In this episode of Plugged In to Public Health, Lauren sits down with Dr. Emily Carlson, a postdoctoral researcher at the University of Iowa, to discuss youth concussions, traumatic brain injuries, and the growing field of concussion policy research. Dr. Carlson explains the difference between concussions and more severe traumatic brain injuries, dispels common myths about diagnosis and recovery, and discusses why today’s treatment recommendations look very different than they did in the past. She also shares her research on “Return to Learn” policies, which are designed to help students transition back to the classroom after a concussion.

The views and opinions expressed in this podcast are solely those of the student hosts, guests, and contributors, and do not necessarily reflect the views or opinions of the University of Iowa or the College of Public Health.

Lauren Lavin:

Hello everybody, and welcome back to Plugged Into Public Health. When most people think about concussions, they think about sports, but concussions can happen anywhere, from falls and car crashes to everyday accidents, and they affect an estimated 1.6 million children in the United States each year. Yet despite how common they are, there are still plenty of misconceptions. You don’t need to lose consciousness to have a concussion. Recovery looks very different than it did a decade ago. And for some students, returning to the classroom can be just as challenging as returning to the playing field.

Today we’re joined by Dr. Emily Carlson, a postdoctoral researcher at the University of Iowa, whose work focuses on youth concussions and the policies designed to support students as they recover. In this episode, we discuss what actually happens after a concussion, why return to learn policies matter, what current research tells us about helping students get back to school safely, and where important gaps in implementation still exist.

I’m Lauren Lavin, and if it’s your first time with us, welcome. We’re a student-run podcast that talks about major issues in public health, and how they’re relevant to anyone both in and outside the field of public health. So let’s get plugged into public health. Plugged into Public Health is produced and edited by the students of the University of Iowa College of Public Health. And the views and opinions expressed in this podcast are solely those of the student hosts, guests, and contributors, and they do not necessarily reflect the views or opinions of the University of Iowa or the College of Public Health.

Thank you so much, Dr. Carlson, for being on the podcast today. I’m so glad to have you, and I’m excited to learn about traumatic brain injury, which is weird to say, but excited to learn from you.

Emily Carlson:

I’m excited to be here.

Lauren Lavin:

So for our listeners who may not be familiar, can you describe what traumatic brain injury is, particularly in youth and how common it is? So just give us the background.

Emily Carlson:

Yeah, of course. Yeah. So a traumatic brain injury is defined by CDC and other sources as a disruption to the normal brain function caused by an external force. So that could be a bump, blow, or jolt to the head or body that causes impairments. And so I think an important thing to note is that traumatic brain injuries can range from mild brain injuries like concussions to more moderate or severe brain injuries that include loss of consciousness. And so I can talk a little bit more about that later on.

But what I really focus on in my research is mild traumatic brain injuries, and so concussions. I think it’s also important to note that ,in children specifically and adolescents, some of the most common causes of concussions or mild traumatic brain injuries are falls, sports and recreational activities, which I’ll talk about more later, motor vehicle crashes, and then physical assaults, and then other miscellaneous impacts.

I think it’s also really important to note that not every blow to the head or body can cause a TBI, and a person can get a concussion even without losing consciousness. And so that’s been a really big misconception that has been broken and debunked in the last couple of years. Because a lot of people were told that you had to lose consciousness to sustain a concussion.

And so what we’re seeing, I think it’s hard to categorize mild traumatic brain injury. And so one of my studies that we looked at was in 2024 specifically, we found that the overall 12-month prevalence of self-reported mild traumatic brain injuries among children was about 2.3%, which represents about an estimated 1.6 million children. Yeah. And so among those then, among those 1.6 million, we found that approximately 68% of them went to a health professional. So that could be their family care practitioner or the emergency department or somewhere to get evaluated. And then about 66% of these injuries occurred from sports and recreation, which again, I mentioned is one of the leading causes of mild traumatic brain injuries.

Lauren Lavin:

Okay. So my first question, thank you for the background, so concussion and traumatic brain injury, are those used synonymously or is there a distinction?

Emily Carlson:

Yes. So you can use them synonymously. A concussion is a type of mild traumatic brain injury though. And I think that’s the distinction. So I mentioned that traumatic brain injuries can be mild, moderate, or severe. And so more moderate and severe traumatic brain injuries are just referred to as traumatic brain injury, whereas concussions are specifically mild traumatic brain injuries. And so if you, moving forward in this interview, just want to call them concussions, I’m happy to do that because that’s more specifically where my research focuses on.

Lauren Lavin:

Okay, that’s really helpful. Two more. So how is one diagnosed? You talked about how about 68% of the people reported going to see a provider of some type. So is that to get a diagnosis, or is that because they want to alleviate symptoms that they’re experiencing?

Emily Carlson:

Yes. Yeah. So I think it’s a little bit of both. I think in children specifically, so first of all, I think it’s important to preface, with mild traumatic brain injury, so concussions specifically, we don’t have a diagnostic test for them. So if you go to the doctor and you say, “Hey, I think I have a concussion,” they’re not going to say, “Great, I’m going to go give you a CT scan. I’m going to go get you a test,” whatever. I know some research is being done in this area on getting blood tests done to be able to diagnose a mild traumatic brain injury, but nothing has, to my knowledge, been validated, verified, or approved just yet. But I know some research institutions are doing that.

But anyways, when somebody goes into the doctor, if they say, “I think I have a concussion,” what the physician does or the health professional does is they pretty much just ask what the signs and symptoms are that they’re experiencing. And so some of the common ones are headaches, dizziness, nausea, sensitivity to light and sound, all of these symptoms. And so then based off of those symptoms and what the cause of it is, then a health professional can make a diagnosis.

And so I think another important thing to note with this diagnosis is that a lot of, although physical trainers can identify these signs and symptoms, they can’t diagnose. Oh my gosh, sorry. I’m like, what is that called? An athletic trainer thing. Sorry. I was like, what is that word? An athletic trainer can say, “Here are these signs and symptoms that this child is experiencing. I recommend that you go see a doctor.”

And the doctor then looks at, tracks, I would say, in the ideal situation, the signs and symptoms, and follows the child until symptom progression is done, which typically is within seven to 10 days for a child. So yeah, so anyways, in general, no diagnostic test, but the signs and symptoms are really important, and that’s how we’re currently diagnosing these head injuries.

Lauren Lavin:

And then what does treatment look like if they’re diagnosed? What happens?

Emily Carlson:

Yeah. So that’s a great question. So it used to be actually that, maybe you’ve heard of this, but back in the day, it actually was that children had to sit in a room, a dark room, and not do anything for multiple hours, but they also could not sleep. And there was this superstition that if somebody who had a mild traumatic brain injury fell asleep, they could die because their brain would just start bleeding. And that’s a really big misconception.

Now what we know is that treatment is really… So rest is actually really important. So sleep, getting the brain to recover is the key piece. And so for the first couple of days, it’s recommended that children just rest, relax, try really hard not to use their brain in the sense of going to school or looking at electronic devices or doing things like that.

And then once their symptoms start to get better, I would say, it’s recommended actually that they start doing very mild activity. So walking, just getting up, being a little more active than they were in that first recovery phase. And then after they get signed off by their doctor, then more moderate and heavy activity is recommended. So just giving them time to rest for the first couple of days, and then letting them get back to normal, I would say, is now the recommended treatment from all the professionals that know best.

Lauren Lavin:

Yeah. Okay, that’s fabulous background. So then my question is, what drew you to researching this, and what was the gap that I guess you were hoping to better understand with your research on concussions?

Emily Carlson:

I’ll start with the gap. I think that a lot of research is being done in the concussion space and the head injury space in general, but it’s really focused on athletes. And so throughout my schooling, I’ve always been drawn to this topic, which I’ll tell you more about in a second. But I’ve always wondered there are also kids outside of sports who get concussions and head injuries. Not that we don’t focus on them because I think some people do a really good job of focusing on them, but our main area is on these athletes.

And so I have always wanted to bridge this gap of athletes as well as non-athletes, how are we doing the research in this area? And so what drew me to this topic was I have a younger brother. I grew up in Northern Minnesota watching a lot of hockey my whole life. And I remember that one of my brother’s best friends in the whole entire world, one season he got eight or nine concussions, and didn’t do anything about them. So he would get a concussion and just continue to play sports. And that’s absolutely not what you’re supposed to do.

Lauren Lavin:

I was going to say that can’t be right.

Emily Carlson:

Yeah. No, it’s not. It’s actually not good for you to do that. Like I was just saying, you need to rest and recover. And at the time, we didn’t have any athletic trainers. And I think athletic trainers are a really key piece nowadays to this concussion management piece is because they can help identify that was a really nasty hit. I’m going to get you out. We’re going to do some protocols. And then I’m going to send you to your primary care physician to help you with the recovery phase.

And so anyways, I watched my brother’s friend all these years later. He has really bad chronic symptoms from getting so many head injuries and not treating them correctly. And so he tells me he has a really bad headache still. He can’t remember things. He has sensitivity to light and noise. And this is 12 years later. And so I think that kind of is my motivation behind this is I don’t want other kids to end up like him, which sounds really bad. But I think that we can do a lot to prevent that nowadays. And the more people research this, the more I think we’re getting better at making sure that doesn’t happen. But also it still happens, I think. And so I’m very motivated because of people like him to do this work.

Lauren Lavin:

I always love when people have a personal connection to what they’re researching because I think they’re so much more passionate about it then.

Emily Carlson:

Yeah, very much. Yes. I see my brother’s friend a lot, and my brother too, but he has really motivated in this data that I have been digging through and doing. I’m like, he was one of these people. And so I think that’s what keeps me going to do this.

Lauren Lavin:

So you just mentioned digging through data. So one of the things you were looking at is academic outcomes for students. So at a high level, what did you find?

Emily Carlson:

Yes. So unfortunately we didn’t find what we wanted to find. And I think that’s how research goes sometimes. One of my studies that I looked at was we were really interested in seeing if high school students in states with return to learn laws did better academically than students in states without return to learn laws who had concussions. And so our sample was all of these high school students who reported concussions, and then we separated out states that had these return to learn laws and these states that didn’t have return to learn laws. And I can describe that a little bit more in a second.

Lauren Lavin:

Yeah. Why don’t you explain what return to learn is quick?

Emily Carlson:

Yes. Yeah, I know. I’m like, let me tell you about return to learn. So return to learn pretty much is just, like I was saying, we need this collaboration between athletics, between our healthcare providers, between our school administrators to help the student, better support the student following a concussion. And so pretty much return to learn is this collaboration, these systems in place to help students after concussion pretty much re-acclimate into the classroom.

And so it can include things like academic accommodations, so extra time for assignments, or limited time in the classroom, or time to go take a little rest if they need it. It’s pretty much just what individualized to each student of what do they need. And so I’m really interested in that because Iowa is actually one of eight states to have a return to learn law on their books. And so pretty much it’s just saying our schools need to have plans in place for these concussed students and for them returning to school pretty much.

And I can tell you a little bit more about what I found in that study in a second because that’s a completely different study, which is so funny. But yeah, so anyway, so I was really curious about, in theory, these return to learn plans should be helping students academically following a concussion. Because in theory, there are these policies that help students return to school after their concussion.

And so I was really interested in, oh, if we separate out these states, we’re going to find this big difference. And we actually found no difference, which is very interesting to me. However, this could be due to, not to get so epidemiological on you, it could be due to a lot of different things. So we unfortunately had a pretty small number of states who actually had return to learn laws in our sample. And so we used the Youth Risk Behavior Survey for our concussion and then academic performance outcomes for that data.

And then I went through all 50 states’ laws and determined if they had return to learn language written in them. And so from there, we categorized those states. And so I had a very small number of states that actually had these laws in my sample because we didn’t get to use all 50 states, unfortunately. So that could be a reason why we weren’t seeing this relationship that we thought we would see.

And then also I think a really big piece, and this kind of goes into my other study, was we only classified these laws as if they had them or if they didn’t have them. So it was like, okay, I know in this language they have something written about return to learn, but we didn’t actually look at how in depth that law was written or what specifically was written about that law, et cetera. It was pretty much just a yes or no thing.

And so we don’t actually know how those laws are being implemented in those states. And so that could be playing a role into why we didn’t see this difference. And so some schools might put these policies into practice and into place, and then others might not. And so there’s just a lot of variability that could potentially help describe what we found. But I think it’s a really good lesson and study for future research. So people want to find things, but unfortunately we didn’t find what we wanted to find. And I think it’s a good opportunity to dive in deeper. So that’s what I’ve been doing is I will hopefully have more information for you at some point. But yeah, so that’s a little bit about that. So yes, we didn’t find, unfortunately, that it affects academic outcomes in the states that were in our sample.

Lauren Lavin:

So when you think about the impact of that, and you’re speaking about those results, do you caveat it, and usually say, “But we don’t know if that’s accurately measured. We don’t know if we have all the variables,” like you just said. Or do you think that this signals that maybe return to learn policies aren’t effective and therefore states don’t need to worry about some… How do you extrapolate that into some sort of policy component?

Emily Carlson:

Yeah. So I think the biggest thing, and as I was doing this research, that I keep coming back to, and I had so many conversations with my mentors and my committee about this because I was like, “Why are we not finding any? In theory, these plans should be effective.” And so I really think that the biggest thing that I think is that implementation piece. Because we don’t know how these laws are being implemented. I think if a state says that they have this law in the books, and then they’re not implementing it, that could explain what we’re finding.

And so anyways, that leads perfectly into my next study, which I’ve briefly mentioned. It was one of the eight states that have return to learn in their concussion legislation. And my other study was looking at how Iowa implements return to learn plans within our schools. And so, a little bit to my surprise, we found that nearly three quarters of schools that responded to our survey reported having a return to learn plan.

However, I think what’s important to note is we saw variability in how those plans within those schools were implemented. And so what I mean by that is we found that approximately 63% of these plans were actually written down in these schools. And then about 83% of these plans were applying to all of the students as opposed to just student athletes or non-athlete students. And I think we’re not seeing that 100% of these policies are written down and applying to all students. We’re seeing variability in that.

And so again, I think it’s a great opportunity for more research because we know now like Iowa, most of Iowa schools, but some aren’t implementing these plans. And so digging into why are we not seeing that some of these schools have plans? Also, why are some of these plans so variable? And so yeah, I think that’s a key piece is that implementation piece too of it.

Lauren Lavin:

If you were to design an ideal return to learn, what would that program protocol, I don’t know what the proper word is, what would it look like?

Emily Carlson:

Yeah. So I’ve been asked this a lot recently, and I don’t know if I have a great answer for you unfortunately. Because I think return to learn is just so individualized. And going back to what I was saying earlier, we can talk about, oh, these are the really common signs and symptoms and things that students are experiencing following a concussion, but it’s so different for every student. And some students might be able to just bounce back the next day and do everything okay. Whereas a different student might need two or three weeks of extended deadlines or time to go and step outside the classroom to just regroup.

And so I would say in the ideal world, I don’t know how you would, again, not a legal expert, but I think how would you put something on the books that’s like you need to provide individualized plans for these students? Because I really don’t think that there’s a gold standard. Unfortunately, maybe someday, but unfortunately I don’t think there’s a great gold standard of this is exactly what it should look like.

Lauren Lavin:

That makes sense. So then where do you think that this system breaks down for children? In states with return to learn or states without, what’s not working currently and how do you propose that we fix it?

Emily Carlson:

Yeah. Well, that’s a big question.

Lauren Lavin:

Yeah, that is a big question with no parameters.

Emily Carlson:

Yeah. No, it’s okay. So I think that’s a really great reason and one of the most important reasons for why that particular study that I was talking about in Iowa is so important. Because it’s showing that simply having, and the other study too, but simply having a return to learn law doesn’t necessarily guarantee that these students are getting or receiving that consistent support that they need post-concussion. And so I think the general theme is implementation really matters, and how things are being implemented really matters. And I think, again, that’s just a big area where more work is needed and just collaboration.

So another big finding that came out of my Iowa research was that there was this disconnect between the school and the physician. And one of the biggest barriers that schools said they were having when it came to implementing these return to learn laws and plans in their schools was that there wasn’t communication between the child’s physician and them.

And so they were like, “I don’t really know what we need to be doing because we’re not hearing specific… The physician should be telling us what needs to be done.” And so I think that’s system level thinking about we need to have this collaboration between all of these different people, like I mentioned earlier, between athletics, between the school administrators, between physicians.

And I think that’s just a really big problem that I don’t know how to fully solve yet. I would love to just be like, oh, let me snap my fingers. Everyone collaborates. But I like to think that we’re starting to do better because I think, not only with mild traumatic brain injury, but I think we do a better job with more severe and moderate brain injuries. But I think we’re shifting towards doing better about this communication piece. I don’t think we’re there just yet. I think we’re still very siloed, and we’re trying, but we’re not there just yet, unfortunately.

Lauren Lavin:

Yeah. I always find that, especially from a policy perspective, things get really complicated when they involve a lot of different people, especially if they’re under different systems, even within a school system, if you’re trying to get different people on the same page. But if you’re trying to get schools and athletic organizations and healthcare organizations to all be on the same page, particularly on something that’s so highly individualistic, it sounds, there probably isn’t a one size fits all policy that is really going to work long-term or be well-adopted and well-executed.

Emily Carlson:

No, no. And I completely agree. And I think a lot of the work being done in this concussion policy space, again, like I mentioned earlier, it’s very highly focused on athletics, which makes… you have to start somewhere and that’s a great population to start with. And a lot of the return to learn came into play after we focused on return to play. And that was getting the athlete safely back to athletics. And so that kind of was in this silo of we’re in the athletic world and how are we going to get this kiddo back to playing sports? And then someone said but it’s also really important that the student succeeds academically, and how can we better support them in that space? And so I think that’s where the return to learn law came into play.

But yeah, like you said, it’s just also you’re adding in the child and their parents, and that whole network of people. It’s just a lot of people that need to collaborate. But I think it’s being done some places. I don’t think this is a, oh, it’s never going to happen. I think some places can do it, whereas I just think it’s such a hard thing to do.

Lauren Lavin:

Yeah. Yeah. So it’s learning from the people who are getting it or experimenting in that space right now.

Emily Carlson:

Yeah. And unfortunately, the research is really limited, unfortunately, in this return to learn area. I know a few researchers who have looked at this, but again, it’s very highly focused on athletes. And that’s okay. Again, I’m not trying to bash athletes. But I think our specific law in Iowa is very specific to athletics. And so it says if a student has a concussion from athletics, the school is required to provide them these return to learn plans.

And so one of my committee members actually made a comment, and was like, “What if a student got a TBI from a motor vehicle crash?” And I was like, “That in theory doesn’t apply under the law because it wasn’t due to athletics.” And so I think that’s another piece is these laws are very highly written and focused on athletes. And again, that’s okay, but I think we can expand that to not only include concussions in relation to or caused by athletics and sports.

Lauren Lavin:

Yeah. You have to meet people where they’re at and then go from, once attention is brought there, you can expand it out.

Emily Carlson:

Yeah, exactly. Exactly. Yes. And again, I have not been in it that long, but this realm of concussions and mild TBI, I think we’ve really over the last five to 10 years have really expanded. I think it used to be a, “Oh, you just got your bell rung, you’re okay.” And now we’re seeing CTE as a thing and all of these kind of adverse health outcomes that come along with that. And so I think more people are diving into this area, which is great. Because as I’ve mentioned so many times, we need more research.

Lauren Lavin:

Always.

Emily Carlson:

Yes.

Lauren Lavin:

Okay. So my final question to you is what is one thing you wish more people understood about youth TBI and concussions and its impact on learning?

Emily Carlson:

Yeah. I think not related to learning specifically, but I think what’s really important for people to understand is that concussions are a brain injury. Because what I’ve heard from a lot of people is like, “Oh, it’s really mild. Oh, it’s fine.” Back to that whole, oh, they just got their bell rung. It’s so much more than that. It’s your brain. It’s impacting your brain, and we only have one brain. So I personally think we need to take care of it.

Also, I think, I keep reiterating, but it takes a lot of collaboration and a lot of kind of people involved to help a child following a concussion. And again, I say this in the fact of not every single kid, and I would say probably a percent of kids are okay after a concussion, and they can just go and be normal and go live their normal lives. But that 20%, they might need extra help, and that’s okay. And so I think we just need to, I think we’re doing an okay job, but I think we can do better supporting them. And yeah, I think this is a really important topic obviously. But yeah, I just think that people need to understand that it’s your brain and we got to protect our brain.

Lauren Lavin:

The brain’s important.

Emily Carlson:

Yes, exactly.

Lauren Lavin:

Thank you so much for taking time out of your day to chat with me. I feel like I learned a lot about concussions, and I hope our listeners did as well.

Emily Carlson:

I hope so too.

Lauren Lavin:

Perfect. Thank you so much.

Emily Carlson:

You’re welcome.

Lauren Lavin:

A big thank you to Dr. Emily Carlson for joining us and sharing her research. One of my biggest takeaways from this conversation is that a concussion isn’t just a bump on the head, it’s a brain injury. And while most children recover fully, recovery isn’t one size fits all. And supporting students often requires coordination between healthcare providers, schools, families, and athletic staff. As Dr. Carlson’s research shows, having policies in place is only part of the equation. Making sure those policies are implemented consistently may be just as important.

This episode is hosted and written by Lauren Lavin and edited and produced by Lauren Lavin. You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast’s available on Spotify, Apple Podcasts, and SoundCloud. If you enjoyed this episode and would like to support the podcast, please share it with your colleagues, friends, family members, coaches, teachers, or anyone interested in public health.

Have a suggestion for our team, you can reach us at cph-gradambassador@uiowa.edu. This episode is brought to you by the University of Iowa College of Public Health. Until next week, stay healthy, stay curious, and take care.