When Anthony Kontos, PhD, delivered one of his first lectures on concussions in 2005, the response was blasé. "People said, ‘Concussion isn't really that big of a deal,'" remembers Kontos, now the assistant research director of the University of Pittsburgh Medical Center Sports Medicine Concussion Program.
Fast forward to January of this year, and all 50 states have adopted youth concussion laws establishing guidelines for removing injured athletes from the field and clearing them to return to play. In May, President Obama hosted a summit calling for more research on concussions and announced a new $30 million research project funded by the NCAA and the U.S. Department of Defense to explore the causes and consequences of concussions and a new $16 million partnership between the NFL and the National Institutes of Health to study the chronic effects of repetitive concussions.
And of course, head injuries aren't just limited to athletes: Members of the military are particularly prone to severe head injuries, while the most common activity that sends children and adolescents to the emergency department for a head injury is biking, according to the Centers for Disease Control and Prevention. Even Hillary Clinton, who fainted and hit her head in 2012, is proof that concussions can affect anyone. "A lot of resources are being committed to this injury," Kontos says.
That's just one reason why today, more than ever, "the horizon is bright" for aspiring psychologists interested in studying, assessing and treating head injuries, including concussions, says Gerard Gioia, PhD, chief of the division of pediatric neuropsychology at Children's National Medical Center in Washington, D.C. "The awareness has never been higher."
Where it's hot
More psychologists are needed on the field to help assess injured athletes of all ages and skill levels, particularly in low-income communities, says David Lechuga, PhD, a sport neuropsychologist who directs The Neurobehavioral Clinical and Counseling Center in Lake Forest, California.
"We need to help people understand what a concussion is and support the clinicians in those areas as they make decisions about return to play," Lechuga says. Professionals who can speak Spanish have an extra advantage, he adds.
Also, as Obama's summit made clear, more psychologist researchers are needed. One burgeoning area is neuroscience research, which is critical to better understanding head injuries' effects on the brain and developing clinical tools based on that work. Psychologists with neuroimaging expertise are needed to help other experts translate the results of such tools into understanding of functional outcomes, Gioia says.
Research with animal models is also important for understanding such questions as how repetitive hits affect the brain, how diseases such as chronic traumatic encephalopathy are connected with concussion and how different types of helmets might help protect an athlete from injury. "That's just going to continue to explode over the next few decades," Lechuga says.
Treatment research is yet another new frontier, Gioia says. For example, what types of cognitive and emotional supports best speed recovery from head injuries? How much rest versus active rehabilitation promotes recovery? How might we predict who is more likely to be depressed or anxious as a result of the injury?
"The various issues that involve treatment are very much along the lines of what a psychologist does: The emotional response to injury, the cognitive challenges of a brain injury, the family dynamics that are affected when a member has been changed by this injury — even if it's short term. All those kinds of things become critically important in a patient's recovery," Gioia says.
What to expect
Psychologists who do clinical work treating the psychological effects of concussions may work with athletes of all levels — from professionals down to Little Leaguers — as well as patients with head injuries from combat, car accidents or seizures. Psychologists can follow an unconventional schedule if, for example, they travel with a team or are on call during practices.
"You can't just put [injured athletes] on a six-week wait list" for treatment if sports is their livelihood, says neuropsychologist Donna Broshek, PhD, associate director of the University of Virginia School of Medicine's Brain Injury and Sports Concussion Institute. "You have to be flexible and bend your schedule and respond very quickly."
For psychologists conducting research on head injuries, it's common to recruit youth and other athletes as participants and to work with imaging technology to assess an injury's impact or to create clinical tools to help do so. Kontos, for example, is working on a multidisciplinary project that uses brain-imaging techniques to help predict the clinical trajectories of concussions among U.S. military personnel. It's the type of research he used to think he'd apply when working with athletes but not conduct himself. But, Kontos says, "Once I started doing research that was meaningful and clinically relevant, I found that it was very much a draw to be behind the scenes, driving how things are done in practice and outreach and education through our findings."
Whether you're a psychologist working in a lab, in a clinic, on the sidelines or all three, the work will be interdisciplinary, experts say. One day a week, for instance, Broshek works in a clinic with physicians, physical and occupational therapists, sports medicine specialists and others who triage and treat patients referred there with head injuries. She's also worked regularly with teachers, school administrators and even state policymakers to educate the community and draft regulations and legislation that protect youth athletes.
That multidisciplinary approach reflects the complicated nature of head injuries: No two are alike. "The reality is any single approach to this injury is going to be ineffective," Kontos says. "You need to be comprehensive in assessing the injury, and you need to be interdisciplinary in your approach to developing targeted treatments based on your assessment."
Earnings outlook
The salaries for psychologists who work in concussion research and practice vary widely, since they can come from a variety of backgrounds, work in a variety of settings and treat a variety of patients. The neuropsychologist for an NFL team, for example, will likely earn more than a clinical psychologist who consults with the local youth soccer league. But in general, psychologists' salaries in this area are similar to those in others: anywhere from $60,000 to $150,000 a year, Kontos estimates.
How to get there
Psychologists who study, assess and treat head injuries tend to be trained in clinical neuropsychology. They have done an internship, a fellowship or both in the area to understand the science of how the brain and nervous system operate and affect behavior. Some programs include a rotation in sports neuropsychology or allow further specialization in concussion, as is the case with fellowships at Children's National Medical Center.
But you don't have to be a neuropsychologist to work with athletes and others with head injuries. Clinical and sport psychologists who can help people deal with the injury's effects, such as anxiety and depression, are highly sought after, too, Broshek says.
In addition to formal training, it's critical for psychologists working with head injuries to get experience on the field, in the lab or in the clinic — know-how even undergraduates can gain by volunteering at a local clinic or shadowing a researcher or clinician. Such experience allows students to test whether a career in the field is right for them and to connect with potential mentors. "Every NFL and NHL team has a neuropsychologist [who] works with it," Gioia says. "Find out who those people are and contact them."
Personal experience in sports or in combat is also great training for these careers, says Lechuga, a U.S. Air Force veteran who's been practicing Shotokan karate since 1978. "When you have that appreciation, that really helps you speak to the athlete not just about winning, but about developing so you can be the best human being you can be in and outside of sports," he says.
Pros and cons
While some psychologists might be lured to the field to work with professional athletes, being star-struck on the job is a recipe for mistakes, experts say. "The reality is to take a humble, behind the scenes, anonymous approach," Lechuga says. "You don't have a glamour role; it's a respected role and it needs to be a humble role." After all, Gioia adds, psychologists can't brag about their clients without breaching confidentiality. "The issue of your ethics is particularly challenged when you're in a media spotlight field," he says.
Another challenge of working with athletes can be that the psychologist's opinion isn't always the most valued. Coaches, owners, sport associations and, at the youngest level, parents, can put psychologists' advice below the priorities of the organization as a whole, experts say.
But those challenges are often worth the reward of helping an athlete return to the sport he or she loves, watching a wounded veteran recover cognitive function after a traumatic brain injury or simply knowing that you've helped a child's family understand the risks of playing sports — and the rewards that outweigh them, psychologists say.
"Sports is a great petri dish for kids' character development, leadership skills and of course physical fitness," Gioia says. "Psychology really has a lot to offer in all those areas."