More than a million youth concussions are estimated to go unreported each year, many from sports-related injuries. While education campaigns have long encouraged athletes to speak up, it's been hard to predict who actually will—until now.

A newly published study in PM&R: The Journal of Injury, Function and Rehabilitation, led by researchers at Stanford, suggests that an athlete’s actions after experiencing a simulated concussion may provide a mirror into what they might do in a live game. Specifically, the study found that high school football players' responses to a survey about concussion reporting reflect how likely they are to follow through in a simulated game. The findings, based on behavior in a virtual interactive experience, offer rare insight into real-time decision-making and may help educators and researchers better track the effectiveness of concussion interventions.

“We know the majority of concussions are undiagnosed,” said Dr. Daniel Daneshvar, Co-Director of Sports Concussion at Mass General Brigham, Chief of Brain Injury Rehabilitation at Harvard Medical School, and senior investigator of the study. “But how do you study something that was never reported, never evaluated, never tracked? That’s the challenge we tried to tackle.”

Daneshvar, also Director of TeachAids’ Institute for Brain Research and Innovation, worked with interdisciplinary researchers across the country to design the study using TeachAids’ innovative concussion education tools. The organization, known for research-backed programs like its award-winning CrashCourse concussion curriculum, creates immersive learning experiences to address complex public health issues, from HIV prevention to traumatic brain injury.

Simulating Real Decisions, Not Just Hypotheticals

To test whether intention matches behavior, over 300 high school football players from seven Colorado schools engaged in a two-minute, first-person virtual reality simulation developed by TeachAids. The simulation places players in the middle of a live-action game, where they experience a potential concussion and must decide: “take a knee” and seek help or stay in the game.

Crucially, players were unaware their decisions would be tracked for research. Before the simulation, they completed a survey rating how likely they were to report a concussion (1 = unlikely, 5 = highly likely). Some athletes received concussion education beforehand; others did not.

The results were striking: for each one-point increase in self-reported intention to report, the odds of actually taking a knee in the simulation nearly doubled for those who had received concussion education, and by a slightly smaller margin for those who hadn’t. Athletes who received education were also nearly twice as likely to report the injury during the simulation compared to their peers.

“This simulation gives us a way to measure the effectiveness of educational interventions in real time,” said Daneshvar. “We no longer have to wait months to draw meaningful conclusions. This model offers a safer and more immediate way to evaluate the effects of interventions on behavior.”

When Intention Meets Reality

Nonetheless, the study revealed a gap: not all players who intended to report did so.

“That disconnect is real,” Daneshvar noted. “It could be pressure, second thoughts, or just curiosity about what happens in the simulated game if they don’t report. But it mirrors what likely happens in real life: athletes say they’ll speak up, and then don’t. Understanding why is the next frontier.”

Roy Pea, David Jacks, professor of education and learning sciences at Stanford, sees broader potential for immersive simulations beyond sports.

“This study is a powerful demonstration of how immersive learning can reveal not only what students know, but what they’re likely to do,” Pea said. “By placing young athletes in context-rich, decision-based environments, we move beyond traditional health education into a far more actionable learning environment.”

Toward a Safer Future for Student Athletes

For schools and sports organizations, this kind of simulation could become a vital tool, both for teaching athletes about brain health and testing whether those lessons stick.

“This study peels back the curtain on unreported concussions,” Daneshvar said. “We now have a tool to better assess, and potentially predict, what helps keep kids safe.”

With so many youth concussions going unnoticed each year, the study’s insights could be a game changer, empowering coaches, educators, and athletes with evidence-based tools to protect student health.

About the Simulation

The interactive video simulation used in the study is part of the CrashCourse concussion education series by TeachAids. Developed in partnership with over 100 medical and sports experts and informed by feedback from more than 300 student-athletes, the series aims to make concussion education more engaging, accessible, and actionable.

All TeachAids’ CrashCourse education is available for free.