About

Stefan Duma is the Harry C. Wyatt Professor of Engineering and a University Distinguished Professor at Virginia Tech. He serves as the Director of the Institute for Critical Technology and Applied Sciences and is the head of the Virginia Tech Helmet Lab. His research focuses on biomechanics, injury and impact biomechanics, automobile safety design, sports biomechanics, and military restraint systems. Duma's educational background includes a Ph.D. in Mechanical Engineering from the University of Virginia, an M.S. in Industrial Engineering from the University of Cincinnati, and a B.S. in Mechanical Engineering from the University of Tennessee. His work involves studying injury mechanisms, impact biomechanics, and developing safety systems, with notable contributions to helmet performance assessment and head impact biomechanics.

Research topics

• Medicine
• Physical therapy
• Medical emergency
• Emergency medicine
• Psychology
• Internal medicine
• Radiology
• Physical medicine and rehabilitation

Selected publications

• Change in Head Impact Exposure following Return to Sport in Concussed Football Athletes

  Medicine & Science in Sports & Exercise · 2025-08-08 · 1 citations

  article

  PURPOSE: Following sport-related concussions, early head impact exposure and premature return to sport are known to increase the risk of repeat concussion in football athletes, yet athletes' true post-injury head impact exposure profiles (i.e., characteristics of recorded head impacts over a given time period) and biomechanical progression have not been explored. Accordingly, this study explored how head impact exposure in American college football athletes was altered during their return to sport from concussion, particularly within the same athletic season. METHODS: This analysis compared daily volume of head impacts following concussion with pre-injury levels using head impact exposure profiles of 52 concussed collegiate football athletes from six NCAA Division I programs, and further compared these athletes to team- and position-matched controls to minimize season- or team-related factors. In addition, this study provided an analysis of the possible association between duration of recovery and change in head impact exposure following concussion using continuous linear regression. RESULTS: When comparing to pre-injury levels, 75% of concussed athletes reduced their head impact exposure in their immediate return to sport, whereas over 40% of concussed athletes did not reach their pre-injury level of head impact exposure at any point during the remainder of the concussion season segment. Furthermore, concussed athletes significantly decreased their head impact exposure over their immediate return-to-sport period when compared with team- and position-matched healthy, nonconcussed athletes over the same time period. Finally, longer postconcussion recovery times were associated with larger decreases in head impact exposure after return to sport. CONCLUSIONS: This study provides evidence for a shift in head impact exposure after returning from concussion, seen most strongly in the immediate days after return to sport. These findings align with the recent shift toward more conservative postconcussion management seen across multiple sports and playing levels.

  PublisherDOI

• Attention-Deficit/Hyperactivity Disorder as a Mediating Variable for Invalid Baseline Profiles on the ImPACT

  Healthcare · 2025-07-01

  articleOpen access

  Background: Individuals with ADHD may perform poorly on tasks targeting executive functioning skills such as the ImPACT, which requires the test-taker to employ judgement in non-routine situations Objective: To determine whether ADHD serves as a mediating variable for increasing the likelihood of an invalid score. Materials and Methods: A total of 39,140 collegiate athletes and United States military cadets consented to the Concussion Assessment, Research, and Education (CARE) Consortium study. Participants completed the CARE Baseline Packet which included various sections through which study participants provide self-report data, including demographic, personal, and family history sections. The personal history portion of the CARE Baseline Packet addressed the participant’s neurological history, including self-reported diagnosis of ADHD and history of traumatic brain injury. Variables utilized for the current study included age, gender, race, ethnicity, the participant’s primary college sport, use of mouthguards for athletes competing in sports requiring them, and the presence of an ADHD diagnosis. Participants responded to a question, inquiring if they had ever been diagnosed by a medical professional with ADHD, ultimately producing a dichotomous yes/no response. Results: We found that participants with ADHD were more likely to produce invalid baseline scores (ß = −0.884; p < 0.001). Similar results were found when controlling for sex, race, age, sport played, mouthguard use, and number of previous concussions (ß = −0.786; p < 0.001). Sex, race, sport played, and mouthguard use each played a significant role in determining profile validity, independent of ADHD diagnosis. With ADHD removed from the model, age negatively affected the likelihood of a valid score (ß = −0.052; p = 0.048). Conclusions: Our study suggests that the relationship between age and ImPACT validity is explained by the presence of ADHD. Results support adjusting ImPACT’s validity thresholds for individuals with ADHD.

  PublisherOA PDFDOI

• 7.14 Do head injury biomechanics predict injury recovery?

  2024-01-01

  article

  <h3>Objective</h3> To test whether higher head injury biomechanics are associated with symptom resolution time (SRT) and return-to-participation time (RTP). <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Six United States NCAA Division 1 colleges. <h3>Participants</h3> We studied 51 college American football players who sustained an incident concussion while participating in a multi-site study. There were no exclusion criteria based on age, sex, or race. <h3>Interventions (or Assessment of Risk Factors)</h3> Head injury linear accelerations were categorized as mild (&lt;66g), moderate (66g-106g), or severe (&gt;106g). Head impact locations, event type, and player race/ethnicity were included as model covariates. <h3>Outcome Measures</h3> SRT and RTP were measured in days. Kruskal-Wallis tests examined SRT and RTP differences by head impact severity. Multivariable negative binomial regression models analyzed associations between higher head impact severity and SRT and RTP. Effect estimates (ratios) with 95% confidence intervals (CI) excluding 1.00 were considered significant. <h3>Main Results</h3> Median linear acceleration was 66.7g, with 9 cases (17.7%) resulting from a severe (&gt;106g) linear acceleration. Median SRT and RTP were 6.1 days (IQR=5.8) and 12.3 days (IQR=7.8), respectively. No SRT (χ²=1.9; p=0.38) or RTP (χ²=0.38; p=0.83) differences were observed across impact severities. Multivariable models revealed no associations between higher head impact severity and SRT (Ratio=0.96; 95%CI=[0.71,1.30]) or RTP (Ratio=0.91; 95%CI=[0.62,1.34]), after adjusting for covariate effects. <h3>Conclusions</h3> Head injury biomechanics do not predict injury recovery. Future work should consider the role pre-injury repeated head impact exposure has on predicting SRT and RTP time given injury head impacts alone are not associated with SRT or RTP.

  PublisherDOI

• Association of Alzheimer’s disease polygenic risk score with concussion severity and recovery metrics

  Alzheimer s & Dementia · 2024-12-01

  articleOpen access

  Abstract Background Shared genetic risk between Alzheimer’s disease (AD) and concussion may help explain the association between concussion and elevated risk for dementia. However, there has been little investigation into whether AD risk genes also associate with concussion severity/recovery, and the limited findings are mixed. We used AD polygenic risk scores (PRS) and APOE genotypes to investigate associations between AD genetic risk and concussion severity/recovery in the NCAA‐DoD Grand Alliance CARE Consortium (CARE) dataset. Method There were 1,917 injuries in the dataset upon project initiation. After removing repeated injuries, related participants, and those without genetic/outcome data, we had 931 participants. Outcomes were number of days to return to play (RTP) as a recovery measure, and four severity measures (scores on SAC and BESS, SCAT symptom severity and total number of symptoms). We calculated PRS using a published score (de Rojas et al., 2021) and performed a linear regression (MLR) of RTP by PRS in normal (&lt;24 days) and long (&gt;24 days) RTP subgroups. We then compared severity measures by PRS using MLR. Next, we used t‐tests to examine outcomes by APOE genotype in military and civilian subgroups. We also performed chi‐squared tests of RTP category (normal vs. long) by APOE genotype. Finally, we analyzed outcomes by PRS in European or African genetic ancestry subgroups using MLR. Result Higher PRS was associated with longer injury to RTP interval in the normal RTP (&lt;24 days) subgroup (estimate = 0.0412, SE = 0.182, p = 0.0237). 1 SD increase in PRS resulted in a 0.412 day (9.89 hours) increase to the interval. This may be clinically meaningful in the collegiate athlete environment. We did not identify any other significant differences. Conclusion Our preliminary results provide limited evidence for an impact of AD PRS on concussion recovery, though the pattern was inconsistent and its clinical significance is uncertain. Future studies should attempt to replicate these findings in larger samples with longer follow‐up using PRS calculated from multiple/diverse populations, which will be especially relevant for diverse datasets like CARE.

  PublisherOA PDFDOI

• Association of Premorbid Anxiety and Depression Symptoms in Concussion Recovery in Collegiate Student-Athletes

  Sports Health A Multidisciplinary Approach · 2024-06-04

  articleOpen access

  BACKGROUND: Mental health disorders are linked to prolonged concussion symptoms. However, the association of premorbid anxiety/depression symptoms with postconcussion return-to-play timelines and total symptom burden is unclear. OBJECTIVE: To examine the association of self-reported premorbid anxiety/depression symptoms in collegiate student-athletes with (1) recovery times until asymptomatic, (2) return-to-play, and (3) postconcussion symptom burden. STUDY DESIGN: Athletes in the Concussion Assessment, Research and Education Consortium completed baseline concussion assessments (Sport Concussion Assessment Tool [SCAT3] and Brief Symptom Inventory-18 [BSI-18]). Athletes were tested postinjury at <6 hours, 24 to 48 hours, time of asymptomatic and start of return-to-play protocol, unrestricted return-to-play, and 6 months after injury. Injured athletes were categorized into 4 groups based on BSI-18 scores: (1) B-ANX, elevated anxiety symptoms only; (2) B-DEP, elevated depression symptoms only; (3) B-ANX&DEP, elevated anxiety and depression symptoms; and (4) B-NEITHER, no elevated anxiety or depression symptoms. Relationship between age, sex, BSI-18 group, SCAT3 total symptom and severity scores, and time to asymptomatic status and return-to-play was assessed with Pearson's chi-squared test and robust analysis of variance. LEVEL OF EVIDENCE: Level 3. RESULTS: = 0.11, respectively). B-ANX, B-DEP, and B-ANX&DEP groups did not have higher total symptom or severity scores postinjury compared with the B-NEITHER group. CONCLUSION: Baseline anxiety/depression symptoms in collegiate student-athletes without a mental health diagnosis are not associated with longer recovery times until asymptomatic, longer time to return-to-play, or higher postconcussion total symptom and severity scores compared with athletes without baseline symptoms. CLINICAL RELEVANCE: Anxiety and depression symptoms without a clear mental health diagnosis should be considered differently from other comorbidities when discussing prolonged recovery in collegiate student-athletes.

  PublisherOA PDFDOI

• The Prevalence and Influence of New or Worsened Neck Pain After a Sport-Related Concussion in Collegiate Athletes: A Study From the CARE Consortium

  Carolina Digital Repository (University of North Carolina at Chapel Hill) · 2024-11-06

  articleOpen access

  BACKGROUND: Neck pain in a concussion population is an emerging area of study that has been shown to have a negative influence on recovery. This effect has not yet been studied in collegiate athletes. HYPOTHESIS: New or worsened neck pain is common after a concussion (>30%), negatively influences recovery, and is associated with patient sex and level of contact in sport. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Varsity-level athletes from 29 National Collegiate Athletic Association member institutions as well as nonvarsity sport athletes at military service academies were eligible for enrollment. Participants completed a preseason baseline assessment and follow-up assessments at 6 and 24 to 48 hours after a concussion, when they were symptom-free, and when they returned to unrestricted play. Data collection occurred between January 2014 and September 2018. RESULTS: A total of 2163 injuries were studied. New or worsened neck pain was reported with 47.0% of injuries. New or worsened neck pain was associated with patient sex (higher in female athletes), an altered mental status after the injury, the mechanism of injury, and what the athlete collided with. The presence of new/worsened neck pain was associated with delayed recovery. Those with new or worsened neck pain had 11.1 days of symptoms versus 8.8 days in those without (<i>P</i> &lt; .001). They were also less likely to have a resolution of self-reported symptoms in ≤7 days (<i>P</i> &lt; .001). However, the mean duration of the return-to-play protocol was not significantly different for those with new or worsened neck pain (7.5 ± 7.7 days) than those without (7.4 ± 8.3 days) (<i>P</i> = .592). CONCLUSION: This novel study shows that neck pain was common in collegiate athletes sustaining a concussion, was influenced by many factors, and negatively affected recovery.

  PublisherOA PDFDOI

• Association of Sport Helmet Status on Concussion Presentation and Recovery in Male Collegiate Student-Athletes

  Annals of Biomedical Engineering · 2024-07-08

  article
  PublisherDOI

• Diffusion tensor analysis of white matter tracts is prognostic of persisting post-concussion symptoms in collegiate athletes

  NeuroImage Clinical · 2024-01-01 · 4 citations

  articleOpen access

  BACKGROUND AND OBJECTIVES: After a concussion diagnosis, the most important issue for patients and loved ones is how long it will take them to recover. The main objective of this study is to develop a prognostic model of concussion recovery. This model would benefit many patients worldwide, allowing for early treatment intervention. METHODS: The Concussion Assessment, Research and Education (CARE) consortium study enrolled collegiate athletes from 30 sites (NCAA athletic departments and US Department of Defense service academies), 4 of which participated in the Advanced Research Core, which included diffusion-weighted MRI (dMRI) data collection. We analyzed the dMRI data of 51 injuries of concussed athletes scanned within 48 h of injury. All athletes were cleared to return-to-play by the local medical staff following a standardized, graduated protocol. The primary outcome measure is days to clearance of unrestricted return-to-play. Injuries were divided into early (return-to-play < 28 days) and late (return-to-play >= 28 days) recovery based on the return-to-play clinical records. The late recovery group meets the standard definition of Persisting Post-Concussion Symptoms (PPCS). Data were processed using automated, state-of-the-art, rigorous methods for reproducible data processing using brainlife.io. All processed data derivatives are made available at https://brainlife.io/project/63b2ecb0daffe2c2407ee3c5/dataset. The microstructural properties of 47 major white matter tracts, 5 callosal, 15 subcortical, and 148 cortical structures were mapped. Fractional Anisotropy (FA) and Mean Diffusivity (MD) were estimated for each tract and structure. Correlation analysis and Receiver Operator Characteristic (ROC) analysis were then performed to assess the association between the microstructural properties and return-to-play. Finally, a Logistic Regression binary classifier (LR-BC) was used to classify the injuries between the two recovery groups. RESULTS: ) of 0.71 ± 0.09 SD was found. The top classification performance of the LR-BC was AUC = 0.90 obtained using the 16 statistically significant white matter tracts. DISCUSSION: Utilizing a free, open-source, and automated cloud-based neuroimaging pipeline and app (https://brainlife.io/docs/tutorial/using-clairvoy/), a prognostic model has been developed, which predicts athletes at risk for slow recovery (PPCS) with an AUC=0.90, balanced accuracy = 0.89, sensitivity = 1.0, and specificity = 0.79. The small number of participants in this study (51 injuries) is a significant limitation and supports the need for future large concussion dMRI studies and focused on recovery.

  PublisherDOI

• The Interval Between Concussions Does Not Influence Time to Asymptomatic or Return to Play: A CARE Consortium Study

  Sports Medicine · 2024-04-26 · 1 citations

  article
  PublisherDOI

• Summary of the 2015 University of Michigan Sport Concussion Summit

  UNC Libraries · 2024-08-27

  articleOpen access

  Discussions surrounding concussion have made their way into the public sphere over the previous decade with media attention and coverage of the injury fueling public debate. These conversations have devolved into discussions on banning contact and collision sports and raised legal questions surrounding injury management. Questions raised about concussion eclipse what science can answer, but the University of Michigan Injury Center (MI, USA) hosted a Concussion Summit in September 2015 as a means to condense, solidify and disseminate what is currently known on the topic. Areas for discussion included concussion incidence and prevention, diagnosis and management, legislation and education, legal and social aspects and future directions. A summary of those presentations are included within.

  PublisherDOI

Recent grants

• Biomechanical Basis of Pediatric mTBI Due to Sports Related Concussion

  NIH · $3.3M · 2015–2021

Frequent coauthors

• Steven Rowson

  Virginia Tech

  143 shared

• Thomas W. McAllister

  University of Indianapolis

  125 shared

• Steven P. Broglio

  95 shared

• Michael McCrea

  Medical College of Wisconsin

  88 shared

• Jason P. Mihalik

  86 shared

• Joel D. Stitzel

  83 shared

• Christopher C. Giza

  79 shared

• Kevin M. Guskiewicz

  University of North Carolina at Chapel Hill

  71 shared