Barrow Brainbook Educates 1M High School Athletes in AZ on Concussion

As fall high school sports open in Arizona, Barrow Neurological Institute is marking the 10-year anniversary of Barrow Brainbook, the nation’s first mandatory concussion education for student-athletes. Since its inception in 2011, Barrow Brainbook has provided concussion education to more than 1 million Arizona high school athletes.

Barrow Brainbook requires Arizona student-athletes to complete concussion education and pass a formal test to participate in Arizona Interscholastic Association sports. The program has been an effective tool to educate student-athletes about the signs and symptoms of concussion in order to prevent serious brain injury.

concussion specialist javier cardenas
Javier Cárdenas, MD

Its mission has become more urgent as research increasingly shows that excessive or improperly treated concussions can cause long-term brain damage, says Barrow Brainbook creator Dr. Javier Cárdenas, a sports neurologist at Barrow Neurological Institute, part of Dignity Health St. Joseph’s Hospital and Medical Center.

“We launched Barrow Brainbook in an effort to protect our young athletes from sustaining brain injuries,” Dr. Cárdenas says. “The initiative is vital to stemming the tide of concussions in youth sports.”

Numerous future professional athletes have completed Barrow Brainbook, including Arizona Cardinals wide receiver Christian Kirk, who graduated from Scottsdale Saguaro High School in 2016. “The message of Barrow Brainbook is an important one – concussions need to be taken seriously,” said Kirk. “This program not only emphasizes that point but also educates student-athletes on how to recognize the signs and symptoms.”

Christian Kirk at Saguaro High School.
Image courtesy of Arizona Cardinals.

This year, Barrow Brainbook has expanded its reach with the release of a Spanish-language version. “The Spanish-language Barrow Brainbook will allow us to better serve the Latino community in Arizona and improve accessibility for Spanish-speaking student-athletes,” Dr. Cárdenas says.

Barrow Brainbook uses an interactive format to provide information to student-athletes on how to prevent, recognize and respond to concussions.

“It is critically important that the education be delivered in an active format,” Dr. Cárdenas says. “It is not a passive presentation.”

The module includes appearances by professional athletes and peer athletes and covers four levels:

  • What is a concussion?
  • Minimize the risk of a concussion
  • Signs and symptoms of a concussion
  • What to do if someone gets a concussion?

The module concludes with a test that student-athletes must pass to compete in AIA sports.

Arizona Concussion Scorecard


  • Barrow Brainbook has provided concussion education to more than 1 million Arizona high school athletes since 2011. It is the nation’s first mandatory concussion education and test for student-athletes, who must complete it before Arizona Interscholastic Association play. The education module is also available in Spanish.
  • Barrow Brainball, concussion education for youth, has been downloaded more than 15,000 times.


  • Arizona Interscholastic Association (AIA) football helmet dislodgement rule of 2011 was adopted by the National Federation of State High School Associations (NFSH) in 2012.
  • AIA’s football contact practice rule of 2013 was adopted by NFHS in 2015.
  • Arizona was the first state in the nation to limit soccer heading practice.
  • AIA’s blindside block rule of 2016 was adopted by NFHS in 2017.
  • Arizona was the second state in the nation to offer a concussion health insurance policy to all AIA athletes.

Barrow Resources

  • More than 300,000 baseline concussion tests have been delivered by Barrow to Arizona high school athletes.
  • Approximately 50,000 post-injury concussion tests have been delivered by Barrow to Arizona high school athletes.
  • More than 600 telemedicine concussion consultations have been provided by Barrow to Arizona athletic trainers.

Pro Athletes & Brainbook

The following is an alphabetical list of active pro athletes who attended or graduated from Arizona high schools since 2011, when athletes were required to pass Barrow Brainbook education to participate in Arizona Interscholastic Association sports.

  • Cody Bellinger, Hamilton (2013), MLB
  • Zach Davies, Mesquite (2011), MLB
  • D.J. Foster, Saguaro (2012), NFL
  • Scott Kingery, Mountain Pointe (2012), MLB
  • Christian Kirk, Saguaro (2015), NFL
  • Andrus Peat, Corona del Sol (2012), NFL
  • Paul Perkins, Chandler (2012), NFL

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