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Member Spotlight: Lily Tiefel and Adaptive Sports

Lily Tiefel, a current University of Michigan Master’s student at the School of Public Health, has significantly advanced our understanding of concussion among adaptive sports athletes. Through her summer internship with the U-M Injury Prevention Center, Lily collaborated with faculty and staff from the U-M Concussion Center to create the first college-level concussion baseline testing using C3 Logix, a cloud-based concussion management system used by clinicians nationwide, for the University of Michigan Adaptive Sports and Fitness Program. She worked alongside Concussion Center Associate Director of Research Dr. James Eckner and Dr. Melissa Tinney, an executive board member of the University of Michigan Adaptive and Inclusive Sports Experience and clinical assistant professor with the Department of Physical Medicine & Rehabilitation, Michigan Medicine. 

Lily Tiefel at the Celebrating Equity: Health Behavior & Health Equity Symposium, hosted by the U-M School of Public Health.

Lily’s research, titled “Pioneering Concussion Baseline Testing in Collegiate Adaptive Athletes: Addressing Gaps and Challenges,” was showcased at the Celebrating Equity: Health Behavior & Health Equity Symposium hosted by the U-M School of Public Health. Lily presented her findings at a poster session, engaging attendees in discussions about her discoveries. She clarified that this summer was dedicated not to conducting new research but to developing and implementing adaptive sports and fitness concussion programs. During this time, Lily and her team collected baseline concussion testing data for every adaptive athlete before the start of their training and fall seasons. The primary focus was to launch the program and establish protocols for these baseline assessments.

Lily acknowledged that before beginning this project, the team understood that adaptive athletes often perceive injuries differently than others, and that the variations of these perceptions can vary depending on the disability. She identified several key findings from her work. Notably, some tests proved to be challenging for the athletes in unintended ways and did not appear to be testing what they were intended to test.  For example, athletes with impaired upper extremity motor control had a difficult time performing Trails tests and had low scores that did not reflect their executive function, which is what the test is intended to evaluate. Another major insight Lily emphasized was the need for research to develop more balanced tests tailored to disabled athletes. Their findings revealed that while some concussion tests were designed for adaptive athletes, they were not adaptable for all types of disabilities. Lily questioned, “When we think about specific disabilities such as visual impairments, and we have a visual acuity test, how can we rethink tests to make everything more equitable?”

Despite the limited time frame of the summer, Lily recognized there was much more to explore. Throughout the summer, she took detailed notes and observations based on themes, dates, and issues that arose during testing. However, the team was only able to gather feedback from one athlete, leaving Lily eager to learn more about the experiences and feedback from other athletes regarding the testing process.

The coaching and mentorship offered by Drs Tinney and Eckner have been transformative in Lily’s summer internship experience. She successfully merged her interests with her mentors to develop this project, which they also found engaging.  Dr. Eckner commented, “Lily was great to work with this summer.  She was a perfect fit for this project, falling at the intersection of concussion and adaptive sports, and she played a critical role in getting this baseline concussion testing program started for our adaptive athletes here at UM.  I’m excited to see where she will take her career from here.” 

Lily’s commitment to this research is also very personal, as she lives with lifelong traumatic brain injury (TBI). Lily mentioned that she has learned to be at peace with her identity. Her experiences have fueled her passion for concussion research and adaptive sports. Prior to her time at the University of Michigan, Lily interned at Michigan State University’s adaptive sports program and now coaches wheelchair adaptive sports there. Since being an undergraduate student, adaptive sports has challenged her to look at health and equity in a different light, and it’s really inspired her to pursue the field of health equity through something she loves, which is sports. 

Reflecting on her academic journey, Lily expressed concern over lacking disability studies courses within top-tier public health programs, underscoring the importance of inclusivity and accessibility in educational and research settings. Lily noted that it makes her think about her trajectory in this field: “If I am going to design or continue research in public health, I need to make it as accessible as possible to all people with disabilities.”

As adaptive sports gain recognition and become more accessible, Lily is enthusiastic about expanding and enhancing these programs. She noted recent developments in Ann Arbor, where local parks and recreation programs have become more accessible thanks to new grants, benefiting the University of Michigan’s adaptive sports programs and the broader community. 

“If I am going to design or continue research in public health, I need to make it as accessible as possible to all people with disabilities.”

– Lily Tiefel

Lily has done amazing research and we are excited to see where her future takes her. Currently one of her greatest aspirations is to find a job or research that she is as passionate about as she was with this past project and make a career out of it. Lily has many interests and many passions in the field of public health and disabilities. She plans to follow that great passion and continue her work towards a more equitable future.

The University of Michigan Concussion Center invites nominations and applications for one open rank (assistant, associate, full professor) tenure-track faculty position to work at one of the world’s preeminent research institutions. As one of the highest-ranked public universities in the nation, the Concussion Center is an international leader in research, clinical care, and education. 

We are seeking a passionate concussion researcher to help the center by developing and sharing groundbreaking ideas that translate laboratory, clinic, and community observations into knowledge products that reduce concussion risk and improve outcomes in those affected by the injury.  The Concussion Center integrates our research, clinical, outreach & engagement cores to create novel solutions that advance concussion knowledge and protocols.  All research domains related to concussion will be considered, including candidates focusing on social and cultural health disparities in concussion prevention, identification, and management.

As the hub of concussion-related activity for the U-M community, the Concussion Center is proud to be located in a renovated facility in the heart of the Ann Arbor campus, with immediate access to clinical research and wet lab space.

U-M School of Kinesiology Building, where the Concussion Center is housed.
U-M School of Kinesiology Building, where the Concussion Center is housed.

Founded in 1817, the University of Michigan has a long and distinguished history as one of the first public universities in the nation. It is one of only two public institutions consistently ranked among the nation’s top ten universities.  With more than $1.7 billion in annual research expenditures, U-M has the second largest research expenditure among all universities in the nation, in addition to an annual general fund budget of $2.8 billion and an endowment valued at more than $17 billion. Adjacent to the central campus, Michigan Medicine, with its hospitals, clinics, and satellite offices, along with the Medical School, and School of Nursing, comprise one of the finest health systems in the country.  The university’s prominent athletic programs and outstanding teaching and research programs in medicine, engineering, and other related disciplines provide ideal collaborative opportunities for center faculty.

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The Department of Defense (DoD) has awarded $731,980 for a three-year research project entitled “A Data-Driven Approach to Individualized Concussion Risk Prediction in US Service Academy Cadets and Midshipmen.” This project is led by University of Michigan (U-M) Concussion Center members Dr. James Eckner and Dr. Mariel Lavieri, whose home departments are Physical Medicine and Rehabilitation (PM&R) at Michigan Medicine and Industrial & Operations Engineering (IOE) at Michigan Engineering. The success of this multidisciplinary grant application was supported by Mr. Hossam Abouzahr from U-M’s E-Health & Artificial Intelligence (e-HAIL), whose mission is to make U-M a premier hub for AI and health and improve health outcomes through technology.

Through collaborative efforts, the research team will develop predictive tools to identify cadets and midshipmen from US Service Academies at the highest risk for sustaining concussions based on baseline information. The project’s major goals include optimizing risk prediction models using pre-season baseline data and comparing the models’ predictive abilities across different years. This initiative is crucial for military cadets and midshipmen, who are at significant risk of mild traumatic brain injury (mTBI) or concussion. 

“Concussion is a common occurrence among our military personnel, and the findings from this research project will have implications for the population at large. As healthcare providers who routinely treat patients with concussion and brain injuries, the department of PM&R is excited about this project, and Drs. Eckner and Lavieri’s success,” said Dr. Nitin Jian, Chair, Department of PM&R, Michigan Medicine.

Concussions account for over 80% of traumatic brain injuries (TBIs) in military personnel, highlighting the critical need for effective identification, prevention, and management strategies. These injuries, often sustained during non-combat activities, post significant short and long-term health risks, impacting cognitive and physical function and potentially leading to chronic conditions in service members and veterans.  

Leveraging the existing NCAA-DoD CARE Consortium database, which includes baseline assessments in over 17,600 Service Academy cadets and midshipmen across 4 U.S. Service Academies, Dr. Eckner and Dr. Lavieri’s research promises to advance the understanding of concussion risks and improve preventative strategies, ultimately benefiting both military and civilian populations engaged in high-risk activities like athletics. “We are excited to harness the richness of the NCAA-DoD CARE Consortium database in parameterizing, calibrating, and validating our models. This will enable us, as a multidisciplinary team, to tackle this important problem faced by our military personnel,” said Dr. Lavieri, Associate Professor of Industrial and Operations Engineering.

“Concussion is a common occurrence among our military personnel, and the findings from this research project will have implications for the population at large. As healthcare providers who routinely treat patients with concussion and brain injuries, the department of PM&R is excited about this project, and Drs. Eckner and Lavieri’s success”.

– Dr. Nitin Jian, Chair, Department of PM&R, Michigan Medicine.

The award secures the necessary funding to push forward this vital research and bring about meaningful improvement in concussion prevention and management. 

“This research is important because the ability to prospectively identify individuals at elevated risk for concussion will allow opportunities for more targeted concussion prevention, education, and surveillance efforts in those at greatest risk. In addition to this project focusing on cadets and midshipmen from the US Service Academies, we are also interested in expanding to conduct a similar study in civilian athletes as well,” said Dr. James Eckner, Associate Professor from the Department of Physical Medicine & Rehabilitation. 

The U-M Concussion Center is pleased to announce its inaugural call for the Zatkoff Graduate Student Fellowship for Concussion Research. Doctoral students are a cornerstone of academia, significantly enriching the research and educational landscape, and are at the beginning of becoming tomorrow’s leaders. These students emerge as content experts with skill sets, such as critical thinking and communication, that are valuable within and beyond academia. Their contributions ensure the continued vitality and innovation of the scholarly community and can lead to broader societal benefits through research and practical applications.

To increase students’ opportunities to attend the University of Michigan, the Michigan Concussion Center has created the Zatkoff Graduate Student Fellowship for Concussion Research. This fellowship provides full tuition (in or out-of-state), a stipend (12 months at 50% effort), and health care costs. One position will be available starting in Fall 2025.

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The Concussion Center, supported by an award from the University of Michigan’s Center for Academic Innovation (CAI), is collaborating with the XR Initiative to pioneer training modules utilizing virtual reality (VR) headsets for comprehensive concussion education. Established in 2019, the XR Initiative strives to enrich the U-M community’s learning experiences through immersive technology. 

Unlike many injuries, concussions are often not immediately visible to medical providers unless self-reported by patients. On the other hand, patients may not be able to correctly recognize symptoms or are motivated to not disclose their injury. In any of these scenarios, the injured athlete receives delay or no medical treatment resulting in suboptimal outcomes. In response, the XR-supported concussion modules developed by the team could empower future healthcare providers to understand the impact of concussions across diverse scenarios, facilitating low-stake evaluation and learning. 

“Our mission is to enhance education through Extended Reality technologies”, stated Jeremy Nelson, Senior Director for XR, Media Design and Production at the Center for Academic Innovation.

Concussion, as an educational subject, poses a distinctive challenge and opportunity. While we can’t replicate the experience of a concussion, leveraging VR technology allows us to create scalable training modules, offering a pathway to improved comprehension and addressing this critical health concern both in the classroom and beyond.

Jeremy Nelson, Senior Director for XR, Media Design and Production

While ongoing module development continues, six students from the School of Kinesiology’s AT613 Special Topics in Sports Medicine course experienced an in-classroom prototype demonstration in CAI’s newly renovated event space, providing a glimpse into the innovative future of concussion education. All participants reported a sense of complete immersion in the VR experience, and a majority confirmed that this innovative educational tool has enhanced the enjoyment of their learning. Most notably, they reported a significant boost in their confidence levels when applying the acquired knowledge and skills in concussion diagnosis. 

“My overall perception of the VR experience was very positive. To have the ability to practice something in a simulation allows the student to learn in a new space. I think that VR will soon become an everyday tool to learn”, said Cameron Wilde, an undergraduate student at U-M.

Melissa McCurry, a Learning Experience Designer at the Center for Academic Innovation, shared her enthusiasm for this innovative project. “This is an exciting project and a great use of the technology, showcasing the vast potential of virtual reality (VR) in educational contexts. Through this VR experience, learners can practice in a safe, low-stakes virtual environment. Some of the students who have tested the prototype shared that the experience has the potential to boost both motivation to practice and confidence, leading them to feel more prepared for real-world application.”

The classroom was joined by Dr. David Millward, U-M Athletics Medical Director/ Head Team Physician, and Dr. JT Eckner, Associate Director of Research for the Concussion Center. Both clinicians provided invaluable feedback for the team as they continued to refine the prototype with a broader vision to enhance pre-season injury education throughout the U-M community. “When I gave instructions, it wasn’t clear the patient heard me correctly”, said Millward. “I look forward to the patient’s understanding being clearer as the XR environment improves”.

The collaboration between the Concussion Center and CAI’s XR Initiative is paving the way for a transformative era in education, where virtual reality becomes a powerful tool for comprehensively addressing and understanding concussions. Beyond enriching classroom experiences, this innovative approach carries the potential to revolutionize the Concussion Center’s outreach and community engagement strategies, offering a forward-thinking alternative for tomorrow’s learners.

Dr. Abigail Bretzin and Ms. Michaela Broadnax represented the U-M Concussion Center at the Detroit Public School Community District’s (DPSCD) Athletic Symposium in [month]. This event saw the participation of approximately 180 coaches from the district, who gathered to deepen their understanding of best practices and techniques to ensure the safety and well-being of student-athletes. “The symposium was a great opportunity to meet with the leaders of DPSCD, and interact with the coaches and athletic coordinators of each school,” said Dr. Bretzin, “the structure of the overall symposium went very well and allowed each participant to contribute to the discussion regarding concussion recognition and management.”

The Concussion Center’s growing partnership with DPSCD started in the Spring of 2020 where a joint grant application on concussion was submitted. A comprehensive Concussion Toolkit was later launched in the spring of 2022, designed to assist the district’s coaches, students, parents and administrators with concussion management by providing educational materials and resources tailored to the district’s requirements.

The concussion-related information disseminated during this year’s Athletic Symposium relayed the most relevant information to coaches who often play a pivotal role in identifying early signs and symptoms of concussions.  The primary objective for the symposium was to foster a dialogue, emphasizing the intricacies of concussions – the physiological changes they trigger in the brain and the inherent risks of overlooking or trivializing the injury. “The coaches were great at keeping the conversation going,” Broadnax shared, “I was able to learn from their day-to-day experiences with their student-athletes and how they combat head injuries during practices and games. They are an amazing group of people, and our team looks forward to future opportunities to engage with DPSCD coaches, athletes, and administrators.”

“I  am so thankful to the University of Michigan Concussion Center for their continued partnership with DPSCD athletics. With their help, our coaches and staff are better equipped to help our student-athletes if they experience a concussion from start to finish.  In addition, they have given us a roadmap to better recognize, understand, care, provide, and how to get follow-up care regarding concussions”

Jay Alexander, Executive Director of DPSCD Office of Athletics

Over 120 coaches were in attendance at the Detroit Public Schools Community District-wide athletic coaches and administrator’s symposium.  “It was a great opportunity to have Michigan Concussion Center teaching classroom sessions.  Our coaches raved about what they learned and how to provide care for our student-athletes”, said Alexander.

Ongoing education and open dialogue are important in ensuring the safety of our young athletes. The partnership between the U-M Concussion Center and DPSCD not only signifies a step forward in concussion awareness but also underscores the collective commitment of educators, coaches, and healthcare professionals to the well-being of student-athletes. As we continue to arm those on the front line with the knowledge and resources needed, we remain hopeful for a future where student-athletes can pursue their passions with minimized risks and maximized support. 

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A landmark development in concussion management, the most recent iteration of the Sport Concussion Assessment Tool, known as SCAT6, has been published in the British Journal of Sports Medicine. The SCAT6 is a thoroughly researched, standardized, and evidence-based tool used in the assessment and management of concussions in athletes. A team of international experts in the field of sports medicine, including the Concussion Center Director Dr. Steven Broglio, meticulously selected the components of the SCAT6 based on a review of the medical literature that included more than 420 published papers.

“It was an honor to contribute to the Concussion in Sport Group (CISG) that developed the SCAT6. The team’s focus was crystal clear –  ‘What are the best tools available to protect the health and well-being of active individuals?”

Steve Broglio, PhD, Director, U-M Concussion Center

Reflecting on his involvement, Dr. Broglio noted, “It was an honor to contribute to the Concussion in Sport Group (CISG) that developed the SCAT6. The team’s focus was crystal clear –  ‘What are the best tools available to protect the health and well-being of active individuals?’” The importance of timely identification and management of concussions for athletes’ safety and welfare cannot be overstated, and the SCAT is a widely acknowledged tool utilized by healthcare professionals to evaluate and monitor athletes who may have suffered a concussion. The SCAT6 is best used within the first 72 hours of a suspected injury and provides a structured approach to assessing concussions by evaluating a range of features commonly associated with concussion.

The U-M Concussion Center recently hosted Dr. Ruben Echemendia, lead author of the SCAT6, Director of the National Hockey League’s Neuropsychological Testing Program, and Co-Chair of the NHL/NHLPA Concussion Subcommittee, to discuss the process and method supporting the design of the new SCAT6 tool. In Dr. Echemendia’s presentation, he noted: “We (CISG) wanted a very structured format that had transparency, with a clinically applicable outcome. It’s a true approach towards translational knowledge and getting the information out there.”

The SCAT6 consists of several components, including a screening for injuries more severe than a concussion, a symptom evaluation, a cognitive assessment, and a coordination and balance examination. One of the significant benefits of SCAT6 is its standardized approach to concussion assessment. It enhances the accuracy and reliability of concussion evaluations, leading to more informed decision-making regarding an athlete’s health status. Moreover, the SCAT6 facilitates communication among healthcare professionals, coaches, and athletes.

“We wanted a very structured format that had transparency, with a clinically applicable outcome. It’s a true approach towards translational knowledge and getting the information out there.”

Ruben Echemendia, PhD, Lead Author of SCAT6

By adopting a common language and assessment tools, different stakeholders involved in an athlete’s care can effectively exchange information and collaborate on appropriate management strategies. This interdisciplinary approach helps ensure the athlete’s well-being and minimizes the risk of further injury.

While the SCAT6 is one part of the comprehensive evaluation process for concussions, it should be used in conjunction with a thorough medical evaluation performed by a healthcare professional. The launch of SCAT6 is a testament to the collaborative efforts of the international community ensuring athlete safety, providing that strides are being made towards better understanding and management of concussion in sports. 

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We are thrilled to share an important milestone in sports medicine – the latest release of the international Concussion in Sport Group (CISG) consensus statement on the management of sports concussions, hot off the press from the British Journal of Sports Medicine as of June 15, 2023.

The statements are published once every four years and lay the foundation for concussion management worldwide. This 2023 release marks the sixth statement the group has published since 2001. Each release represents our advanced understanding and management of sport-related concussions, safeguarding the health and safety of athletes worldwide. 

The CISG document distills the current scientific knowledge, research findings, clinical experience, and consensus among professionals working across a variety of settings. It provides a platform for ongoing dialogue and research. Concussion Center Director, Dr. Steven Broglio, had the privilege of co-authoring this statement. He observed, “It has been great to see the continual evolution of guidelines as our understanding of concussion grows. This consensus statement is the culmination of ten systematic reviews that screened over 78,000 citations and completed nearly 1500 full-text reviews. To be one of the 28 researchers and medical providers convening, deliberating, and ultimately deciding on the best recommendations to put forward was an honor.” Concussion Center members contributed to three of the ten systematic reviews.

Dr. Steve Broglio at the 6th International Consensus Conference on Concussion in Sport, October 2022

This statement serves as a pivotal document, providing guidelines and recommendations for the recognition, assessment, and management of concussions in sports. With a focus on evidence-based practices and a multidisciplinary approach to medical care, the CISG has successfully sketched a blueprint for a more harmonized understanding and consistent protocols across the sporting community. At the heart of this consensus statement lies a commitment to the safety and well-being of athletes. It provides clear guidelines on the removal and evaluation of athletes suspected of having a concussion, as well as structured and gradual return-to-learn and return-to-play protocols.

“To be one of the 28 researchers and medical providers convening, deliberating, and ultimately deciding on the best recommendations to put forward was an honor.”

Steve Broglio, PhD, U-M Concussion Center Director

The document serves as a valuable resource for healthcare professionals to access the best available evidence-based practices in the field of concussion management. It provides guidelines ensuring athletes are allowed the necessary time to recover fully, minimizing the risk of repeated injury. By bringing together different perspectives and expertise, the consensus statement contributes to the advancement of knowledge, identification of gaps, and the development of future research initiatives aimed at protecting the health and well-being of athletes across various disciplines.

Interested in hearing more from the co-authors of the CISG Consensus Statement:

The Concussion Center is proud to support Dr. Andy Hashikawa’s Pop-up Safety Town initiative, providing age-focused injury prevention resources to Michigan’s underserved communities.

Introduction to Pop-up Safety Town

Pop-Up Safety Town, a unique program dedicated to pediatric injury prevention education supported by AAA and the Auto Club Group Foundation, caters to young children and their families. In the 2022-2023 school year, Dr. Hashikawa led a multitude of successful events across the state. Locations included the Marygrove Conservancy in the Detroit Public School Community District, Cummings Head Start Center in Flint, Genesee Intermediate School District (GISD), Jackson, Ypsilanti, Addison, and Whitmore Lake. Our shared mission saw us fit over 600 helmets, a step towards our goal of extending our reach to more underserved communities. 

Dr. Hashikawa’s dedication to this cause is evident. He is already actively liaising with other districts, with a special focus on rural and tribal communities in dire need of these resources. In addition, we are working with student organizations, such as Medical Arabic at the University of Michigan, in organizing more events in Hamtramck, a region rich with a multicultural population with immigrant backgrounds. 

As we look to the future, Dr. Hashikawa aspires to broaden our approach to include children aged five and older, an idea informed by valuable feedback from administrators and families alike. To connect with Head Start centers and schools beyond our driving radius, including reaching the Native American Tribal Head Start programs in Michigan,  a “Safety Curriculum in a Box” program will be launched next year. This innovative concept involves creating four comprehensive lesson plans for teachers, complete with a dedicated website for orientation, handouts for parents, and a box filled with props to enrich each lesson. A series of educational videos have been developed covering crucial topics like helmet safety, pedestrian safety, medication safety, and dog bite prevention. Additional demonstration videos are planned for the coming year to enhance the core curriculum.

“This comprehensive approach sets us apart from other organizations in the field, making the U-M Concussion Center a leader in not only understanding concussions but also actively working towards preventing them.”

Andrew Hashikawa, MD, Clinical Professor, Emergency Medicine

As we reflect on the accomplishments in the past year, we remain cognizant that our mission to maximize societal impact is far from over. With every helmet fitted, every lesson given, and every community reached, we’ve seen the transformative power of early education in the sphere of injury prevention. “To ensure children have access, we offer free helmets and educate families on proper helmet-fitting techniques,” said Dr. Hashikawa, “By reaching out to preschool children and elementary students, our aim is to instill good safety habits from an early age, empowering families with knowledge that can help prevent head injuries. This comprehensive approach sets us apart from other organizations in the field, making the U-M Concussion Center a leader in not only understanding concussions but also actively working towards preventing them.”