the important role coaches have in handling the issue of sport-related concussion.

COACHING EXPERTISE

First and foremost, it is important to clearly define coaching expertise as it relates to the effectiveness of the sport coach. In a brief article, Gilbert (2013) used the following definition for coach effectiveness: “The consistent application of integrated professional, interpersonal, and intrapersonal knowledge to improve athletes’ competence, confidence, connection, and character in specific coaching contexts.” Coaches’ knowledge is separated into professional knowledge, interpersonal knowledge, and intrapersonal knowledge (Gilbert & Cote, 2013). Professional knowledge refers to knowledge of one’s sport and how to apply this knowledge (Gilbert, 2013). Interpersonal knowledge refers to the ability to connect and communicate with athletes and other sport stakeholders, while intrapersonal knowledge refers to self-awareness and introspection (Gilbert, 2013). These domains are critical areas for coaches to develop in order to be an effective member of the sport concussion team.

DELIBERATE PRACTICE

Anders Ericsson is regarded as one of the main contributors to developing the framework of deliberate practice. Ericsson was not the first to propose the 10,000 hour rule, but his research and work has shaped the field of elite performance and the development of expertise. Deliberate practice can be divided into three basic principles: 1) a clearly defined task designed with the appropriate level of challenge for the specific learner, 2) provision of unambiguous feedback, and 3) repeatable to allow for error correction and subtle refinements (Ericsson, 2003). Now, being that we are dealing with the topic of sport-related concussions, some of the basic concepts of deliberate practice will not fall directly in place. In no way, shape, or form is a concussed athlete to be practiced with or used to develop expertise within a particular field. As a suggestion, it is a belief that the ideas and concepts of deliberate practice that are so widely used in a variety of fields, can also be applied to help coaches develop in the area of sport-related concussions. This development can be done in many ways such as the implementation of school-based programs, seminars, and skill training.

Research studies in the area of sport coaching suggest that coaches learn to coach by participating in different learning situations (Trudel & Gilbert, 2013). In addition, the coaches’ experience as an athlete many times directly influences the way in which coaches approach their craft (Chesterfield, Potrac, & Jones, 2010). Although this statement is true and viewed as positive in many sport activities; when taken in the context of sport-related concussions and American football, old experiences from the coach can sometimes lead to misconceptions. Just a few decades ago, this injury called concussion was viewed as a sign of weakness and was often referred to as ‘bell-ringers’ or ‘athletes getting their bell rung.’ Now, medical professionals identify a concussion as a mild traumatic brain and is probably one of the most talked about injuries in sports media.

Every sport coach will have a different developmental path shaped by their education and personal experiences. Although this is true in the development of coaches, Trudel & Gilbert (2013) suggest common principles for creating environments for supporting deliberate practice and the development of coaching expertise. Trudel and Gilbert’s position is grounded in (1) how coaches learn to coach and the relative importance of three types of learning situations and (2) deliberate practice and stages of coach expertise development—beginner, competent, proficient, and expert (Trudel & Gilbert, 2013).

The beginner coach stage usually corresponds to the first few years of coaching. Unlike many other professions, many coaches will start coaching and then seek out formal coach education (Trudel & Gilbert, 2013). In addition, contemporary coaching education is usually delivered in a condensed format and is often criticized for its lack of relevance to real-world coaching practices (Cushion, Armour & Jones, 2003). Researchers in the area of sport coaching suggest that sport leaders should take more of a coach-learner perspective rather than an instructional perspective to improve coaching education programs. In this stage of development, coaches will be seeking to acquire new information and the seriousness of sport-related concussion should be presented at this stage.

The second stage of coach expertise development is the competent coach. Competent coaches will participate in mediated learning situations such as seminars and workshops, usually for professional development reasons or to preserve specific certifications (Trudel & Gilbert, 2013). Coaches at this stage of development will reflect on their coaching techniques and practices to identify gaps and make adjustments (Trudel & Gilbert, 2013). Competent coaches should be willing to learn from other coaches and share information with their colleagues. This is a very important stage for the development of the coach in the area of sport concussions. Any information that is useful in protecting and managing young athletes should be disseminated from one coach to the next.

The third and fourth stages of coach expertise development are the proficient and the expert coach. The coaches who have reached these two stages are very knowledgeable of their craft and will usually take on the responsibility to mentor beginner and competent coaches (Trudel & Gilbert, 2013). These coaches are critical thinkers, which allow them to see the big picture and identify new ways of thinking and solving problems. The proficient coach and the expert coach are similar and by definition can be hard to distinguish one from the other. Although these two groups share the same coaching practice and learning situations, the one thing that differentiates a proficient coach from an expert coach is deliberate practice. As mentioned earlier in the paper, the three main principles of deliberate practice are: 1) a clearly defined task at the appropriate level of challenge for the specific learner, 2) provision of unambiguous feedback, and 3) opportunities to repeat to allow for error correction and subtle refinements. Anders Ericsson said it best when he made the statement, “genuine experts not only practice deliberately but also think deliberately.”

Expert coaches recognize that in order to develop as a coach, they must adopt a conscious learning approach. These coaches actively seek situations or environments of learning. There needs to be more expert sport coaches who have a thirst to learn more about sport-related concussions. Many coaches, regardless of the level, feel that protecting, identifying, or managing their athletes in the context of sport-related concussions is not their responsibility. Many coaches feel this responsibility is pushed solely towards the athletic trainer or healthcare professional. Sport coaches play a significant role in protecting and managing their athletes. Simply put, there needs to be more coaches who take the issue of sport concussion seriously. In order to develop expert coaches in the context of protecting athletes from concussions, coaches should take note of these five things: (1) set goals to learn more about concussions and how it affects young athletes, (2) use a deep learning approach by being open to modify what they already know, (3) ask for feedback from qualified professionals, (4) implement new knowledge, skills, and practices in their sport programs, (5) have perseverance if a new approach takes time to be successfully implemented.

DEFINING AND DEVELOPING EXPERT COACHES

One of the more difficult tasks when investigating in the area of elite performance and expertise is first defining expertise. What does it mean to be an expert coach? How does one become an expert coach? How do researchers define expert coaches? These questions and more are addressed in an article by Wiman, Salmoni and Hall in 2010 entitled “An Examination of the Definition and Development of Expert Coaching.” According to most researchers, expert performers must consistently demonstrate a high level of performance to be perceived as an expert. In sport coaching, coaches are defined as experts based primarily on the performance of their athletes and years of experience (Wiman, Salmoni & Hall, 2010). Coaches can increase their level of expertise by investing the appropriate amount of time and seeking the correct type of practice for skills to be developed. In addition, there were seven major themes that two researchers (Fleurance and Cotteau) identified in developing coaching expertise: formal coaching education, experience as a player in the sport, coaching experience, working with and learning from mentors, interaction with high level athletes, ongoing coaching education, and a personal commitment to coaching (Fleurance & Cotteau, 1999).

Some of the elements that are needed to develop coaches in the area of sport-related concussions are formal coaching education, ongoing coaching education, and a personal commitment to coaching. According to Wiman, Salmoni, and Hall (2010) coaches can be identified as either a generalist expert coach or a specialist expert coach. Both types can be considered an expert coach but they have different knowledge bases and skill sets (Wiman, Salmoni & Hall, 2010). A generalist expert can be defined as an individual who is good at a variety of tasks, whereas a specialist expert is an individual who has expertise in a particular area of coaching. A generalist expert would be fitting for high school and youth level coaches who need to be proficient in many different areas, including the prevention and management of sport-related concussions.

KEYS TO DEVELOPING A SUCCESSFUL PROGRAM

There are a limited number of coaches who are able to build a successful program and maintain a high level of excellence for an extended period of time. This particular section will provide an overview of key and common elements of expert coaches as it relates to building a successful sports program. In addition, this section reviews important factors that can help coaches create conducive environments for reporting concussions at the high school and youth levels.

Good leadership qualities are necessary for coaches to develop expertise. Chelladurai’s Multidimensional Model of Leadership was the first behavioral model of leadership created specifically for sport situations (Vallee & Bloom, 2005). This model allowed researchers to evaluate leadership effectiveness through the satisfaction and performance of athletes (Vallee & Bloom, 2005). Researchers investigating with this model found that athlete performance and satisfaction was the product of three types of leadership behaviors: required leadership behaviors, preferred leadership behaviors, and actual leadership behaviors (Vallee & Bloom, 2005). In addition, these behaviors were influenced by three factors: characteristics of the environment, characteristics of the athlete, and personal characteristics of the coach (Vallee & Bloom, 2005). Great coaches will display leadership behaviors that respond to the demands of the environment.

In order to develop a successful sports program, coaches must first form healthy relationships with their athletes (Valee & Bloom, 2005). The study by Valee and Bloom showed that individual growth, organizational skills, and vision are all critical elements in developing a successful sports program. These three elements are also important in the context of sport-related concussions as well. Individual growth refers to the overall philosophy of personal development that coaches promote as part of their programs (Valee & Bloom, 2005). Results of this study showed that expert coaches have the desire to develop their athletes’ athletic abilities and individual attributes. The coaches who were interviewed invested a significant amount of time in building self-confidence and maturity in their athletes (Valee & Bloom, 2005). These coaching attributes should be applied in the context of concussion care for athletes as well.

The organizational skills of sport coaches will have an impact on the way athletes are affected by concussions. Coaches’ responsibilities extend beyond planning practices and preparing for competitions. These responsibilities include implementing programs to educate athletes about concussions, teaching appropriate drills and techniques to prevent concussions, and developing a system to document athletes who have sustained concussions.

The vision of the coach is an essential element in understanding how coaches develop great programs. Coaches spend a great deal of time and energy to get athletes to buy into their vision. This vision should include creating an environment in which athletes are willing to report signs and symptoms of concussion.

USEFUL CONCUSSION TESTING FOR HIGH SCHOOL AND YOUTH COACHES

In 2011, Laura Balcer, a professor of Neurology at the University of Pennsylvania stated that “no single test can be utilized to diagnose or manage concussions in athletes.” Most of the concussion assessments in place are used evaluate an athlete’s readiness to return to competition. Research shows that detecting early signs of concussion can improve outcomes (Lovell, 2009); therefore, there is a need for a rapid screening test to assess athletes who may have a concussion (Galetta et al., 2011). The King-Devick Test is a concussion screening test that could meet this need and is based on measuring the speed participants complete rapid number naming test cards. This screening tool captures many aspects of brain functions, including subcortical pathways that extend beyond eye movements (Galetta et al., 2011). It has the ability to capture impairments of eye movements, attention, language, and other areas that correlate with suboptimal brain function (Galetta et al, 2011).

The test includes a total of four test cards; one demonstration card and three test cards (Galetta et al., 2011). Participants should read the cards as fast as possible and avoid making errors. Each test card is designed and structured in a more difficult format than the previous one. The sum of each test card is added up to get the overall test score. Time of completion and the number of errors are both recorded for evaluating purposes (Galetta et al., 2011).

Over the last few years, the King-Devick Test has become a highly researched assessment in concussion detection. Two research studies bring significant contributions to the existing body of literature. The first study “The King-Devick Test as a determinant of head trauma and concussion in boxers and MMA fighters” investigates the screening tool in a cohort of boxers and mixed martial arts (MMA) fighters. Results showed that post-fight time scores were significantly higher (worse) for participants who had head trauma during the match (Head trauma: 59 ± 7.4 vs. No head trauma: 41.0 ± 6.7 s). It also showed that participants with head trauma who experienced a loss of consciousness had an even higher post-fight time score.

Another research investigation demonstrated similar results. The University of Pennsylvania investigated the King-Devick Test on 219 student athletes. Sideline time scores were significantly higher (worse) than the baseline scores for the athletes who had concussions during competition or practice (Post concussion: 46.9 s vs. Baseline: 37.0 s). An athlete having a score that is five seconds worse than their baseline score is a distinguishing characteristic of an individual who may have sustained a concussion. This characteristic can also be useful in recommending the athlete to seek medical evaluation.

The results of each of these studies demonstrate the King-Devick Test as an accurate and reliable method of identifying athletes with head trauma. The test also has the advantage of being portable and easily adaptable for sideline use. It does not require a certified athletic trainer or medical professional to administer and would be extremely useful in high school and youth sports.

CONCLUSIONS

In conclusion, using the concepts and applications of deliberate practice, high school and youth sport coaches can implement easy-to-use assessments such as the King-Devick Test into their sport programs. In addition, having a philosophy that addresses the current issues young athletes face is critical for the retention of athletes participating in sports. Developing a coaching system and thoroughly practicing and applying that system can help with the prevention and management of sport-related concussions in sport programs. Many sports medicine professionals have already referred to the King-Devick Test as the “missing link” for practical management of concussions. If coaches do decide to implement the King-Devick Test, it should be used in conjunction with other assessments and practices reviewed in the sports medicine literature. Nonetheless, thoroughly practicing and applying proper concussion management is critical for youth and high school coaches. This is needed for athletes to demonstrate elite performance and for coaches to develop expertise.

ACKNOWLEDGMENTS
None

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