Baseline Neurocognitive Performance and Clearance for Athletes to Return to Contact

Abstract

Context: Computerized neurocognitive assessments are commonly used to manage sport-related concussion. Variations in baseline performance may influence neurocognitive performance after injury as well as the amount of time needed for an athlete to be cleared for return to sport participation.Objective: To investigate the relationship between mean baseline Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) scores and postconcussion reliable decline as well as the association between postconcussion cognitive decline and days missed after injury.Design: Cross-sectional study. Setting: University concussion databank. Patients or Other Participants: A total of 84 collegiate athletes who sustained a concussion between 2008 and 2015 were studied. For each ImPACT composite score (verbal memory, visual memory, visual motor speed, reaction time), athletes were grouped based on the presence or absence of reliable decline and on the presence of reliable decline in 0, 1, 2, 3, or 4 cognitive domains.Main Outcome Measure(s): Outcome measures were baseline ImPACT composite scores and days missed due to concussion.Results: Athletes with a reliable decline in visual memory scored higher on baseline visual memory than did athletes with no decline or an improvement (t 82 ¼À2.348, P ¼ .021, d ¼ 0.65). When comparing athletes who displayed a reliable decline with those who showed no change or an improvement in any composite score, days missed did not differ. The number of composite scores with a reliable decline demonstrated no main effect on days missed (P ¼ .530).Conclusions: Athletes who exhibited cognitive decline in most or all of the composite scores did not miss more days after injury than athletes with a decline in fewer or none of the composite scores. Athletes should be educated regarding the lack of association between baseline neurocognitive scores and the presence or absence of a reliable decline after concussion, as well as the fact that, on average, individuals with a reliable decline across multiple domains did not miss more time after concussion.

A systematic review and meta-analysis of factors influencing ImPACT concussion testing in high school and collegiate athletes with self-reported ADHD and/or LD.

“…Given that invalid baseline classification can have implications for postconcussion comparisons (e.g., return-to-play decisions made without a valid baseline comparison), even trivial differences are important to attend to. The reason for this increase in invalid classification rates in athletes with ADHD and/or LD is unclear; however, prior studies suggest that this finding might be attributed to generally reduced performance secondary to the cognitive effects of ADHD and/or LD, lack of knowledge about the importance of baseline neurocognitive testing, sleep disturbance the night before testing, or purposeful failure in an effort to have lower preinjury baseline that could be used to regain return-to-play status more quickly following concussion (Asken et al, 2017; Maietta, Barchard, et al, 2021; Manderino & Gunstad, 2018; McClure et al, 2014; Rabinowitz et al, 2015; Schatz et al, 2017). It is important to note that despite higher rates of invalid classification, there is no direct evidence that athletes with ADHD and/or LD have higher rates of purposeful sandbagging behavior (i.e., intentional suppression of true performance via suboptimal effort in order to return-to-play more quickly if they were to sustain a concussion, this is sometimes referred to as sandbagging or “faking bad”).…”

Video analysis of potential concussions in elite male Hurling: are players being assessed according to league guidelines?

“…Players are not receiving standardized assessment following PCEs and RTP at a high rate, even when visible signs of concussion are present. Those returning to play without being properly screened for concussion are at risk of further strikes to the head and more severe post-concussive symptoms and complications [ 14 , 18 , 28 , 29 ]. Despite the wishes of the players, manager, or fans, medical staff must err on the side of caution when deciding whether to allow a player to RTP.…”

Immediate Post-Concussion and Cognitive Testing (ImPACT): Effects of Data Integration Strategies on Classification Accuracy

“…This finding is not entirely unexpected, given research showing contradictory findings regarding the incremental utility of CNTs relative to other indicators in concussion assessment and management. 9,21,22 Although not intended for use as a stand-alone diagnostic tool, this result calls into question the utility of ImPACT's cognitive tests and their incremental value in clinical decision-making.…”