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Grad Student’s Concussion Assessment Innovation Adopted University-wide

UVA doctoral candidate Cat Donahue’s innovation to the University’s concussion management protocol is making things easier for student athletes, athletic trainers, and team physicians.

Audrey Breen

While concussions are serious injuries, most athletes diagnosed with a concussion can expect a full recovery and can eventually return to their sport of choice, given they take the time to fully heal. But because each athlete and each concussion is unique, it can be a challenge to know exactly how much time that takes.

One effective practice used to ensure an athlete has recovered fully from a concussion is a baseline concussion assessment, conducted before the start of practices. By comparing the scores of a concussed athlete to their baseline scores, athletic trainers and other healthcare providers can determine the appropriate course of action for rehabilitation and timeline for return to play.

“With a baseline assessment, we use an individualized approach to concussion management ensuring we are not inappropriately speeding up or slowing down an athlete’s return to play following an injury,” said Jake Resch, associate professor of kinesiology and athletic trainer at the UVA School of Education and Human Development.

Since 2015, the University of Virginia athletic training staff and student athletes have been using a comprehensive assessment developed by Resch. The battery of tests, including a health history plus balance, neurocognitive, symptom, and visual tests, when administered together have shown 100 percent sensitivity to identifying a concussion and then help inform return to play decisions.  But it was Cat Donahue, a fourth-year Ph.D. student in kinesiology, who figured out a way to digitize Resch’s assessments. That technological advancement has changed the way UVA student athletes are cared for before and after a concussion. 

Donahue, who earned her master’s degree in athletic training at UVA, returned to the kinesiology program to pursue her Ph.D. in 2019. Joining Resch’s lab, she spent hours of her first year of study building a database by hand-entering assessment data from paper forms.

A female athletic trainer kneels over a football player in an orange jersey and helmet, who is lying on the field, and offers him water.
Cat Donahue attends to an injured UVA football player during her time as a graduate assistant athletic trainer. Photo courtesy of UVA Athletics.

The Impact of Innovation

Donahue, who earned her master’s degree in athletic training at UVA, returned to the kinesiology program to pursue her Ph.D. in 2019. Joining Resch’s lab, she spent hours of her first year of study building a database by hand-entering assessment data from paper forms.

“Everything was stored in a secure location, but it was all on paper,” Donahue said. “Being able to digitize all that allowed us an opportunity to do research more efficiently. Once it was all in a central location, that was the point where I wanted to create a way for future data to be added automatically.”

Donahue spent much of her second year designing digital versions of four assessments that are administered by athletic trainers at the University. In the event of a concussion, athletic trainers scan a QR code to be connected to a sideline assessment that is used minutes after a suspected injury. In the days following the injury, the athlete scans a separate QR code under the supervision of an athletic trainer to complete a quick daily symptom inventory that helps determine when the athlete can return to play.

The sophisticated design moves the athlete through the questionnaires with such efficiency, the time needed to complete the test has been reduced from nearly 20 minutes to about 5-7.

Donahue’s digital assessments were fully adopted by UVA athletics last summer, and her impact extends way beyond efficiency. Her innovation has improved athletic trainers’ ability to connect with student athletes and each other.

When a sideline assessment happens, all the team physicians immediately receive a copy of the report. “Even if a team physician wasn't traveling with that team at the time, they're still aware the injury occurred,” Donahue said. “Because an athlete diagnosed with a concussion requires a multidisciplinary approach for their care, this system allows all the people who work with that athlete to be on the same page, right at the same time.”

Using the digital system, notifications between athletic trainers and their colleagues and student athletes is immediate. If an athlete comes into a training room needing to be evaluated and a different team athletic trainer is there, that athletic trainer can conduct an assessment and immediately notify all the athletic trainers working regularly with that athlete. Similarly, athletic trainers can see in real time how students are responding to their daily symptom checklists to monitor their recovery.

“Dr. Resch and his research team’s assessment already add a depth and breadth to the concussion care for the student athletes at UVA that many schools don’t provide.”

“Dr. Resch and his research team’s assessment already add a depth and breadth to the concussion care for the student athletes at UVA that many schools don’t provide,” said Kelli Pugh, UVA’s associate athletics director for sports medicine. “Digitizing these forms and questionnaires can make this kind of care accessible to many more athletic trainers. Cat’s clinical experience and willingness to make tweaks to the digital forms based on feedback from our staff made it much easier to adopt this change in practice. The timely email notification of the results makes it easier to review changes in student athlete’s symptoms from day to day.”

Donahue’s efforts are not only impacting the care of UVA student athletes, but they have also been a game-changer for current and future doctoral students and researchers. Because the portions of the data that are being used in research are already digitized, the students and researchers are no longer bogged down with having to enter it manually.

“One of the most rewarding aspects of being a doctoral student mentor is the ability to learn from them and vice versa,” Resch said. “Cat’s innovation is a product of her clinical experience as an athletic trainer and her abilities as a researcher.”

For Donahue, she is grateful to have created something that will benefit a place and the people to which she has such a strong connection.

“I've been able to give something back to the staff and to Jake that is, hopefully, going to last,” Donahue said. “It means a lot being able to leave them with something that makes their job easier, as well as allows them to care for the athletes as best they can. I think it's neat to see it come to fruition.”

Impact Beyond Grounds

Because Donahue’s digital tool shaved 13 to 15 minutes off each assessment, it is now possible to conduct a large number of assessments in a relatively short time.

Resch and Donahue are putting the assessment to work in a pilot program offering free baseline assessments to area high school athletes this fall. The program is designed to supplement baseline testing already occurring at area high schools, potentially alleviating part of the immense workload of athletic trainers working with high school athletes.

“Cat’s innovation will allow for a more consistent and streamlined approach to concussion in collegiate and high school athletes alike while also helping to advance what we know about the injury,” Resch said.

In partnership with the nurses and athletic trainers in UVA Orthopedics, Resch and Donahue have started to baseline test up to 20 athletes per hour during after school hours. While this pilot is in partnership with athletic directors and coaches from two small area private schools, Resch aims to open the program to all interested area high school athletes next year.

“The ability to implement Cat’s innovation into the new Musculoskeletal Center is truly exciting,” Resch said. “The physicians and clinicians of UVA Orthopedics, Sports Medicine, Neurology, and Psychiatry and Neurobehavioral Sciences have been tremendously supportive of the development of a multidisciplinary concussion clinic and outreach effort.”

Concussion Research

Learn more about cutting-edge concussion research taking place in Jake Resch's lab.

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Audrey Breen

Research Center or Department

  • Kinesiology