This section provides valuable information on concussions in soccer including specific information related to players in the following pathways:
Para Football (CP, Stroke, TBI)
Recognise – Report – Remove
Concussions are rare in soccer but they do happen and they need to be recognised quickly, reported to medical staff or referred to a healthcare professional and the player needs to complete a thorough Return to Play process before playing again.
On this page you will find content specific to players with a disability. The content created by both the International Blind Sport Association (IBSA) and the International Federation of Cerebral Palsy Football (IFCPC) is adapted and compliments the Sport Concussion Assessment Tool (SCAT) used commonly in football. Currently in it’s 5th version, SCAT 5 was created and now regularly reviewed by medical experts of the Concussion in Sport Group. It is important to note that ‘the diagnosis of a concussion is a clinical judgment, ideally made by a physician or other licensed medical professional. The SCAT5 and Child SCAT5 should not be used solely to make, or exclude, the diagnosis of concussion in the absence of clinical judgement. A person may have a concussion even if their SCAT5 or Child SCAT5 is “normal”.
In 2021, under the shadow of the global COVID19 pandemic a group of medical professionals held virtual meetings on a regular basis and issued the Concussion in para sport: the first position statement of the Concussion in Para Sport (CIPS)
The group note in particular that ‘While tools assessing brain function (eg, Sport Concussion Assessment Tool 5 (SCAT5) and neurocognitive tests) are widely acknowledged to be helpful following concussion, these tools are neither validated nor applicable in some respects within a para sport population. Significant differences were shown between baseline SCAT3 scores for footballers with and without impairment. These differences, among others, need to be recognised and considered, in order to create concussion guidelines that are specific to the wide variety of impairments noted in the growing number of athletes living with impairment. Within previous iterations of the consensus statements from the Concussion in Sport Group (CIS), there has been no consideration of the specific issues faced by para athletes, which may reflect the lack of concussion-related research that focuses on para athletes. Despite a paucity of research, the concussion issues faced by para athletes and their support staff are of concern and therefore specific recommendations for standards of care are needed’. This groundbreaking research paper goes as far as to identify a traffic light system (green, yellow red) assessment of athletes and to structure it based on sport specific impairments.Incredible work has been achieved by this group in a relatively short space of time but this speaks to the extensive experience of the group who are named below. The fact remains that much more research needs to be carried out into the concussion assessment of para athletes and the subsequent return to play. The members of CIPSG include: Richard Weiler, Cheri Blauwet, David Clarke, Kristine Dalton, Wayne Derman, Kristina Fagher, Vincent Gouttebarge, James Kissick, Kenneth Lee, Jan Lexell, Peter Van de Vliet, Evert Verhagen, Nick Webborn, Osman Hassan Ahmed
Examples of SCAT5 sport-specific impairment considerations.
IFCPF Policy and Protocol
IFCPF aim to protect and improve the health and welfare of all who play CP Football. At all levels they are committed to promoting CP Football as a healthy physical activity and a key part is the prevention of injuries and how best to manage injuries in football. Concussion assessment and management is an area of particular focus in CP football, given that all players will have experienced a brain injury of some degree (either through Cerebral Palsy, Traumatic Brain Injury, or Stroke) which has made them eligible for the sport. Use the resources on the right for more guidance.
IBSA Policy and Protocol
For immediate assessment, para athletes with total vision loss, regardless of whether the globe is intact, damaged or absent will not be able to report double vision or demonstrate a ‘blank or vacant’ facial expression after a head injury. Furthermore, the best eye response on the Glasgow Coma Scale (GCS) may be limited in non-concussed Para athletes with visual impairments and so a need for a baseline GCS score becomes important to be able to make comparison if they suffer a suspected concussion.
A Temporary Concussion Substitute (TCS) can be requested by a medical team official if they believe one of their players has sustained a head injury. This player can remain on pitch for 10 minutes while their teammate is assessed, to allow play to continue.
If the injured athlete can return, they will be allowed to do so by the referee at the next available stoppage of play. If they cannot, the TCS can remain on the pitch as a normal substitute. If the team have no available substitutions, they will still be able to use a TCS but the player must leave the pitch after 10 minutes if the injured player can return or not.
The new policy was successfully tested at the 2020 World Grand Prix in Shinagawa, Japan and then in place at all blind football matches at the Tokyo 2020 Paralympic Games.
It will apply to every IBSA Blind Football and IBSA Partially Sighted Football sanctioned competition and is one of the first to be introduced in Para sport.
For athletes with Down’s syndrome, or achondroplasia or osteogenesis imperfecta, caution is needed when examining the cervical spine because of the associated risk of atlantoaxial instability. Similar caution will be required for those with previous cervical injury as a cause of their existing SCI. Neurological screening tests and use of symptom lists may require alternative methods for communication (eg, Braille or text to speech technology for athletes with visual impairment), or the use of different wording to explain symptoms and visual prompts for athletes with intellectual impairment. For athletes with SCI and other more severe forms of lower limb neurological impairment, use of balance tests is not possible. Alternative tests such as the wheelchair error scoring system (WESS), if validated in this setting, may emerge as suitable clinical alternatives.
Intellectual impairment (which sometimes is also associated with CP, some neurological disorders, previous significant head injuries, vision impairment and spina bifida) poses significant challenges for the reliable assessment of cognitive function and may affect the results of many SCAT5 cognitive tests. Furthermore, the degree of intellectual impairment may also affect the reliability and repeatability of the assessments as a baseline or comparative tool during recovery. Athletes with arthrogryphosis, post-polio syndrome, muscular dystrophy, multiple sclerosis and spina bifida commonly have challenges with lower limb strength and balance. Results of neurological screening tests are variable depending on the level of impairment, and assessments of these athletes must therefore be interpreted with caution.