March is Brain Injury Awareness Month: Dr. Rayna Hirst Makes a Difference with PAU’s Sport Concussion Study

March 14, 2022
Rayna Hirst
by Rayna Hirst, PhD, PAU Associate Professor, Director of the PAU Neuropsychology Program 
For several years, graduate students working in my lab, the Behavioral Research and Assessment in Neuropsychology (BRAIN) Lab, have conducted a Sport Concussion Study in which we’ve gathered data to help families and sports organizations assess when it is safe for student-athletes to return to play after a concussion. 
It's important to remember that brain injuries can happen in any sport and this month, Brain Injury Awareness Month, is a great reminder. A 2020 study showed the most common sports for concussions were football, hockey, and soccer, but also occur in other sports. PAU’s Sport Concussion Study provides baseline testing for a full range of organized sports, including football, hockey, and soccer, but also gymnastics, cheerleading, basketball, and rugby. 
Related to recovery time and the ability to safely return to play, another 2020 study suggests that just one concussion can take a high-school athlete up to 30 days to recover from, and even longer for roughly 10 percent of those athletes. 
Additional concerns include the cognitive effects of repeat concussions, risks of chronic traumatic encephalopathy, and discrepancies in personal baseline versus average function. All these concerns keep the topic of return-to-play protocol highly prioritized in the minds of researchers, coaches, and parents.
About the Sport Concussion Study
PAU graduate students in the Sport Concussion Study have played a significant role in advancing effective concussion care and return-to-play protocols at no cost to parents or coaches. At sports medicine clinics, cognitive baseline evaluations can cost thousands of dollars, but the PAU Sport Concussion Study offers evaluations for free. Recruitment into the Sport Concussion Study, however, is currently on pause due to the pandemic, but we plan to resume as soon as possible. 
The Sport Concussion Study benefits two groups: 
  1. Student-Athletes: Giving personalized insights into a student-athlete’s “normal” function to accurately assess when it is safe to return to play after a concussion, as well as reduce further risks associated with subsequent concussions.
  2. PAU Graduate Students: Offering students in our PhD in Clinical Psychology program opportunities to deliver clinical care and contribute to the growing body of research in concussion management and treatment. 
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) 
What are Cognitive Baseline Evaluations? 
Cognitive baseline evaluations are tests that establish a normal baseline for a student-athlete’s main cognitive domains and executive functions. They are conducted before the student-athlete has a concussion so that they can serve as a comparison for after the concussive injury, allowing for a more accurate assessment of when it is safe for the athlete to return to play.  
Cognitive Baseline Evaluations include the testing of:
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
In the Sport Concussion Study, PAU graduate students conduct these cognitive baseline evaluations. Student-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 student-athlete gets a concussion down the line, they are eligible for free post-concussion testing that compares their results to their personal baseline.  
Why are Cognitive Baseline Evaluations Important?
Knowing the cognitive baselines for student-athlete individually is important because each athlete will recover from a concussion at a different rate, meaning the time when it is safe for them to return to play varies. In the Sport Concussion Study, PAU graduate students are establishing cognitive baselines for individual student-athletes who play sports that have an increased risk of concussion.
Standard baselines are tricky in student-athletes because their brains are still maturing, and children’s brains develop at different rates and have varying cognitive abilities. For example, a 2022 study shows that children with ADHD may be up to twice as likely to have a concussion, suggesting that weaknesses in attention or executive functioning may increase concussion risk. Prior concussion history and accident proneness may also be predictors of future concussions. Researchers in the PAU Sport Concussion Study analyze these and other risk factors to better understand which children may be at greater risk for experiencing sport-related concussion. 
Another big challenge with post-concussion testing is that coaches and parents typically don’t know their athletes’ cognitive strengths and weaknesses before the concussive injury. Without personalized data, recovery rates are based upon a comparative standard baseline rather than the athlete’s actual prior function. Going by baseline trends means student-athletes may return to practice or play too early, risking further injury to their already traumatized brains. 
Our program is unique in that it provides data for younger students (aged eight to 16 years old) whereas most programs throughout the country focus on high school and collegiate athletes.
Hands-On Training Opens Doors for PAU Grad Students  
At PAU, first- or second-year neuropsychology students who rotate in our Sport Concussion Study work directly with student-athletes, parents, and nationally recognized neuropsychology faculty, in preparation for their third- and fourth-year practicum.
This study has prepared graduate 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 
As a country, there has been a concerted effort over the past decade for improved brain-injury health and to complete baseline cognitive baseline evaluations for athletes. For example, the US military is now conducting baseline testing before deploying servicemembers to improve treatment should brain injuries occur in the line of duty. I’m proud to say that PAU’s Sport Concussion Study has been part of this nationwide effort, which has led to more employment opportunities for our graduates.  
Training in the Sport Concussion Study has given PAU 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 and research interests in neuropsychology are broad and can encompass many different industries and environments, so it can be challenging to determine a student’s career focus. However, clinical experience from this in-depth, strategic training can help grad students determine the trajectory of their careers in the first few years at PAU. 
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. 
If you are a prospective student and would like to learn more about PAU’s Neuropsychology Program, schedule time with an admissions counselor here.