Practice Tip of the Week | Concussion Awareness in Sports

By Daniel Cabrera DNP, MBA, RN and Jenny Kelly, DNP, RN in partnership with the TNA Nursing Practice Committee 

On a Friday night, I can hear the roar of the crowd as they cheer on their team, with the sounds echoing as if a professional team were playing. The excitement and energy are like no other. In an instant, the crowd quiets down as one of the players takes a hard hit and is slow to get up. As we know, most kids shake it off and run back into the game. Texas and sports are synonymous and a way of life for most communities. Unfortunately, we also have to deal with injuries and their lasting effects. Concussions account for 5-9% of all sport related injuries each year (Zynda et al., 2022). This accounts to about 1.1-1.9 million concussion cases annually in pediatric population in the United States (Zynda et al., 2022). Texas addressed concussions, leading the passage of Senate Bill 2398, which became effective in 2025. We are going to explore concisions and how the new bill will affect our schools.  

What is a concussion?

 It is described as a short-term disruption in normal brain activity that occurs when the brain experiences a jolt or impact, such as from fall or other injury (Jaffee, Broshek, & Svingos , 2023).  

What happens during a concussion?

When a concussion occurs,  there is a sudden disruption of the brain’s chemical balance and energy supply causing temporary impairment of functions like thinking, movement, emotions, and speech (Jaffee, Broshek, & Svingos , 2023). During recovery, the brain faces an energy mismatch, needing more fuel while receiving less, which can cause symptoms such as headaches, dizziness, vision problems, and difficulty concentrating until normal function is restored (Jaffee, Broshek, & Svingos , 2023). This can take generally from 1 to 4 weeks and closer to 4 weeks in children (Jaffee, Broshek, & Svingos , 2023).  

Recognizing concussion symptoms

According to Jaffee, Broshek, and Svingos (2023), most people are unaware that they have had a concussion. Some have a feeling of being “a bit off” or like they “had their bell rung”. Some may have more obvious symptoms, but it is always important to understand that everyone will present differently. Concussion symptoms fall under three main categories and vary per person: 

• Physical Symptoms: include headache, light and noise sensitivity, neck pain, blurred vision, balance problems, dizziness, and sleep difficulties 
• Cognitive Symptoms: involve feeling slowed down, foggy, or “not right”, along with difficulty concentrating, remembering, or confusion.  
• Emotional symptoms: can include irritability, increased emotionality, sadness, anxiety, and lack of motivation.  

Please take caution, as these symptoms might be overlooked and dismissed as something else, making concussion easy to miss. It is important to collect a history, including activities leading up to the onset of symptoms, to help identify a potential concussion. For school age children, it is helpful to inquire about sports participation. 

What does Senate Bill 2398 (SB 2398) do?

SB 2398 directs the Texas Education Agency (TEA) to develop a list of non-medical accommodation for students diagnosed with a concussion or brain injury. The TEA will also create a form to be used by the school district describing the accommodations they may offer under this section.  This form will be made available on the internet to be used by educators, administrators, students, and parents or guardians. The bill also amends section 38.151 to include a concussion response policy on how to respond to a concussion that has occurred while on school property or participating in a school sponsored or related activity on or off property. This section also calls for the immediate removal of a student from a school sponsored or related activity if it is believed they have sustained a concussion.  

Why it matters

Concussions are considered silent injuries, and SB 2398 creates consistency across Texas schools for prevention and accommodation for concussion injuries and protects both the students’ learning and safety.  

Concussion Tips & Takeaways 

For Parents, Coaches, and Educators  

•  Watch for subtle signs- not just obvious ones 
• When in doubt, pull the child out 
• Ask your school about SB 2398 accommodation if you child has a concussion 

For School Nurses 

Best Practices  

•  Use a collaborative team approach to provide support as students diagnosed with a concussion return to school (Daniels, 2023).  
• Promote an individualized plan for students diagnosed with concussion 

Plan elements can include: 

• Starting with a shorter school day 
• Taking rest breaks 
• Avoiding activities that need concentration, such as quizzes or tests 
• Take fewer classes 
• Give extra time to complete assignments 
• Allowing student to wear sunglasses to help with light sensitivity

In a recent podcast episode, the Texas Nurses Association interviewed a school nurse and athletic trainer to discuss the impact of concussions on students in the school setting. They also describe the importance of a collaborative relationship between all school personnel and with the child and their family. Join us by listening to the Texas Nurses Podcast to learn more.  

REFERENCES

Daniels, B. (2023). Going back to school after a concussion. Nemours Children’s Health. https://kidshealth.org/en/teens/school-concussions.html

Jaffee, M. S., Broshek, D. K., & Svingos, A. M. (2023). Navigating the Challenges of Concussion (1st ed.). Oxford University Press. https://doi.org/10.1093/oso/9780190630119.001.0001S.B. 2398, 89th Leg., Reg. Sess. (Tex. 2025). https://capitol.texas.gov/tlodocs/89R/billtext/html/SB02398F.htm

Zynda, A. J., Worrall, H. M., Sabatino, M. J., Ellis, H. B., Chung, J. S., Cullum, C. M., & Miller, S. M. (2022). Continued play following adolescent sport-related concussion: Prospective data from the North Texas Concussion Registry. Applied Neuropsychology: Child, 11(4), 740–751. https://doi.org/10.1080/21622965.2021.1957677