Return-to-Play After Concussion: How Neuropsychology PhD Students Help Improve Student-Athlete Protocols

November 17, 2021
Rayna Hirst
By Rayna Hirst, PhD
Return-to-play protocol is one of the most hotly debated topics in neuropsychology. Recent research suggests that over 90% of high school athletes who sustain a concussion will be fully recovered within a month. 
However, concerns about cognitive effects of repeat concussions, risks of chronic traumatic encephalopathy (CTE), and discrepancies in personal baseline vs. average function keep this topic highly prioritized in the minds of researchers, coaches, and parents.
Over several years, Palo Alto University’s Sport Concussion Study has gathered data to help families and sports organizations establish cognitive baselines for student-athletes at risk for concussion. Recruitment into the study is on pause due to the pandemic, and we plan to resume as soon as possible.
The Sport Concussion Study serves a twofold purpose: 
  • Giving personalized insights into individual athletes’ “normal” function to reduce risks associated with sustaining subsequent concussions upon return to play
  • Offering our PhD in Clinical Psychology graduate students unique opportunities to deliver clinical care and contribute to the growing body of research in concussion management and treatment. 
First- or second-year neuropsychology students who rotate in our Sport Concussion Study in preparation for their third/fourth year practicum work directly with student-athletes, parents, and nationally recognized neuropsychology faculty. 
This work has prepared students for a range of neuropsychology career options, including:
  • Clinical patient care, such as diagnosing and treating patients after traumatic brain injury or progressive cognitive conditions such as Alzheimer’s disease
  • Forensic or legal consultation
  • Academic research or neuropsychology education
  • Pharmaceutical consultation
  • Industrial design consultation
PAU graduate students in the Sport Concussion Study have played a significant role in advancing the journey toward effective concussion care and return-to-play protocols—at no charge to student-athletes or their families. 

Why Cognitive Baselines Matter

One challenge with post-concussion testing is that coaches and parents typically don’t precisely know what their athletes’ cognitive strengths and weaknesses were before a concussive injury. Without personalized data, recovery rates are based upon a comparative standard baseline rather than the athlete’s actual prior function.
Standard baselines are tricky in student-athletes—their brains are still maturing, and children develop at different rates with varying cognitive abilities. Going by baseline trends means student-athletes may return to practice or play too early, risking further injury to their already traumatized brains. 
Brain injuries can happen in any sport—even one concussion can take a young athlete up to 30 days to recover, and the recovery period can be even longer for 5-10% of athletes. A 2020 study in Orthopaedics showed the most common sports for concussions were football, hockey, and soccer. The Sport Concussion Study also provides baseline testing for the full range of organized sports, including cheerleaders, gymnasts, basketball players, and rugby players. 

About the Study

The Sport Concussion Study has been part of a concerted effort over the past decade to complete baseline cognitive evaluations for athletes. The U.S. military, for example, is now conducting baseline testing before deploying servicemembers to improve treatment should brain injuries occur in the line of duty.
Concussions can cause a range of symptoms that affect cognitive and executive functions. Common concussion symptoms include:
  • Appearing dazed or confused
  • Dizziness or clumsiness  
  • Experiencing nausea or vomiting (for an unexplained reason)
  • Forgetting what happened prior and/or after the event
  • Headache or pressure in the head
  • Losing consciousness (even for a moment) 
At PAU, student-led assessments consist of selected tests to help establish a normal baseline for a student-athlete’s main cognitive domains and executive functions. Our program is unique by providing research data for younger students, from ages 8-16 years—most programs throughout the country focus solely on high school and collegiate athletes.
Cognitive domains:
  • Attention and processing speed
  • Language
  • Visual spatial skills
  • Learning and memory
Executive functions:
  • Higher order complex processes
  • Problem solving
  • Set shifting (or task switching)
  • Cognitive flexibility
Athletes are encouraged to try their best when given these tests. Parents fill out self-reports of personality and behavioral questionnaires. We provide a brief report to each parent after the assessment is completed. If the athlete gets a concussion down the line, they are eligible for free post-concussion testing that compares their results to their personal baseline.  
Baseline evaluations at sports medicine clinics can cost several thousand dollars, but the Sport Concussion Study has offered them for free to student-athletes of all ages in participating athletic programs. 

Hands-On Training Opens Doors for PAU Students  

Training in the Sport Concussion Study, a research study in the Behavioral Research and Assessment in Neuropsychology (BRAIN) Lab, has given students opportunities to start seeing patients on an accelerated timeline. When we are actively testing young athletes, students can amass training hours while gaining experience in administering and interpreting assessments, as well as writing reports.  
Clinical experience from this in-depth, strategic training can help you determine the trajectory of your career in your first few years at PAU. Clinical and research interests in neuropsychology are broad and can encompass many different industries and environments. 
PAU graduates control their own futures. They decide the best use of the experience and skills they obtain during their time with us at PAU. That knowledge, combined with their passion and drive, will be a constant companion throughout their journey.