Aotearoa New Zealand has a high incidence youth concussion (mild traumatic brain injury), which occur as a result of incidents in sport, physical activity or everyday life events. Concussions can lead to headaches, tiredness and difficulty concentrating which can interfere with students' ability to fully participate in learning and sporting related activities at school. The process to recover from a concussion involves mental rest and a gradual return to learning, which can be at odds with continuing academic demands of secondary schooling, potentially influencing student stress and recovery.
Early detection and a managed return to activity is paramount for timely recovery. Yet, based on research undertaken under the auspices of New Zealand Rugby, secondary school support for students with concussion was often lacking.
Challenges with such support is highlighted in the following enactment of a composite case of students’ experiences during the course of this project.
This research aimed to provide a framework to outline the 'what', 'where', 'who' and 'how' for managing concussion in secondary schools. Using a collaborative approach, we developed processes in school-based concussion management, stakeholders' (teachers and coaches) awareness of signs, symptoms and importance of early diagnosis and healthcare, and students' needs for graduated return to learn.
The research followed a four-stage process
We co-designed a FRAmework for MaNagement of Concussion in Secondary Schools (FRANCS) with stakeholders from five schools and their communities in 2021: three schools in Dunedin and two in Auckland with 95 school and healthcare stakeholders (Phase 1a). We explored processes they were already implementing within their schools’ context using their strengths, and strategies to overcome barriers.
In 2022, FRANCS was implemented and evaluated in three schools in Dunedin and two in Hawkes Bay (Phase 1b). The schools adapted the framework based on their local resources and structures. An assistant research fellow (ARF) provided support with implementation throughout the whole year.
Students who sustained a concussion and who agreed to be part of the project were tracked by the ARF as they progressed though the pathway towards recovery. We also gathered feedback about FRANCS from stakeholders (teachers, parents, students, coaches, manager and healthcare providers; Phase 2a).
We also sought input from sports organisations, healthcare provider organisations, ACC, policy makers and education systems, for advice in preparation for a national roll-out of the framework (Phase 2b).
The outcomes of these evaluations informed Phase 3 in 2023, implementing FRANCS in seven further schools. During Phase 4, we evaluated the process again and refined FRANCS further.
Listen to more information about the study below.
Success story
To date (July 2024), we have worked with 12 schools to develop, implement and refine FRANCS. This clip contains an enactment of a composite case, based on parent and student experiences we encountered during the course of the project.
We have gained funding for 2024 to develop more resources for schools and plan to make these available to schools across Aotearoa early in 2025.
The FRANCS documentation is available for schools, via Professor Gisela Sole, gisela.sole@otago.ac.nz or Dr Anja Zoellner, anja.zoellner@aut.ac.nz
Research Funding
Otago Participatory Science Platform (PSP)
2021
Development of a concussion management policy for high schools. Danielle Salmon, Marelise Badenhorst, Gisela Sole, Simon Walters, Chris Whatman, and community and education partners. Amount: $19,680
2022
Collaboration between national governing bodies and regional organisations in Otago to refine a community-designed framework and implement concussion management in Dunedin-based secondary schools.
Danielle Salmon, Gisela Sole, Maria Bentley, Kate Mossmann, Marelise Badenhorst, Patricia Lucas, Simon Walters, and community partners. Amount: $19,680
Lottery Health Grant
2022/2023
Implementation and evaluation of a FRAmework for maNaging Concussions in Secondary schools (FRANCS).
Gisela Sole, Danielle Salmon, Marelise Badenhorst, Kate Mossman, Sierra Keung, Simon Walters. Amount: $120,000
Health Research Council Activation Fund
2023
Connecting rangatahi with concussion management
Simon Walters, Anja Zoellner, Chris Whatman, Kylie Thomson, Gisela Sole. Amount: $30,000
Auckland University of Technology, Faculty of Health and Environmental Sciences, Research Development Fund
2024
Evaluation of the implementation of a FRAmework for managing Concussions in secondary Schools (FRANCS).
Anja Zoellner, Simon Walters, Sierra Keung, Patricia Lucas, Kylie Thompson, Marelise Badenhorst, Gisela Sole. Amount: $8,230.26
2024/2025
Connecting rangatahi with concussion management
Kylie Thompson, Chris Whatman, Sierra Keung (AUT). Amount: $9,829.09
Publications
Peer-reviewed Journal Articles
Salmon DM, Badenhorst M, Keung S, Lucas P, Mossman K, Thompson K, Walters S, Sole G (2023). Designing, implementing and evaluating a framework for managing concussions in New Zealand secondary schools: a study protocol. NZ Journal of Physiotherapy, 51(3), S1-S9
Media
Study to look at youth concussions, The Star, 18th November 2021. https://www.odt.co.nz/the-star/study-look-youth-concussions
NZ Rugby piloting return to learning concussion program, 1news, 22nd June 2022. https://www.1news.co.nz/2022/06/22/nz-rugby-piloting-return-to-learning-concussion-program/
Presentations
Mossman K, Sole G, Badenhorst M, Salmon D, Sutherland C, Lucas P. Concussion management in secondary schools. New Zealand Secondary Schools Sports Conference, Wellington NZ, 23 September 2022
Research Team
Project leads:
Professor Gisela Sole (Centre for Health, Activity and Rehabilitation Research, CHARR, School of Physiotherapy, University of Otago)
Dr Danielle Salmon (World Rugby)
Associate Professor Simon Walters (School of Sport and Recreation, - Auckland University of Technology)
Co-researchers:
Dr Marelise Badenhorst (Sport Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology)
Richelle Caya (CHARR, School of Physiotherapy, University of Otago)
Dr Sierra Keung (SPRINZ, Auckland University of Technology)
Dr Patricia Lucas (SPRINZ, Auckland University of Technology)
Dr Kate Mossman (CHARR, School of Physiotherapy, University of Otago)
Debbie Skilton (SPRINZ, Auckland University of Technology)
Kylie Thompson (SPRINZ, Auckland University of Technology)
Christina Sutherland (CHARR, School of Physiotherapy, University of Otago)
Dr Anja Zoellner (SPRINZ, Auckland University of Technology)
Contact Us
For more details about this study please email Professor Gisela Sole at gisela.sole@otago.ac.nz