In April 2010, the N.C.A.A. required every member college to have a concussion management plan mandating that any athlete showing signs of a concussion be removed from practice or competition. Colleges were also told to educate athletes on how to identify concussions so that the athletes could report symptoms to college staff members.
A study published last month in the American Journal of Sports Medicine found that most N.C.A.A. institutions have followed through on adopting a management plan. More than 90 percent of respondents at roughly 900 universities said such a plan was in place, and nearly all said their plans protected athletes well or very well.
But on closer review, the picture is not so positive. About 24 percent of respondents said their universities had no process for annual athlete concussion education. How are athletes to report concussion symptoms if they have not been taught how to identify those symptoms? And the instruction they do receive is often very limited. The Chronicle of Higher Education has noted that some colleges limit their guidance to a one-page handout, which some do not even allow the athletes to keep.
Some colleges are still violating N.C.A.A. rules. Nearly 7 percent of respondents in the study said they thought athletes could have final responsibility for deciding whether to return to play after a concussion even though under the N.C.A.A. concussion policy a physician or physicians designee should make the call. Some 7 percent said the final say could rest with the coach.