The Role of Concussion History and Gender in Recovery From Soccer-Related Concussion

Department of Orthopaedics, Mount Sinai Medical Center, 5 East 98th St, Box 1188, New York, NY 10029, USA.
The American Journal of Sports Medicine (Impact Factor: 4.7). 06/2009; 37(9):1699-704. DOI: 10.1177/0363546509332497
Source: PubMed

ABSTRACT This study was designed to investigate differences in recovery in male and female soccer athletes.
Soccer players with a history of concussion will perform worse on neurocognitive testing than players without a history of concussion. Furthermore, female athletes will demonstrate poorer performance on neurocognitive testing than male athletes.
Cohort study (prognosis): Level of evidence, 2.
Computer-based neuropsychological testing using reaction time, memory, and visual motor-speed composite scores of the ImPACT test battery was performed postconcussion in soccer players ranging in age from 8 to 24 years (N = 234; 141 females, 93 males). A multivariate analysis of variance was conducted to examine group differences in neurocognitive performance between male and female athletes with and without a history of concussion.
Soccer players with a history of at least 1 previous concussion performed significantly worse on ImPACT than those who had not sustained a prior concussion (F = 2.92, P =.03). In addition, female soccer players performed worse on neurocognitive testing (F = 2.72, P =.05) and also reported more symptoms (F = 20.1, P =.00001) than male soccer players. There was no significant difference in body mass index between male and female players (F =.04, P =.85).
A history of concussion and gender may account for significant differences in postconcussive neurocognitive test scores in soccer players and may play a role in determining recovery. These differences do not appear to reflect differences in mass between genders and may be related to other gender-specific factors that deserve further study.

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    • "With regard to neurocognitive testing for concussion among youth, large samples stratified by age are of particular importance as cognitive maturation occurs dramatically during adolescence (Casey, Giedd, & Thomas, 2000; Yurgelun-Todd, 2007). Gender-based data are also important as men and women perform differently on neurocognitive measures postconcussion (Colvin et al., 2009; Covassin, Elbin, Harris, Parker, & Kontos, 2012; Covassin, Elbin, Larson, & Kontos, 2012). "
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    ABSTRACT: The neurocognitive testing of sports concussion for injury management and return-to-play decisions has long been considered the gold standard in evaluation of the injury. Computerized testing batteries are frequently employed, with the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) being the most used of all the current testing platforms to evaluate concussion. ImPACT's clinical report yields four normed composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, and Reaction Time) and another composite score that is not normed but is used as a validity measure (Impulse Control), as well as their corresponding subtest scores, which are not normed. The current study provides normative data on each of the subtests used to calculate the composite scores. Normative data are separated by gender for athletes aged 13 to 21 years old and are stratified by the norm age brackets already employed by the ImPACT. These norms may be helpful in the interpretation of the ImPACT clinical report and further delineation of areas of neurocognitive dysfunction.
    11/2014; DOI:10.1080/21622965.2014.911094
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    • "Reports of sex differences in neuropsychological deficits have also revealed mixed findings, with some authors reporting greater impairment for concussed females in some neurocognitive domains (Broshek et al. 2005; Colvin et al. 2009) and others appearing to report no injury-related sex differences in neuropsychological functioning (e.g., sex differences in neuropsychological performance reported by Covassin et al. 2007, 2012 reflected main effects of sex across pre-and post-injury time points and therefore did not appear to be injury related). A large meta-analysis of 3,801 concussed athletes and 5,631 controls found greater post-concussive neuropsychological deficits in females at their first postinjury assessment (1–10 days after injury) after accounting for time since injury, comparison group (personal baseline vs. controls), and age group (Dougan et al. 2013). "
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    ABSTRACT: Concussion is a highly prevalent injury in contact and collision sports that has historically been poorly understood. An influx of sport-concussion research in recent years has led to a dramatic improvement in our understanding of the injury's defining characteristics and natural history of recovery. In this review, we discuss the current state of knowledge regarding the characteristic features of concussion and typical acute course of recovery, with an emphasis on the aspects of functioning most commonly assessed by clinicians and researchers (e.g., symptoms, cognitive deficits, postural stability). While prototypical clinical recovery is becoming better understood, questions remain regarding what factors (e.g., injury severity, demographic variables, history of prior concussions, psychological factors) may explain individual variability in recovery. Although research concerning individual differences in response to concussion is relatively new, and in many cases limited methodologically, we discuss the evidence about several potential moderators of concussion recovery and point out areas for future research. Finally, we describe how increased knowledge about the negative effects of and recovery following concussion has been translated into clinical guidelines for managing concussed athletes.
    Neuropsychology Review 11/2013; 23(4). DOI:10.1007/s11065-013-9240-7 · 5.40 Impact Factor
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    • "Despite symptom differences, females and males perform similarly on baseline neurocognitive tests (Covassin, Schatz, & Swanik, 2007). When studies have controlled for that enhanced reporting phenomenon (e.g., Colvin et al., 2009), it was found that women (aged 8-24) did nonetheless report more symptoms than men following concussion. Neurocognitive tools have also showed consistent impairments in women following even one concussion, and more persistent cognitive decline (Broshek et al., 2009). "
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    ABSTRACT: Although the contemporary sport neuropsychology literature includes studies of many sports played by men and women, children and adolescents, many races and ethnicities, the observers of the modern sport scene – including many neuropsychologists – might be functionally unaware that sport-related concussions are prevalent and of importance outside of American football and professional ice hockey. Barth and colleagues (1989) seminal work on concussions in college football primed the pump for future studies, and established football as the showpiece domain of sport neuropsychology. Professional ice hockey has joined football not only as an epidemiologically related venue for sport concussions, but also as a magnet for media attention. The predominant focus on concussions in these sports has created the appearance of a gendered phenomenon, since male participation dominates in these arenas. The cultural diversity of football players has at least made it clear that sport concussions are an 'equal opportunity' injury. Accumulating evidence regarding the epidemiology of concussion supports that athletes of other sports, women, and those from other cultural groups may have equivalent or greater risk than in football (Dick, 2009; Gessel, Fields, Collins, Dick, & Comstock, 2007). Moreover, a significant proportion of the world's youth play sports such as soccer where the concussion risk is moderate to high (Webbe and Salinas, 2010).
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