American Journal of Sports Science and Medicine
ISSN (Print): 2333-4592 ISSN (Online): 2333-4606 Website: Editor-in-chief: Ratko Pavlović
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American Journal of Sports Science and Medicine. 2019, 7(2), 34-39
DOI: 10.12691/ajssm-7-2-2
Open AccessCase Study

Prevention and Management of Sport-Related Concussions in Uganda: A Case Study

Samuel K Lubega1, , Mike Lambert1, Timothy Makubuya2, Shelina Babul3, Haruna Muwonge4, Robert Zavuga5, Josephine Kasolo4 and Joseph Kalanzi6

1Department of Human Biology, University of Cape Town, Cape Town, South Africa

2Department of Educator Preparation and Leadership, University of Missouri-St. Louis, St. Louis, USA

3Department of Pediatrics, University of British Columbia, Vancouver, Canada

4Department of Physiology, Makerere University, Kampala, Uganda

5Medical Commission, Uganda Olympic Committee, Kampala, Uganda

6Emergency Medicine Division, Makerere University, Kampala, Uganda

Pub. Date: April 24, 2019

Cite this paper:
Samuel K Lubega, Mike Lambert, Timothy Makubuya, Shelina Babul, Haruna Muwonge, Robert Zavuga, Josephine Kasolo and Joseph Kalanzi. Prevention and Management of Sport-Related Concussions in Uganda: A Case Study. American Journal of Sports Science and Medicine. 2019; 7(2):34-39. doi: 10.12691/ajssm-7-2-2


Head injuries in sports often go unnoticed and untreated with a risk of increasing the severity of neurological difficulties for affected athletes. While there is much research on athletes in developed countries, the data on athletes from developing countries is lacking. Using a descriptive case study approach, this report focuses on concussions from four main sports (football, athletics, basketball and rugby). Emphasis was placed on those athletes who had been identified with a sport-related concussion (SRC). The phases of emergency, intermediate, rehabilitative, and return to sports participation were considered in this study. Three SRC cases from both male and female athletes were observed and interviewed for post-injury management from the emergency phase to return to sports participation. There was evidence of lack of specific pre-season screening of athletes for concussion history and standard care for concussed athletes in all the three cases observed using the best medical practice framework. Our study shows barriers such as knowledge among the sports resource providers; a law and policies to mandate care, and the absence of specific facilities for managing athletes with concussions. Implementation of sports health care policies is necessary to mandate care for athletes. Strategies for prevention and management of concussions are necessary, especially through increasing the awareness and knowledge using the Concussion Awareness Training Tool (CATT). Further studies with larger samples are encouraged to ascertain the magnitude of existing barriers.

concussion knowledge prevention emergency rehabilitation best medical practice

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[1]  Conidi FX, Drogan O, Giza CC, Kutcher JS, Alessi AG, Crutchfield KE. Sports neurology topics in neurologic practice: A survey of AAN members. Neurol Clin Pract. 2014; 4(2):153-160.
[2]  Kimbler DE, Murphy M, Dhandapani KM. Concussion and the adolescent athlete. J Neurosci Nurs. 2011; 43(6): 286-90.
[3]  Conder RL, Conder AA. Sports-related concussions. N C Med J. 2015; 76(2):89-95.
[4]  Scorza KA, Raleigh MF, O’Connor FG. Current concepts in concussion: evaluation and management. Am Fam Physician. 2012; 85(2): 123-32.
[5]  Moser RS, Iverson GL, Echemendia RJ, et al. Neuropsychological evaluation in the diagnosis and management of sports-related concussion. Arch Clin Neuropsychol. 2007; 22(8): 909-916.
[6]  Centers for Disease Control and Prevention (CDC). Traumatic brain injury in the United States: fact sheet. CDC website. Published June 2014. Accessed February 18, 2015.
[7]  Centers for Disease Control and Prevention (CDC). What can I do to help prevent traumatic brain injury? CDC website. Updated September 13, 2013. Accessed February 18, 2015.
[8]  DePadilla L, Miller GF, Jones SE, Peterson AB, Breiding MJ. Self- reported concussions from playing a sport or being physically active among high school students, United States 2017. MMWR Morb Mortal Wkly Rep. 2018; 67(24): 682-685.
[9]  Muwonge H, Zavuga R, Kabenge PA, Makubuya T. Nutritional supplement practices of professional Ugandan athletes: a cross-sectional study. J Int Soc Sports Nutr. 2017; 14:41. Published 2017 Nov 13.
[10]  Prien A, Grafe A, Rössler R, Junge A, Verhagen E. Epidemiology of Head Injuries Focusing on Concussions in Team Contact Sports: A Systematic Review. Sports Med 48 (4): 953-969, 2018.
[11]  McCrory P, Meeuwisse W, and Johnston K, et al. Consensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Br J Sports Med 2009; 43(Suppl 1): i76-90.
[12]  Martin G (2016) Concussion & Consequences: A Review. Ann Sports Med Res 3(2): 1064.
[13]  King D, Hume PA, Brughelli M, et al. Instrumented mouthguard acceleration analyses for head impacts in amateur rugby union players over a season of matches. Am J Sports Med 2015; 43: 614-24?
[14]  Maroon JC, Winkelman R, Bost J, Amos A, Mathyssek C, Miele V. Chronic traumatic encephalopathy in contact sports: a systematic review of all reported pathological cases. PLoS One. 2015; 10(2):e0117338. Published 2015 Feb 11.
[15]  McKee AC, Stein TD, Kiernan PT, Alvarez VE. The neuropathology of chronic traumatic encephalopathy. Brain Pathol. 2015; 25(3):350-64.
[16]  Lakhan SE, Kirchgessner A. Chronic traumatic encephalopathy: the dangers of getting “dinged”. Springerplus. 2012; 1:2. Published 2012 Mar 12.
[17]  Stern RA, Riley DO, Daneshvar DH, Nowinski CJ, Cantu RC, McKee AC. Long-term consequences of repetitive brain trauma: chronic traumatic encephalopathy. PM R 2011; 3: S460-7.
[18]  Castellani RJ, Perry G, Iverson GL. Chronic effects of mild neurotrauma: putting the cart before the horse? J Neuropathol Exp Neurol. 2015; 74(6):493-9.
[19]  Omalu BI, Hamilton RL, Kamboh MI, et al. Chronic traumatic encephalopathy (CTE) in a national football league player: case report and emerging medicolegal 215 practice questions. J Forensic Nurs 2010; 6: 40-6.
[20]  Omalu BI, Fitzsimmons RP, Hammers J, et al. Chronic traumatic encephalopathy 214 in a professional American wrestler. J Forensic Nurs 2010; 6: 130-6.
[21]  Omalu BI, DeKosky ST, Minster RL, et al. Chronic traumatic encephalopathy in a national football league player. Neurosurgery 2005; 57: 128-34; discussion 128-134.
[22]  Omalu BI, Bailes J, Hammers JL, et al. Chronic traumatic encephalopathy, suicides 211 and parasuicides in professional American athletes: the role of the forensic pathologist. Am J Forensic Med Pathol 2010; 31: 130-2?
[23]  Breslow JM. Concussion watch. PBS Frontline.2015 Retrieved from watch/ - positions_2012.
[24]  Breslow JM. What the NFL’s new concussion numbers don’t answer? PBS Frontline. 2016 Retrieved from
[25]  Weinmeyer R. Concussion-related litigation against the National Football League. Virtual Mentor. 2014; 16(7): 552-8.
[26]  Enniss TM, Basiouny K, Brewer B, et al. Primary prevention of contact sports-related concussions in amateur athletes: a systematic review from the Eastern Association for the Surgery of Trauma. Trauma Surg Acute Care Open. 2018; 3(1): e000153. Published 2018 Jun 20.
[27]  Pachman S, Lamba A. Legal Aspects of Concussion: The Ever-Evolving Standard of Care. J Athl Train. 2017; 52(3): 186-194.
[28]  Babul S. Addressing the need for standardized concussion care in Canada: Concussion Awareness Training Tool. Can Fam Physician. 2015; 61(8):660-2.
[29]  Hurtubise JM, Hughes CE, Sergio LE, Macpherson AK. Comparison of baseline and postconcussion SCAT3 scores and symptoms in varsity athletes: an investigation into differences by sex and history of concussion. BMJ Open Sport Exerc Med. 2018; 4(1):e000312. Published 2018 Mar 21.
[30]  Strand SL. Post-concussive syndrome in a female basketball player: a case study. Open Access J Sports Med. 2013; 4: 123-5. Published 2013 May 14.
[31]  Maffey L, Emery C. Physiotherapist delivered preparticipation examination; rationale and evidence. N Am J Sports Phy Ther. 2006; 1(4); 176-186.
[32]  Sanders B, Blackburn TA, Boucher B. Preparticipation screening - the sports physical therapy perspective. Int J Sports Phys Ther. 2013; 8(2): 180-93.
[33]  Ljungqvist, A., Jenoure, P.J., Engebretsen, A.H., Alonso, J.M., Bahr, R., Clough, A.F., et al. The international olympic committee consensus statement on periodic health evaluation of Elite Athletes, March 2009. Clin. J. Sport Med. 19, 347-360.
[34]  McCall, A., Dupont, G., Ekstrand, J. Injury prevention strategies, coach compliance and player adherence of 33 of the UEFA Elite Club Injury Study teams: a survey of teams' head medical officers. Br. J. Sports Med.2016; 50, 725-730.
[35]  Mirabelli MH, Devine MJ, Singh J, Mendoza M. The preparticipation sports evaluation. Am Fam Physician 2015; 92.
[36]  Kroshus E, Daneshvar DH, Baugh CM, Nowinski CJ, Cantu RC. NCAA concussion education in ice hockey: an ineffective mandate. Br J Sports Med. 2014; 48: 135-40.
[37]  Echlin PS, Johnson AM, Riverin S, Tator CH, Cantu RC, Cusimano MD, et al: A prospective study of concussion education in 2 junior ice hockey teams: implications for sports concussion education. Neurosurg Focus, 2010, 29(5): E6
[38]  Emery CA, Black AM, Kolstad A, et al. What strategies can be used to effectively reduce the risk of concussion in sport? A systematic review. Br J Sports Med 2017; 51: 978-984.
[39]  McCrory P, Meeuwisse W, Dvorak J, et al Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016 Br J Sports Med 2017; 51: 838-847.
[40]  Abrahams S, Fie SM, Patricios J, et al. Risk factors for sports concussion: an evidence-based systematic review Br J Sports Med 2014; 48: 91-97.
[41]  Semrud-Clikeman M, Klipfel KM. J Pediatr Neuropsychol 2016; 2:58.
[42]  Broglio SP, Cantu RC, Gioia GA, et al. National Athletic Trainers' Association position statement: management of sport concussion. J Athl Train. 2014; 49(2): 245-65.
[43]  National Council of Sports v Peter Grace Sseruwagi [2004] UGHC 17
[44]  Echemendia RJ, Meeuwisse W, McCrory P, et al. The Concussion Recognition Tool 5th Edition (CRT5): Background and rationale Br J Sports Med 2017; 51: 870-871.
[45] 2674609.pdf?cloudid=pwkybrzpulzjofsbtt9n.
[46]  Babul S, Korn P, Goldman R, et al. Preventing Adverse Concussion Outcome: The Online Concussion Awareness Training Toolkit (CATT). Br J Sports Med 2014; 48: 563-564.
[47]  Cantu RC. Cerebral concussion in sport: management and prevention. Phys Sportsmed 1992; 14: 64-74.
[48]  Cantu RC. Posttraumatic retrograde and anterograde amnesia: pathophysiology and implications in grading and safe return to play. J Athletic Training 2001; 36: 244-8.
[49]  American Academy of Neurology. Practice parameter: the management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee. Neurology 1997; 48: 581-5.
[50]  Kelly JP, Nichols JS, Filley CM. Concussion in sports: guidelines for the prevention of catastrophic outcome. JAMA 1991; 266: 2867-9.
[51]  Kathryn Y. Manning, Amy Schranz, Robert Bartha, Gregory A.Dekaban, Christy Barreira, Arthur Brown, Lisa Fischer, Kevin Asem, Timothy J. Doherty, Douglas D. Fraser, Jeff Holmes, Ravi S. Menon. Multiparametric MRI changes persist beyond recovery in concussed adolescent hockey players Neurology Nov 2017, 89 (21) 2157-2166.