Subthemes, codes and exemplary quotes on the theme “Do I have a concussion?”
| Subtheme | Code | Exemplary quotes |
| “Did I have a concussion?” | I don’t know |
“Obviously, I don’t necessarily know if I definitely had a concussion. It was just, oh, hurt my head, and just kept on going, but I could tell, bloody hell, it was a big old hit that one, something is not right.”
“I suppose I don’t…I didn’t necessarily know what I’d be looking for to know whether I did or didn’t have it.” “I wouldn’t be surprised if I had a couple more concussions…more sort of minor ones.” “I think some people don’t even know if they’ve got it, do they? That’s the thing, isn’t it? My perception of it is like you can obviously mess up with your memory a little bit for a short period of time or maybe confusion.” |
| Maybe I did |
“I think there’s a fringe, isn’t there, where it could be a concussion, or it could be the adrenaline of the situation has overridden what’s happened and sometimes it’s hard to recall what’s happened at the time or straight after the event.” “At the time, I had quite a lot of blood loss, and I had to go to the hospital. It was at the time a potential concussion, but it wasn’t a full-blown diagnosis of a concussion. Concussion protocol was taken, but I’d say it was on the fringe. It was a grey area, whether it was or if it was just adrenaline at the time.” “I suppose you get tired during games which causes you to lose concentration, so I guess you don’t know whether you attribute sometimes lapses in concentration to just fatigue or whether there are other elements. You know whether there’s been a knock that kind of contributed to that as well. So it can be difficult to decide whether that’s specifically due to age, a knock on the head or whether it’s just general fatigue.” “I think I can remember, you know, times after training where I’ve had a really bad knock and you kind of feel a bit all over the place for the rest of the day, and you know you just want to kind sit down and not do very much.” | |
| I know, as I already had one |
“For the second one, I knew I was a little bit in trouble, and I got the doctor involved, and then he did the protocols actually when I got home after the tournament.” “I can go back to my last concussion as an example, really. I got a severe head knock, I got very, very disorientated, but I was only able to almost get through that head knock and reorientate myself because I understood where our bench was and orientate myself from our guide and our goalkeeper in order to play. If I’d had that headlock when I first started playing, I wouldn’t have been able to orientate…reorientate myself again, and I would have just been just, you know, just nowhere, that sort of thing.” “The first one was during a training camp… it was literally just a head knock in the training game, and from my recollection, it wasn’t even that big an incident or big collision, but it just left me feeling quite dizzy and just sort of unsteady on my feet for maybe sort of a day afterwards.” “I believe I stayed on the pitch for a few minutes afterwards, which maybe wasn’t the best thing until they actually realised that I probably was concussed. And I’ve got no recollection of anything after the game.” | |
| What is a concussion? | Based on mechanism |
“A bang to the head which causes a fall or equipment to be lost. That bang to the head is usually from the side rather than front on. The bang to the head causes a bit of a blank or a bang or a shockwave.” “A significant head injury that’s…I suppose changes in cognitive function and/or some kind of emotional change.” “Getting knocked out, being out cold. And then, at a lower type of stage, I’d probably say dizziness, not being able to walk properly straight after the incident. Maybe not being a-ble to see, but, in our case, obviously, we wouldn’t have that. Things like nosebleeds and things like that I’d say is a concussion.” “A kind of…a temporary of…not sort of brain…almost like a brain…a short term brain injury almost…that seems like a very strong word to use but…yeah…and one that kind of affects your memory and your ability to…your ability to function and do kind of everyday things for a short period of time.” |
| Based on symptoms |
“I suppose the main kind of things I remember was, yes, huge clashes and kind of the pain of that, but I also remember headaches.” “Some of the lads have come in. They’ve talked about feeling a bit cloudy thinking.” “I think confusion’s a big one… memory and probably the balance.” “I think it’s mild headaches. Really, I would say that’s the sort of the symptoms that I’d say that I have had.” “It’s loss of memory, unable to walk straight, unable to recall certain things, whether it’s from the long-term memory or short-term memory.” “I was definitely confused, dazed, hyper-emotional for quite a number of days afterwards and during the game and just really drowsy, groggy for three/four days afterwards as well.” | |
| Based on delayed symptoms |
“We had two nights left after that tournament ended, and I pretty much spent the whole of those two days sleeping. I didn’t go to the functions, didn’t do anything, so I just knew that I just had to sleep and just stay horizontal because my head was pounding. I was dizzy as hell, and there wasn’t much more I could do for myself really other than that.” “I can remember kind of not feeling so great the next day or two, kind of having a bit of a quite large headache and struggling to kind of walk in a straight line and things like that. And yeah, I improved kind of pretty quickly. I’d say within a few days, four or five days. I was feeling more normal again. But even so, I remember…yeah, even kind of a week or so, maybe even two weeks afterwards, I was…I still felt a bit kind of dinged, if that’s a word, and I was quite tired and yeah, just needed to rest, really.” “I struggled with sleep for the first few nights afterwards.” | |
| Would I report a concussion? | I want to play |
“I think, like many sports people, you’re fundamental drive and desire is to get back on the pitch.” “In major competitions, I would probably be a little bit loose with the truth… I would play down reporting to ensure that I could play.” “In the long run, you should tell someone about a head injury or concussion, but then in the heat of the moment, then you don’t want to be subbed off or go, or there could be a million and one reasons.” “I think definitely during a game. You just think that it’s nothing, especially the clash of heads or something, and you don’t realise that something has happened, and you just get on with it.” “I know the medical staff in place would carry out protocols if they knew the truth. So I’m comfortable with that, and I’m comfortable with the choices that I make, and I know the sacrifices.” |
| Fear of long-term sequelae |
“My view over the last couple of years definitely changed to more of those concerns than before. I was just getting on with it, and I didn’t really know what my view was, but it was more the fact that I didn’t really mind. I didn’t really have an idea of it, but now I’m a bit more concerned. “Concussion is a big thing, and you might think about, you know, concealing it now but in later life or whatever that could come back to haunt you, so for me, you know, it’s a big thing now in every football, so for me, I wouldn’t conceal it, but I could see how some people might try and cover it up.” “Say you were concussed or whatever and lied about it or didn’t realise, or you go back on and get another one. We all know what can happen like so and I’ve got a wife and kids at home.” “I think across all sports, I think we’re a lot more aware of kind of the risks of concussion now and what repeated concussion can do to people, kind of the effect it can have on them in later life even as well.” | |
| Impact on performance |
“From a football point of view of it is, you might be the best player in the world, but if you can’t… think straight here, you’re no good to the team anyway.” “If you don’t think that you’ve got a concussion and you get put on the pitch, for one, it could worsen it, and also, two, you’re not in that mindset. You might think you are, but then you’re not. You might not think straight and things, so it obviously affects your performance but then also the team’s performance.” | |
| Factors influencing diagnosis? | The medical staff need to tell me I have a concussion |
“We have a physio, and he’s been excellent at visibly seeing when something is not right, or something has happened, and he’s like, okay, I saw that I saw exactly what happened, and he knows, he’ll call out head injury and then all of a sudden you’ll get checked.” “Obviously, we can’t see the physio looking at us because we can’t see, but I’m certain he’ll be looking to see how are they walking, how are they moving, and he’ll check in to see you’re okay.” “I think you’ve got to kind of trust in what that medical person’s judgment is.” “Someone’s health has to come first, so if that medical person who doesn’t know the person that they're working with makes that judgment, I think it’s got to be gone with because you’ve got to, I think you’ve always got to be better safe than sorry.” “I think the way I’d know I had a concussion is for someone else to tell me. I think the thing I’ve learnt is that having witnessed people, including my own son, with a concussion, is that I’m not sure I’d know. So I think it needs to be taken out of the athlete’s hands completely.” |
| The concussion assessor needs to know me |
“I think that knowing you as a person is a big thing because someone like me, I’m very good at hiding things like fatigue.” “So, someone that you know will be able to know that he seems like the kind of individual who is good at hiding things, so you need to make sure that we keep an eye on him because he ain’t going to voluntarily come off. Whereas some lads, you’ll be able to physically see straight away they’re not right, or they’ll say they’re not right. I think it’s a responsibility on both people, both parties; physios and us as players.” “I think it’s a difficult one. If it’s somebody who knows you well, a physio or medical staff who have worked with you, who know you as a person and know your sort of movements, I don’t really see there being a problem because I would imagine that they would judge you based on this isn’t how you normally move or act. However, I suppose if it’s somebody who doesn’t know you… It’s a difficult one because I suppose, for instance, if someone said to you can you go over there and sit on the chair to your left and you missed it looking for it, that might just be because you didn’t see that it was there or, you know, you might move in a different way.” “Whether or not the player is going, to be honest, or if you’ve got like a baseline, the SCAT test… if you don’t have a base knowledge of how well they can perform outside of playing, I think that can be a hindrance to the tests.” “I definitely am working on balance. Yeah, definitely a concern of if someone has got bad balance, then you can’t really 100% go off that. I know obviously, during the test, there are other things, but that’s definitely one of the things that you can’t really go off for whether you’ve got a concussion or not because some people might not be able to balance.” | |
| Concussion assessments are visually bias |
“The lack of visual feedback for the medical staff to identify whether it is a concussion.” “I think definitely with a concussion and being blind is a lot harder because, with not having that sight, you’re only going off a feeling.” “You’d have to change the measuring points, I think, and try and get it to be not visual dominant. I suppose you haven’t got those visual cues where, you know, you’ve got those different tests, the cognitive tests that you do with somebody who is sighted so, you know, just a simple test on walking in a straight line you couldn’t have…you could still not have a concussion and still not be able to walk in a straight line.” “I suppose one of the obvious ones is things like double vision, but when you haven’t really got any vision to start with, then that’s quite a difficult one. I remember being in a hospital because of a mild head injury that wasn’t necessarily a concussion, but they said to me… one of the first things they said is if you have any double vision, you know, that was one of the first things they said as like a sign to look out for. I said I barely have light and dark protection, so I don’t think that I would even know if I was seeing double anyway.” “It was kind of balance and fix points, even the standing on one leg those tests, that’s quite hard for a blind person because you haven’t got that point to focus on. But the actual mechanism of it, I’m not quite sure how they would present differently, but I know it would be harder to explain the symptoms for a blind person compared to a sighted one.” | |
| Additional challenges relating to visual impairment |
“I would start off potentially with how visually impaired people manage under mental fatigue or daily tasks and that stressed situation. As simple as it may sound, it could be travelling unaided with a mobility aid such as a guide dog or a cane, travelling just through the centre of town where there are lots of different obstacles and things like that or situations that might arise and uncertainty, I think that would be a good indicator of how they’re coping.” “It’s worth noting how challenging their tasks can be and how mentally draining they are actually for a long period of time. The hardest thing for a blind or visually impaired athlete isn’t necessarily the physical training. It’s the mental exertion because of how they work to keep their orientation around the pitch and their awareness around the situation or changes.” | |
| Consider removing the blindfold worn during the game for assessment |
“If somebody comes off the pitch and they’ve still got a blindfold and an eye patch, that’s your first barrier to understand…to know if people are focussing where they should be or if they're not, sort of not presenting…not actually facing you…you know talking to you as they should be and then when you take those eye patches off you know you could be presented with a blind player that has two prosthetic eyes…so you won’t be seeing if there’s any kind of issues going on there, focus issues, that sort of thing and then you’ve got all the different conditions, you know, weird and wonderful all the way in between where people could have eyes will be wobbling about quite naturally all the time.” “So it would give a true chance to reflect on the situation for the blind person. You can be startled sometimes from a knock or a collision. It’s not necessarily a concussion. It’s just where you’ve had the wind knocked out of you, and it’s knocked your senses slightly. So being able to recalibrate by taking off your blindfold and your patches will give you a chance to show if it’s a long-term effect or not.” “In my football life, a portion of your face when you play is covered by a blindfold. Quite often, people, because of the visual impairment, won’t actually display much kind of eye contact, this is my interpretation anyway, but display much eye kind of movement and so on and often won’t make a kind of or is unable to make eye contact with somebody in day-to-day life anyway so you’ve really, really got the bottom part of the face to look at until you actually take someone’s blindfold off and then…yeah even then I can imagine the expression might be a less reliable indicator.” | |
| Consider orientation during the assessment |
“I’ve obviously never had a concussion from a sighted point of view, so I have no point of reference, but I guess you’ve obviously already got one less centre to orientate yourself with and certainly when you’re playing blind football, you are very reliant on using your hearing and your spatial awareness to orientate yourself and I guess it’s just kind of maybe that difference that you’re missing is amplified when you’re concussed.” “For me, I would add the orientation like do they actually know where their left, right, forward and back is…and can they tell you where basic things like can they tell you where the goal they’re defending is and where the opposition goal is, like can you point roughly speaking in that direction.” “Your spatial awareness is a really important thing in blind football, and I think, you know, a head injury can really, really mess with that and again, like with this…if you use sighted football as the kind of stark example, you don’t have those troubles really, do you, you don’t have to reorientate yourself if you are suffering with a head injury, you just carry on playing, that’s why so many players carry on playing, and nobody really realises for a while afterwards.” |
SCAT, Sport Concussion Assessment Tool.