U-M Team Creates First Concussion Protocol for Performing Arts Students

A team of researchers at the University of Michigan has developed what it describes as the first standardized, discipline-specific concussion management framework for university performing arts students.

The Progressive Return-to-Performance Protocol was created by representatives from the U-M School of Music, Theatre & Dance and School of Kinesiology in partnership with the U-M Concussion Center. The six-step framework is designed to help dancers, musicians and actors safely return to performing following a concussion.

The researchers developed the protocol to address a gap between the resources available to collegiate athletes and performing arts students. While athletes have established return-to-play procedures following concussions, performing artists have historically lacked comparable guidance addressing the specific demands of their disciplines.

"While traditional sports have well-established return-to-play rules, dancers, musicians and actors previously had to self-govern their recovery, lacking guidance tailored to stage environments, props and artistic endurance," said Kristen Schuyten, a physical therapist in the School of Music, Theatre & Dance's Wellness Program and lecturer in the Department of Dance.

Six-Step Return-to-Performance Protocol

The Progressive Return-to-Performance Protocol follows a stepwise approach modeled on international sports concussion guidelines while incorporating considerations specific to music, theatre and dance.

Students begin by avoiding activities that increase symptoms before progressing to light aerobic exercise and individual discipline-specific activities. Later stages gradually reintroduce performance demands, including performing from memory, ensemble interaction and exposure to environmental factors such as lighting, sound and staging.

The final stages are intended to return students to their typical performance capacity before allowing full participation in their performance environments without restrictions.

The recommendations can also be adapted to the student's discipline. Dancers, for example, may begin with warm-ups, marking movement and balance exercises, while musicians and theatre students can gradually increase their exposure to sound or music alongside aerobic activity.

Addressing Concussions in Performing Arts Education

The researchers said the absence of standardized concussion procedures can be particularly consequential for performing arts students because performance is often an integral part of their education.

An injury can potentially affect casting, participation in productions or a student's academic standing. Researchers also noted that these pressures could discourage students from reporting concussions and lead them to continue performing while injured.

"Although I wasn't entirely surprised, it was striking to discover that only a small number had formal written protocols, and most lacked dedicated healthcare support for performing arts students altogether," said Paola Savvidou, a lecturer and Wellness Program manager at the School of Music, Theatre & Dance.

The school's Wellness Program has also introduced neurological baseline screenings for incoming students. The assessments establish individual baselines for vision, balance and cognitive function that can later assist healthcare providers following a concussion.

Research Behind the Protocol

The project grew out of the doctoral research of Allyssa Memmini, who conducted the work while a Ph.D. student at the School of Kinesiology and its Concussion Center and is now a faculty member at the University of New Mexico.

Memmini collaborated with Schuyten and Savvidou on a grant-funded Delphi study bringing together faculty members, academic counselors, former performing arts students who had experienced concussions, researchers, clinicians and other participants.

The Delphi method uses rounds of anonymous opinions and feedback to develop consensus around complex issues. The team's findings and recommendations were subsequently published in a peer-reviewed American Academy of Neurology journal.

Training and Certification Course Coming in 2027

The researchers are now developing Concussion Education and Management for Performing Arts, a related educational and certification program designed to share the framework more broadly.

The course, funded by the U-M Center for Academic Innovation, will be offered through Michigan Online beginning in spring 2027 and will be available to academics, theatre professionals and the general public.

The initiative also involved partners across the university, including Services for Students with Disabilities, the Division of Public Safety and Security, Insurance and Claims Administration and Information and Technology Services.

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