Tracking neuropsychological recovery following concussion in sport

Iverson, Grant L.; Brooks, Brian L.; Collins, Michael W.; Lovell, Mark R.

doi:10.1080/02699050500487910

Cited by 275 publications

(197 citation statements)

References 47 publications

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“…Previous studies have demonstrated that athletes tend to recover from perceived symptoms and their neurocognitive performance normalizes within 3-10 days, with a smaller percentage of individuals that require more time to recover. 1,12,[14][15][16]18 Previous studies have also demonstrated that players who sustained a concussion in a season were 3 times more likely to sustain a second concussion in the same season compared with uninjured players. 11,29 Five (29%) of 17 players who sustained a concussion in this study also sustained a second concussion in the same season.…”

Section: Discussionmentioning

confidence: 99%

“…Previously published return-to-play concussion-focused studies have been difficult to compare, as they have been based on different surveillance and return-to-play protocols. 1,10,12,[14][15][16]18,24,28 The primary goal of the present study was to prospectively measure the duration of medical restriction from play (return-to-play period) after each physicianobserved and -diagnosed concussion or recurrent concussion, by direct clinical evaluation augmented with the SCAT2 and ImPACT neuropsychological tools. We studied players from 2 teams of junior ice hockey players during a single regular (36-game) season using the Zurich return-to-play protocol.…”

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confidence: 99%

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Return to play after an initial or recurrent concussion in a prospective study of physician-observed junior ice hockey concussions: implications for return to play after a concussion

Echlin¹,

Tator

Cusimano

et al. 2010

FOC

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Object The authors investigated return-to-play duration for initial and recurrent concussion in the same season in 2 teams of junior (16–21-year-old) ice hockey players during a regular season. Methods The authors conducted a prospective cohort study during 1 junior regular season (2009–2010) of 67 male fourth-tier ice hockey players (mean age 18.2 ± 1.2 years [SD], range 16–21 years) from 2 teams. Prior to the start of the season, every player underwent baseline assessments that were determined using the Sideline Concussion Assessment Tool 2 (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). The study protocol also required players who entered the study during the season to complete a baseline SCAT2 and ImPACT. If the protocol was not followed, the postinjury test results of a player without true baseline test results were compared with previously established age- and sex-matched group normative levels. Each game was directly observed by a physician and at least 1 neutral nonphysician observer. Players suspected of suffering a concussion were evaluated by the physician during the game. If a concussion was diagnosed, the player underwent clinical evaluation at the physician's office within 24 hours. The return-to-play decision was based on clinical evaluation guided by the Zurich return-to-play protocol (contained in the consensus statement of international expert opinion at the 3rd International Conference on Concussion in Sport held in Zurich, November 2008). This clinical evaluation and return-to-play protocol was augmented by the 2 tests (SCAT2 and ImPACT) also recommended by the Zurich consensus statement, for which baseline values had been obtained. Results Seventeen players sustained a physician-observed or self-reported, physician-diagnosed concussion during a physician-observed ice hockey game. The mean clinical return-to-play duration (in 15 cases) was 12.8 ± 7.02 days (median 10 days, range 7–29 days); the mean number of physician office visits by players who suffered a concussion (15 cases) was 2.1 ± 1.29 (median 1.5 visits). Five of the 17 players who sustained a concussion also suffered a recurrent or second concussion. One of the 5 individuals who suffered a repeat concussion sustained his initial concussion in a regular season game that was not observed by a physician, and as a result this single case was not included in the total of 21 concussions. This initial concussion of the player was identified during baseline testing 2 days after the injury and was subsequently medically diagnosed and treated. The mean interval between the first and second concussions in these 5 players was 78.6 ± 39.8 days (median 82 days), and the mean time between the return-to-play date of the first and second concussions was 61.8 ± 39.7 days (median 60 days). Conclusions The mean rates of return to play for single and recurrent concussions were higher than rates cited in recent studies involving sport concussions. The time interval between the first and second concussions was also greater than previously cited. This difference may be the result of the methodology of direct independent physician observation, diagnosis, and adherence to the Zurich return-to-play protocol.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Return to play after an initial or recurrent concussion in a prospective study of physician-observed junior ice hockey concussions: implications for return to play after a concussion

Echlin¹,

Tator

Cusimano

et al. 2010

FOC

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“…Plainly, presence of litigation is a major confound in research in mTBI and its presence in research studies has likely obscured the true effects of concussion, including PPCS. Also, whenever analyzing group data, if all subjects with concussion are examined at a particular time period, the effects on individual subjects who may be symptomatic get washed out by the total group effects (Iverson et al, 2006a;Kent, 2007;McHugh et al, 2006;Sterr et al, 2006). This is a very important point, because few studies compare symptomatic versus non-symptomatic subjects who have been concussed and those who do, find those who are symptomatic to have greater neuropsychological impairment (Collie et al, 2006;Iverson et al, 2004;Sterr et al, 2006).…”

Section: Limitations Of Neuropsychological Research To Advance the Fimentioning

confidence: 99%

Neuropsychology and clinical neuroscience of persistent post-concussive syndrome

Bigler

2007

J Int Neuropsychol Soc

363

248

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On the mild end of the acquired brain injury spectrum, the terms concussion and mild traumatic brain injury (mTBI) have been used interchangeably, where persistent post-concussive syndrome (PPCS) has been a label given when symptoms persist for more than three months post-concussion. Whereas a brief history of concussion research is overviewed, the focus of this review is on the current status of PPCS as a clinical entity from the perspective of recent advances in the biomechanical modeling of concussion in human and animal studies, particularly directed at a better understanding of the neuropathology associated with concussion. These studies implicate common regions of injury, including the upper brainstem, base of the frontal lobe, hypothalamic-pituitary axis, medial temporal lobe, fornix, and corpus callosum. Limitations of current neuropsychological techniques for the clinical assessment of memory and executive function are explored and recommendations for improved research designs offered, that may enhance the study of long-term neuropsychological sequelae of concussion. (JINS, 2008, 14, 1-22.)

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“…The utility, reliability, and validity of ImPACT have been discussed in the literature. 5,17,[25][26][27] For the final sample in this study, data extracted from each de-identified baseline testing record included the following demographics: date of birth, testing date, sex, current sport, and number of prior concussions. Neurocognitive data extracted verbal memory, visual memory, visual motor (processing) speed, reaction time, impulse control composite scores, total symptom score, and the validity of the baseline test.…”

Section: Materials and Proceduresmentioning

confidence: 99%

Supervision and Computerized Neurocognitive Baseline Test Performance in High School Athletes: An Initial Investigation

Kuhn

Solomon

2014

Journal of Athletic Training

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Context: Computerized neuropsychological testing batteries have provided a time-efficient and cost-efficient way to assess and manage the neurocognitive aspects of patients with sport-related concussion. These tests are straightforward and mostly self-guided, reducing the degree of clinician involvement required by traditional clinical neuropsychological paper-andpencil tests.Objective: To determine if self-reported supervision status affected computerized neurocognitive baseline test performance in high school athletes.Design: Retrospective cohort study. . They reported taking the test either supervised by a sports medicine professional or unsupervised. These athletes (n ¼ 2140) were subjected to inclusion and exclusion criteria and then matched based on age, sex, and number of prior concussions. Main Outcome Measure(s):We extracted demographic and performance-based data from each de-identified baseline testing record. Paired t tests were performed between the selfreported supervised and unsupervised groups, comparing the following ImPACT baseline composite scores: verbal memory, visual memory, visual motor (processing) speed, reaction time, impulse control, and total symptom score. For differences that reached P , .05, the Cohen d was calculated to measure the effect size. Lastly, a v 2 analysis was conducted to compare the rate of invalid baseline testing between the groups. All statistical tests were performed at the 95% confidence interval level.Results Conclusions: Speed-based tasks were most affected by self-reported supervision status, although the effect sizes were relatively small. These data lend credence to the hypothesis that supervision status may be a factor in the evaluation of ImPACT baseline test scores.

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Tracking neuropsychological recovery following concussion in sport

Abstract: This study illustrates the importance of analysing individual athletes' test data because group analyses can obscure slow recovery in a substantial minority of athletes.

Cited by 275 publications

References 47 publications

Return to play after an initial or recurrent concussion in a prospective study of physician-observed junior ice hockey concussions: implications for return to play after a concussion

Return to play after an initial or recurrent concussion in a prospective study of physician-observed junior ice hockey concussions: implications for return to play after a concussion

Neuropsychology and clinical neuroscience of persistent post-concussive syndrome

Supervision and Computerized Neurocognitive Baseline Test Performance in High School Athletes: An Initial Investigation

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