Dr. Gary Wilkerson (left) explains the VR testing process as UTC women’s soccer player Elle Wakefield participates in a perceptual decision-making assessment. Photo by Angela Foster.
When athletes step onto the field, reacting a fraction of a second too late can be the difference between making a play and sustaining an injury.
At the University of Tennessee at Chattanooga, faculty in the Department of Health and Human Performance (HHP) are studying what drives those split-second decisions and how sleep, mental health and cognitive processing affect performance and injury risk.
The research is led by Dr. Gary Wilkerson, a professor in the graduate athletic training program who has studied sports injury prevention and cognitive performance for nearly 35 years. Conducted in collaboration with several UTC Athletics programs, most notably the women’s soccer team, the project examines how efficiently athletes process visual information and convert it into physical action.
For Dr. Eric Hungenberg, the HHP department head, the project aims to help student-athletes better understand how factors beyond practice and conditioning influence what happens on the field.
“The research has increasingly focused on educating athletes about the connection between sleep, mental health and performance,” Hungenberg said. “Mental health strategy and sleep attentiveness impact performance by maximizing an athlete’s physical capabilities and decision-making during competition.”
UTC women’s soccer player Sophia Mize participates in VR testing that evaluates how quickly visual information is translated into movement.
The work begins with a simple premise: What athletes see—and how quickly their brains interpret it—matters.
In competition, players constantly process peripheral cues, such as an opponent approaching, a ball changing direction or a teammate moving into space. That ability to perceive and react quickly, often referred to as perceptual decision-making, plays a critical role in both performance and injury prevention.
Wilkerson’s research examines how efficiently athletes process those cues using a virtual reality headset equipped with eye-tracking technology and motion sensors. Inside the headset, athletes respond to fast-moving visual targets, quickly deciding which direction to lunge and reach for execution of a correct response.
The system captures reaction time, movement speed and decision accuracy with millisecond precision and measures eye movements, which Wilkerson said are among the most valuable indicators.
“What we’re able to do is measure exactly how quickly someone recognizes what they’re seeing and converts that into the correct movement,” said Wilkerson, a member of the National Athletic Trainers’ Association Hall of Fame. “It’s not just about speed; it’s speed, accuracy and consistency.”
UTC women’s soccer coach Gavin McKinney said the collaboration has provided another lens for understanding how players perform on the field.
“Our sport is decision-making and awareness,” McKinney said. “If this helps them with that cognitive process, it’s beneficial. And if it keeps them healthy, even better.”
Soccer players Elle Wakefield, a sophomore defender from Atlanta, and Sophia Mize, a sophomore defender from Ooltewah, Tennessee, said the experience felt disorienting at first.
“I did not do well my first time,” said Mize, who is majoring in marketing. “You feel like you’re in a different world and you don’t know your surroundings with the headset on.”
Wakefield, a business finance major and member of the Innovations in Honors program, said the adjustment period is real, but so is the progression.
“It takes a second for your eyes to adjust to looking at a screen so close to your face,” she said. “When we first did it, it was super new. But now it’s really smooth to use.”
Performance metrics—including accuracy, completion time and reaction speed—are displayed from VR-based perceptual testing.
The tests may appear simple, Wilkerson explained, but they reveal complex processes occurring in the brain.
Visual information enters through the eyes, travels to the occipital region and moves through neural pathways that control how quickly athletes recognize and respond to a stimulus.
“When you’re irritable, when you’re sad, when you’re worrying, it disrupts that synchronization. Processing slows down,” Wilkerson said.
Those disruptions can lead to hesitation or poor decision-making on the field—moments when athletes freeze or react too late to avoid a collision or an awkward movement.
The research also examines how sleep quality and mood-related stress influence those neural processes. Using established self-report tools, such as the Pittsburgh Sleep Quality Index, along with cognitive-response data from VR testing, Wilkerson and his colleagues have identified patterns linking sleep, mental health and injury risk.
In one dataset involving UTC women’s soccer players, athletes who had none of the three risk factors—poor sleep, mood distress or inefficient perceptual decision-making—experienced no injuries during the study period. Athletes with one risk factor had a 23% injury rate. Those with two risk factors saw injuries rise to 60%, and every athlete with all three factors present sustained an injury during the same timeframe.
“That graded association is pretty striking,” Wilkerson said, noting that the results align with patterns seen in other groups of athletes.
Across a broader sample that included women’s soccer, women’s basketball and men’s basketball, 27 injuries—including concussions, ankle and foot injuries and knee injuries—were recorded among 21 athletes, reinforcing the consistency of the pattern across sports.
While injuries are an inevitable part of competitive sports, Wilkerson believes identifying risk factors and improving cognitive readiness can help reduce their frequency and severity.
“There’s no way that we can eliminate injuries,” he said. “They’re always going to occur. But if I have somebody who’s already had two concussions and I can make them just a split second faster to avoid getting that third concussion, that can make a huge difference in their lives.”
Wakefield recalled one early moment when the connection became clear.
“We had probably only been doing it for about two weeks and our coach got the results,” she said. “Our goalie had the fastest reaction time, which was super fitting. She had been performing so well, and it was like, ‘Wait, that makes so much sense.’ It was one of those moments where it all kind of clicked.”
Close-up of handheld controllers used ito measure reaction time, movement and decision-making.
Wakefield said that impact is becoming part of her day-to-day experience.
“I would say it’s not always obvious, but it definitely is there,” Wakefield said. “I wear a Whoop (fitness tracker) and she wears a Garmin, so it tracks our sleep. During the season, it can be hard to prioritize sleep, but I was able to recover really well. That allows me to perform better.”
Both defenders said the focus required during testing has translated into the classroom.
“I feel like I’m able to focus a lot more in my in-person classes,” Wakefield said. “It’s kind of like VR—you have to be so focused when you’re doing it to get the most out of it.”
“I agree with that,” Mize said. “I like taking in-person classes more. You have to be present.”
During the fall 2025 season, the women’s soccer team saw results that reinforced the program’s emphasis on holistic athlete development.
“All 27 players on our squad were still available in our conference tournament,” McKinney said. “There’s a lot of factors in that—sports medicine, strength staff, load management—but awareness and the things we’re talking about here play a role, too.”
During the fall 2025 semester, the women’s soccer program had 15 players with a perfect 4.0 grade-point average and the team GPA was 3.79.
“It’s not just athletic performance,” McKinney said. “We’re trying to get them to perform at their highest level in all areas of their life.”
Movement patterns for eye gaze (left) and neck motion (right) are displayed across 40 trials of a perceptual decision-making task.
At a late-March VR demonstration, Mize and Wakefield showed the testing process, offering a firsthand look at the system.
Mize said improvement over time has been noticeable, even after time away from testing.
“I would rarely get 40 (out of 40), and I just got one,” she said following the demonstration. “It was like muscle memory.”
McKinney said players regularly complete brief check-ins about their physical and mental state, providing coaches with insight into stress levels, fatigue and other factors that might affect performance.
“If someone isn’t sleeping well or is dealing with stress, it gives us a starting point for a conversation,” McKinney said.
Hungenberg said the project represents an example of how academic research can directly benefit students beyond the classroom.
“I think every researcher wants their work to have impact,” Hungenberg said. “This has been a great example of research that not only generates knowledge but also provides something meaningful to the students we’re working with.”
McKinney sees that impact reflected in the way athletes think about the game itself.
“Nineteen years ago, it was about wins and losses,” McKinney said. “Now it’s more about the overall success and development of the individual and the team.
“If you can make your players a little bit smarter and more aware, it’s going to benefit them in the long run.”
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Department of Health and Human Performance
Master of Science in Athletic Training
UTC women’s soccer players Elle Wakefield (left) and Sophia Mize.
