Dr. Katie Scott is a clinical neuropsychologist providing testing and assessment for the Mary A. Rackham Institute at the University of Michigan. After completing her neuropsychology fellowship at Mary Free Bed Rehabilitation Hospital in Grand Rapids, MI, she worked at Spectrum Health before joining U-M in 2019. Dr. Scott has a wide range of clinical experience, including acquired brain injury, mild cognitive impairment, dementia, movement science disorders, developmental disorders, and learning disorders. She has also worked with interdisciplinary teams in sport concussion clinics and inpatient rehab units.
We spoke with Dr. Scott about the role she plays in concussion management, her return-to-learn research, and what excites her about becoming a member of the Michigan Concussion Center.
Michigan Concussion Center: What is a clinical neuropsychologist?
Dr. Katie Scott: Clinical neuropsychologists complete doctoral degrees in counseling or clinical psychology followed by two years of fellowship training in neuropsychology, which provides an extensive background in clinical psychology, brain-behavior relationships, and neurologic disorders like dementia, stroke, and traumatic brain injury. We collect data on the brain’s processes, such as memory, attention, and processing speed, and we integrate that information with what we know about the patient’s background and cognitive, psychological, physical, and behavioral functioning. This helps us to understand how the brain is functioning, how that might relate to different kinds of diagnosis, and how we can make helpful recommendations for future functioning. These recommendations include compensatory strategies and follow-up therapies to address specific symptoms, which can benefit cognitive functioning and therefore overall functioning.
MCC: How did you become interested in working with concussions?
KS: I did a lot of clinical work around concussions during my internship at Denver VA Medical Center. One of the things I enjoyed was working with veterans in mild TBI (concussion) psychoeducational groups. The veterans participating in these groups had histories of combat-related concussions from recent military service as well as from service dating back several decades, and we provided education and resources around concussion and intervention strategies for symptoms. I found this fit well with the things I enjoyed doing clinically: connecting with patients, having empathy for their experiences, and providing education to address their symptoms and concerns. Research has told us that having access to sound, accurate information about concussion is a driving factor in concussion recovery, and I certainly saw that bear out during my experience with those groups.
MCC: What is the role of a clinical neuropsychologist in concussion management?
KS: Given the expertise in psychological functioning and brain-behavior relationships, clinical neuropsychologists can play a variety of roles at different time points following a concussion. For instance, early after a concussion, a neuropsychologist can provide intervention via education and reassurance. As a patient goes through their recovery process, a neuropsychologist can also help to monitor return to normal activity, including return to school, work, and sports, as well as provide recommendations for strategies to manage symptoms during this process. Another very important role is assessing for and treating psychological factors that might add complexity to a patient’s recovery trajectory. Finally, if symptoms after a concussion persist and interfere with normal functioning, a neuropsychologist can complete a comprehensive evaluation to better understand what factors might be driving a patient’s presentation.
MCC: What symptom patterns do you look for?
KS: I think it’s important to keep in mind that, although concussions are largely injuries that people get better from, there can be complexity in recovery based on neurologic and psychological factors. As an example, a person’s daily life often changes after they sustain a concussion. Maybe they’re a collegiate student-athlete who is initially unable to attend classes and participate in practice and games, or maybe they’re a working professional who needs to temporarily reduce their work hours and refrain from hobbies outside of work. Even if these are short-lived, they can result in added stress and potential experience of low mood, which can overlap with other concussion-related symptoms like poor sleep quality and trouble concentrating. Understanding the cascade of symptoms that occur within the context of concussion can help to sort out treatment strategies. For instance, in these examples, psychological support while day-to-day adjustments are happening may go a long way to help manage overall symptoms.
MCC: What areas of concussion work have you done, and what interests do you have moving forward?
KS: My current interest centers around return-to-learn. In my prior role at Spectrum Health, I was the team neuropsychologist for Davenport University. I was involved in helping them develop their return-to-learn protocol when they switched from the National Association of Intercollegiate Athletes to the National Collegiate Athletic Association (NCAA) Division II, which is an important consideration when being affiliated with the NCAA. That opportunity spurred my interest in better understanding and optimizing return-to-learn as well as providing the best and most appropriate accommodations and support for student-athletes as they go back to the classroom. Student-athletes need to get back to the classroom, but they might be impacted by acute symptoms related to their concussion, so it is important to help them return safely. This is true for our collegiate student-athletes as well as our high school and elementary student-athletes.
I’m motivated to continue looking at collegiate athletes as well as high school and elementary athletes. I think it is just as important to have a good understanding of both groups.
MCC: What other research have you done?
KS: While I was at Mary Free Bed, I studied the importance of neuropsychologists in concussion assessment in a clinical setting. I worked with my supervisors, Dr. Jacobus Donders and Dr. Carrie Strong, to look at the added value of having a neuropsychologist in an interdisciplinary concussion clinic. We found that having a neuropsychologist in this role adds important information about patients’ past and current psychological functioning, which can impact the recovery trajectory following a concussion. This can also inform the best treatment strategies. For instance, will the patient benefit from focused psychotherapy to address mood concerns that could complicate their recovery? Or what premorbid factors, such as long-standing anxiety or previously-diagnosed ADHD, might be complicating their recovery, and how should these be addressed in conjunction with their concussion?
MCC: What do you see as the key barrier towards the next-level understanding of concussion or return-to-learn?
KS: We have a good understanding of the return-to-play process for particular sports, but when we talk about return-to-learn, it is more difficult to operationalize what that looks like. What might be cognitively taxing for one person isn’t for another; for instance, what does reading several pages in your textbook look like versus completing college algebra equations? Another important point to consider is what the stakeholders involved, such as the athletes themselves, parents, and teachers, know about the return-to-learn process as this can be a relatively novel concept when discussing recovery. Digging into questions along these lines will help us better understand what we’re dealing with when getting students back into the classroom following a concussion.
Return-to-learn is important because we can’t forget that our student-athletes are students first. A lot of the focus has been on getting them back to athletics and play, which is certainly an important part of their identity, but we also need to support their success as students.
MCC: What excites you about being a member of the Concussion Center?
KS: For me, it’s exciting to be involved with faculty coming from different backgrounds and fields with a similar goal of addressing concussion across the lifespan and the best way to do that. This allows for rich collaboration across disciplines. I think the center’s mission of concussion identification, treatment, and prevention is also important as these aims have the potential to positively impact long-term outcomes.
MCC: Why is now the right time to start the Concussion Center?
KS: We’re at a point now where concussions have received a lot of attention and there’s a lot of information available to clinicians, patients, their families, and communities. Institutions like the Concussion Center can work to not only continue producing quality research, but also identify what available information is sound and consistent with the true standard of concussion care. Bringing excellent researchers and clinicians together to begin collaborating helps identify and provide that standard. We have years of clinical research and ideas about concussion and its management, and now it is time to hone in on that information and provide it to the public and our patients.