Infographic. Concussion through my eyes: a qualitative study exploring concussion experiences and perceptions of male English blind footballers

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WeilerR, etal. Br J Sports Med Month 2023 Vol 0 No 0
Infographic. Concussion through my eyes: a qualitative study
exploring concussion experiences and perceptions of male
English blindfootballers
Richard Weiler ,1,2,3 Osman Hassan Ahmed ,4,5,6 Willem van Mechelen,1,7,8,9 Evert Verhagen ,1
Adam Virgile ,10 Caroline Bolling1
Infographic
INTRODUCTION
Para athletes play sports with a risk of
sustaining head injuries and concussions,1 2
with concussion assessment of para athletes
presenting additional challenges due to their
impairments.3 Consequently, injury surveil-
lance studies may not accurately reflect para
concussion prevalence. Guidelines for para
concussion clinical assessment and manage-
ment have only recently been published.3
Our qualitative study explored English
blind 5- a- side footballers’ perceptions of
concussion, concussion risks and concus-
sion prevention to improve para concussion
care.4 Nine semistructured interviews were
conducted with male English blind footbal-
lers underpinned by a pragmatic paradigm.
Data were analysed using thematic analysis.
WHAT DID WE FIND?
Blind footballers were unsure about the
number of concussions they had sustained.
They lacked understanding of what to
experience when concussed, and perceived
both their diagnosis and concussion expe-
riences to be different from people who
have vision. Concussion severity, mech-
anism of injury and previous concussion
experiences were highlighted as key issues
which affect their concussion reporting
behaviours. Spatial orientation and sleep
were reported as important factors to
function (both in daily life and for football
performance) and are affected by concus-
sion. Spatial orientation is not included in
current assessment tools or clinical guid-
ance for sports- related concussions and
sleep is one subjective symptom question
on current assessment tools. Blind foot-
ballers stated the rules of blind football
are important, with the collision preven-
tion rules being especially important to
prevent collisions and allow game flow.
Opinions varied regarding whether colli-
sion prevention rules are enforced appro-
priately, and several participants suggested
that collisions (and subsequently concus-
sions) increase when referees and athletes
are less experienced.
PRACTICAL IMPLICATIONS
Our study found a perceived lack of
understanding of what is experienced
with concussion, and blind footballers also
experienced a high number of concussive
symptoms when uninjured.5 This supports
their perceptions that effective education
methods are needed to provide more
concussion information to blind footbal-
lers, coaches and medical staff, in order to
promote signs and symptoms of concus-
sion to improve concussion reporting and
diagnosis. Given the perceived differ-
ences between blind footballers who had
sustained a concussion and those who had
not, varied approaches may be required
due to different perceptions, experiences
and behaviours reported.
and East of England (NHS). Protected by copyright. on February 7, 2023 at GPs and Practice Staff in the Midlandshttp://bjsm.bmj.com/Br J Sports Med: first published as 10.1136/bjsports-2022-106507 on 30 January 2023. Downloaded from

2WeilerR, etal. Br J Sports Med Month 2023 Vol 0 No 0
Infographic
FUTURE DIRECTIONS
Future studies should capture concus-
sion experiences and perceptions of
para athletes from a wider range of
countries to explore contextual and
cultural differences across para sports
and other impairments. To improve
clinical concussion care, the percep-
tions of medical staff also need to be
better understood. This will enhance
improvements in concussion reporting
by para athletes and their subsequent
assessment.
1Amsterdam Collaboration on Health and Safety
in Sports, Department of Public and Occupational
Health, Amsterdam Public Health Research Institute,
Amsterdam University Medical Centers, location VUmc,
Amsterdam, The Netherlands
2Para Football Foundation, Arnhem, The Netherlands
3Sport & Exercise Medicine, Fortius Clinic, London, UK
4Physiotherapy Department, University Hospitals Dorset
NHS Foundation Trust, Poole, UK
5School of Sport, Health and Exercise Science, University
of Portsmouth, Portsmouth, UK
6The Football Association, Burton- upon- Trent, UK
7School of Human Movement and Nutrition Sciences,
Faculty of Health and Behavioural Sciences, University
of Queensland, Brisbane, Queensland, Australia
8Division of Exercise Science and Sports Medicine
(ESSM), Department of Human Biology, Faculty of
Health Sciences, University of Cape Town, Cape Town,
South Africa
9School of Public Health, Physiotherapy and Population
Sciences, University College Dublin, Dublin, Ireland
10College of Nursing and Health Sciences, University of
Vermont, Burlington, Vermont, USA
Correspondence to Dr Richard Weiler, Amsterdam
Collaboration on Health & Safety in Sports, Department
of Public and Occupational Health, Amsterdam
Movement Sciences, Amsterdam UMC, University
Medical Centres – Vrije Universiteit, Amsterdam, The
Netherlands; rweiler@ doctors. org. uk
Twitter Osman Hassan Ahmed @osmanhahmed,
Evert Verhagen @Evertverhagen and Adam Virgile
@adamvirgile
Acknowledgements The authors would like to
sincerely thank the athletes who gave their time to
share their experiences and stories.
Contributors RW, OHA, WvM, EV and CB wrote the
first draft. AV produced the infographic. All authors
provided feedback and content to the final version.
Funding The authors have not declared a specific
grant for this research from any funding agency in the
public, commercial or not- for- profit sectors.
Competing interests None declared.
Patient consent for publication Consent obtained
directly from patient(s).
Ethics approval This study involves human
participants and was approved by Amsterdam UMC
Ethics Committee approved the study (2021.0319).
Participants gave informed consent to participate in the
study before taking part.
Provenance and peer review Not commissioned;
externally peer reviewed.
© Author(s) (or their employer(s)) 2023. No commercial
re- use. See rights and permissions. Published by BMJ.
To cite WeilerR, AhmedOH, MechelenW, etal.
Br J Sports Med Epub ahead of print: [please include
Day Month Year]. doi:10.1136/bjsports-2022-106507
Accepted 11 January 2023
Br J Sports Med 2023;0:1–2.
doi:10.1136/bjsports-2022-106507
ORCID iDs
RichardWeiler http://orcid.org/0000-0002-6216-839X
Osman HassanAhmed http://orcid.org/0000-0002-
1439-0076
EvertVerhagen http://orcid.org/0000-0001-9227-8234
AdamVirgile http://orcid.org/0000-0003-2146-7964
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and East of England (NHS). Protected by copyright. on February 7, 2023 at GPs and Practice Staff in the Midlandshttp://bjsm.bmj.com/Br J Sports Med: first published as 10.1136/bjsports-2022-106507 on 30 January 2023. Downloaded from