As a doctoral student at the University of Michigan’s School of Kinesiology and its Concussion Center, Allyssa Memmini identified a critical need in concussion management.

Through her dissertation work, which was focused on developing a university-specific return-to-learn (RTL) protocol, she uncovered specific gaps for post-concussion management among college-aged students, including performing arts students—a population that faces distinct physical and cognitive challenges similar to those of student athletes, but without the same safety net.

A member of Memmini’s initial research team and a continued contributor to her work, Kristen Schuyten is uniquely placed between the U-M School of Music, Theatre & Dance, where she leads risk-screening and customizes exercise prescriptions, and Michigan Medicine, where she serves as the Performing Arts Rehabilitation Program Coordinator. She is also a member of the U.S. Figure Skating Team’s medical team.

Schuyten brought up the idea to expand Memmini’s prior work to support this underserved demographic within the university setting by establishing a return-to-performance (RTP) protocol.

While collegiate sports have established return-to-sport (RTS) and RTL protocols with enforcing bodies such as the National Collegiate Athletic Association, no comparable guidelines currently exist for university performing arts students recovering from concussions.

This leaves academic teams, who are not required to obtain concussion training for their roles, without clear direction for safely reintegrating performing artists post-injury. Oftentimes, this results in patients self-governing their own recovery and RTL process, which can be dangerous if done prematurely.

This is in contrast to university athletic teams, which are mandated by the NCAA to complete annual concussion training to understand the experience of their student athlete and to ensure their full recovery before returning to competition.

“Personally, my children are in recreational soccer at 8 and 11 years old, and I still sign a form every year talking about concussion, even though at that age they are not even supposed to be heading the ball,” Schuyten said.

“We have these young children who are already receiving that education, yet we have nothing systematically in place for dancers, musical theater or drama students who are doing lifting and partnering work, combat training, maneuvering heavy equipment or performing stunts. There is a disconnect.”

Another such disconnect lies in the student’s ability to rest. For a student athlete, their academic performance is separate from their game. For performing arts students, their education is tied to their ability to perform. Being removed from activity due to injury could mean losing their position in a performance, or experiencing financial distress if a scholarship is tied to their academic standing. This added stressor may contribute to their refraining to report concussion, and continuing to perform through their injury.

“Their ability to participate in their academics is directly tied to their ability to be physically healthy and cognitively healthy,” Schuyten said. “And if you have something that affects multiple body systems, like a concussion, they may not be able to participate in many facets of their education while they are recovering, outside of just physical performance.”

While student athletes have access to athletic trainers and physicians on staff to guide them through their RTS process, currently performing arts students are left without a pathway that considers the combined academic and performance demands of their field.

These students are also exposed to sensory-heavy environments: bright stage lights, loud music, fast movement and high-pressure performances that challenge balance, coordination and focus. After a concussion, these elements can significantly prolong recovery and safe return to performance.

Now a faculty member at the University of New Mexico, Memmini is working to combat the lack of existing research in the cross section of concussion and the performing arts for students; her team found a total of two articles that satisfied their search criteria during their systematic review.

She is leading the charge in collecting vital learnings through her grant-funded Delphi study. The Delphi method is a group communication process used to reach consensus on complex issues through rounds of anonymous opinions and feedback on a topic.

Memmini’s Delphi study is composed of individuals with varying expertise. From faculty, academic counselors and past students who had concussions during their performing arts training, to researchers, clinicians and other key partners, the team aims to establish best practices for a progressive RTP protocol.

“Allyssa was one of the first to identify and address the needs of students and performers to get back to the classroom and studio,” said Steven Broglio, director of the Michigan Concussion Center and collaborator. “It’s been incredible to watch the national and international acceptance and adoption of her protocols.”

Memmini, Schuyten and their team are working closely with other institutions across the state and nationally to achieve their goal of widespread adoption of these protocols and future initiatives across universities, seeking to establish a new industry standard.