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  • Repetitive head impacts (RHIs) are multiple sub-concussive forces that may result from either a direct or indirect impact to the head or body over a period of time that result with no presence of symptoms immediately following the mechanism.
  • Football players are at an increased risk of repeated head injuries.
  • Athletes who have experienced RHIs are hypothesized to have increased negative effects on their academic tolerance, mental health, and cognition compared to their peers.


  • The purpose of this study is to compare the cognition, mental health, and academic tolerance of Division II football players during a non-competitive (2020) and competitive (2021) season.



  • 30 Division II football players from Concordia University, St. Paul with a mean age of 20.5 +/- 1.22 years and a range of 19 - 23.

Tests and Measures:

  • Paced Auditory Serial Addition Test (PASAT) for working memory
  • Center for Epidemiological Studies Depression Scale (CES-D)
  • Demographic survey
  • Personal interview

Data Analysis:

  • Qualitative interviews were recorded, transcribed and de-identified then coded and analyzed on NVIVO-12
  • PASAT and CES-D data were both analyzed on SPSS-28, using a Wilcoxon Signed Rank Test

Major Themes

  • Effortful Mental Activity: Cognitive exertion associated with prolonged academic demand.
  • Attention: The ability to sustain focus on a given task.
  • Sensitivity to Stimuli: Increased responsiveness or vulnerability to sensory input.
  • Headaches: A painful sensation localized to the head region.
  • Slow Processing: Increased time required to interpret, process, and respond to information or stimuli.
  • Fatigue: Physical or mental exhaustion due to internal or external sources.
  • Memory: The ability to recall past events or facts learned previously.
  • Sleep Difficulty: Inconsistent or frequently interrupted sleeping habits.


  • While group cognition scores increased between years, some participants consistently scored below the age and education-based normative mean score.
  • Players continue to complain of cognitive changes and worsening depressive symptoms that are consistent with what is expected from an individual suffering from a concussion though players were not actively concussed at the time of measurement.

Clinical Relevance

  • There is a potential for cognition to heal or improve as evidenced by the improvement in group cognitive scores, but the long-term effects are still largely unknown.
  • There may be a neuroprotective effect of exercise, as well as a high learning effect associated with the PASAT that may have impacted results.
  • Depressive symptoms worsened over time which should warrant further study.
  • The potential for academic struggles from RHI for collegiate football players should not be ruled out despite quantitative findings.



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