Research In Action

Within the Minds Matter Concussion Program at Children’s Hospital of Philadelphia, we have extended our work in pediatric concussion and directed our efforts to increase our understanding of repetitive head impacts that occur during sport, and ways to more accurately measure when and how they occur. We share a common goal with colleagues across the globe who seek to understand more about the scope and significance of repetitive head impacts and the potential impacts on short and long-term health outcomes.

From clinicians to researchers, from caregivers to school officials, and even among young people themselves – there are gaps in knowledge related to the influence of repetitive head impacts on brain health, and even how best to define these impacts. This can lead to misinformation and general confusion about how to assess the risk on the young brain in context of the benefits of participation in activities such as contact sports that involve exposure to head impacts.

In April 2025, we served as members of the planning committee for a virtual workshop hosted by the National Academies of Sciences, Engineering, and Medicine Forum on Traumatic Brain Injury. This two-day workshop brought together experts from across the country to discuss these information gaps and related challenges, to develop evidence-based recommendations regarding the risks of repeated head impacts (RHI) for children. Newly published proceedings from that workshop give a detailed and expansive look at these discussions about RHI and reinforce why there is a need for more research and collaboration.

Along with Laura Keyes, social worker with the Minds Matter program, we presented in multiple workshop sessions. We highlight some key concepts from the rich discussions below:

Defining Repeated Head Impacts

To guide the content of the virtual workshop, we presented the following proposed definition of RHI as: repeated head acceleration events that occur in the absence of diagnosed injury. The marketplace is filled with various wearable sensors that offer opportunities to quantify these events. Other approaches involve more manual approaches including an observer counting head impacts, in real time or via video. Accurate measurement practices (using a validated sensor, confirming that sensors are functioning properly, validating RHI through video or machine learning algorithms, etc.) have helped reduce some of the variability and inaccuracy in prior efforts to quantify RHI.

However, there is a need for greater standardization and transparency among RHI-related studies to allow for more meaningful comparisons that can ultimately close gaps in information.

Recognizing the Different Factors That May Influence Health Outcomes

One of the areas of focus for the workshop included the various biological and social factors that play a role in health outcomes after a head impact. From age and sex, to care access and educational opportunities, many factors need to be considered when discussing the overall impacts of RHI on youth, rather than simply focusing on the exposure itself. Significant information gaps exist when it comes to the impact of social determinants of health (SDoH), the conditions in which people are born, grow, live, work, and age, on the environment in which RHI occur and how they are monitored.

Engaging Communities, Families, and Policymakers

Collaboration is key in the efforts to better understand how RHI affects youth, with the goal of developing policies and practices to reduce exposure. We have previously introduced the concept of concussion-aware communities where those responsible for the health of youth can make informed decisions regarding injury prevention strategies and management of concussion in the form of return to play and return to learn. The workshop discussed extending that concept to “RHI-aware” communities. Widespread education – even changes by policymakers at various levels – can lead to more awareness and trustworthy information when young people and their caregivers need it most.

There are challenges, however, in creating these communities. First, the science to guide best practices is still unfolding. Second, unwillingness to change rules of the game for sports that are beloved, variability in values among families and caregivers, and access to equal resources all weigh heavily on efforts to achieve a unified view of the risks of RHI for youth.

For more on these conversations, read the workshop overview or the full proceedings.