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ASU student is 'brains' behind concussion tutorial for high school athletes


November 05, 2013

Editor's Note: This story is part of an ongoing series about student excellence at the university. To read more about some of ASU's outstanding students, click here.

For decades, the devastating effects of repeated concussions on the health of professional athletes was a well-kept secret – until it exploded into a national controversy. As investigative journalists reported scientific evidence of the long-term impact of head injuries on NFL players, the focus soon shifted to high school athletes. How could we protect their health and safety?

Arizona was an early adopter of protection for high school athletes. In 2011, the state legislature passed a law requiring coaches to remove high school athletes from play if they even so much as suspect a concussion. The law requires that the athlete must obtain written clearance from a medical professional, such as a physician or athletic trainer, in order to return to the sport.

State legislators also called for preventive measures that would make it mandatory for high school coaches, students and parents to complete concussion-education programs. To comply with the law, the Arizona Interscholastic Association deemed that every high school athlete in the state must complete Barrow Brainbook. This interactive, online training was developed in part by Barrow Neurological Institute at St. Joseph’s Hospital and Medical Center in Phoenix.

But the real brains behind Barrow Brainbook belong to Arizona State University educational technology doctoral student Robert Christopherson.

“Over 180,000 high school athletes in the State of Arizona have benefitted from the knowledge of Robert Christopherson,” said Dr. Javier Cárdenas, neurologist and brain injury expert who is director of St. Joseph’s B.R.A.I.N.S. Clinic. “Robert’s expertise in educational technology is the primary reason Barrow Brainbook has not only successfully taught high school athletes about concussion dangers, but has become the most successful concussion education program in the country.”

When he began his research, Christopherson noticed immediately that most available concussion education programs targeted coaches and parents, but few addressed the athletes themselves. From the start, he said the directive from Cárdenas was empowering youth to assess the situation and be part of the decision-making process. Today, Barrow Brainbook remains the only concussion education program in the nation directed at high school athletes.

“Nobody was telling the young athletes, ‘This is an issue you’re dealing with and you should be aware of what you can do,’” Christopherson said. “’You don’t have to just follow what everyone else is saying.’”

The doctoral student in ASU’s Mary Lou Fulton Teachers College noted that high school athletes get pressured not only by their peers, but also by their coaches and parents who expect them to perform. Consequently, Barrow Brainbook needed to educate the athletes about concussion in order to change how they respond to these interactive situations.

“The high-level goal was to teach the athletes the signs and the symptoms of concussion, basically what you can see and what you are feeling,” he explained. “We wanted to make them stop and think that they needed to pay attention to their bodies.”

To engage the young athletes, Christopherson considered social media for two reasons. First, research showed that student behavior online and in classrooms was becoming increasingly similar. Second, it was important to deliver concussion instruction close to where the head injuries happen. Teaching the athletes on the football field was not an option, so the researcher had to come up with an equally effective venue.

“So we decided to make a pseudo-Facebook,” he explained. “We created an environment that looks like Facebook, has a lot of the same social network interactions and includes characters that represent those people who influence the athletes most – peers, role models, including NFL players and college athletes, and doctors.”

The four peer personas featured on Barrow Brainbook represent different perspectives about high school athlete concussions. For example, soccer player Paranoid Pete is hyper-vigilant and afraid to perform because he fears getting hurt. He posts on “Facebook” all the time about the hazards of playing sports. Basketball star Show-Off Sally is a crowd-pleaser whose mantra is ‘the bigger, the better’ regardless of her safety. For football player Daredevil Dan, it’s all about the thrill of the sport and taking unnecessary risks. Hockey player Healthy Hank, on the other hand, offers a good balance of performance versus safety. He says things such as, “If I want to play professionally, I need to take care of my body now.”

As the four imaginary characters dialogue back and forth on “Facebook,” Cárdenas serves as a moderator who occasionally comments and offers additional information. He might say, “You know, Healthy Hank was right, maybe you should consider this, here’s a video.” Then the doctor plays a message from another Arizona physician talking about the pros and cons of what is being discussed. Then students comment on what they just saw.

According to Christopherson, it was also important to involve role models such as professionals from the WNBA and NFL in the “Facebook” conversation. He said Barrow Brainbook skews heavily toward football-related examples and role models since about two-thirds of the high school athletes completing the program play football. All of the Arizona athletes completing the education program must score 80 percent or higher on a quiz in order to play high school sports.

Initially, Christopherson worked with a small group of his doctoral student peers in Teachers College to get the project off the ground – Angela Barrus, Quincy Conley and Renee Pilbeam. Looking ahead, he is helping Cárdenas to plan the expansion of Barrow Brainbook into non-high school sports, such as club teams, as well as Arizona’s middle schools and even other states. 

The educational technology student also recently helped to direct the development of Barrow Brain Ball, a groundbreaking, interactive video game that teaches children ages 8 to 12 how to avoid collisions with other players. Launched in August 2013, the free game can be downloaded on Android phones and soon the iPhone, too.

“We want these youngest of athletes to play safe and to understand that if you get hit in the head and then get up and go, there could be a consequence to your actions,” he said.