Neuropsychological evaluation in the diagnosis and management of sports-related concussion

RSM Psychology Center, LLC, USA.
Archives of Clinical Neuropsychology (Impact Factor: 1.99). 12/2007; 22(8):909-16. DOI: 10.1016/j.acn.2007.09.004
Source: PubMed


A mild traumatic brain injury in sports is typically referred to as a concussion. This is a common injury in amateur and professional athletics, particularly in contact sports. This injury can be very distressing for the athlete, his or her family, coaches, and school personnel. Fortunately, most athletes recover quickly and fully from this injury. However, some athletes have a slow recovery, and there are reasons to be particularly concerned about re-injury during the acute recovery period. Moreover, some athletes who have experienced multiple concussions are at risk for long-term adverse effects. Neuropsychologists are uniquely qualified to assess the neurocognitive and psychological effects of concussion. The National Academy of Neuropsychology recommends neuropsychological evaluation for the diagnosis, treatment, and management of sports-related concussion at all levels of play.

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Article: Neuropsychological evaluation in the diagnosis and management of sports-related concussion

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    • "Consequently, cognitive testing is used widely in concussion management programs across all levels of sports. In many programs, athletes are required to provide a baseline test against which any post-injury performance can be compared (Echemendia et al., 2013; Louey et al., 2014; Moser et al., 2007). Given the high participation rates in contact sports, this means pre-season baseline tests must be collected from large numbers of athletes. "
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    ABSTRACT: Repeat cognitive assessment comparing post-injury performance to a pre-injury baseline is common in concussion management. Although post-injury tests are typically administered in clinical settings, baseline tests may be conducted individually with one-on-one supervision, in a group with supervision, or without supervision. The extent to which these different test settings affect cognitive performance is not well understood. To assess if performance on the Cogstate Brief Battery (CBB) differs across these settings, tests completed individually with one-on-one supervision were compared to those taken either in a group with supervision or individually but without supervision. A crossover study design was utilized to account for any effect of individual variability or test order to provide an unbiased examination of the effect of test setting on cognitive performance. Young adult participants completed an individually supervised test either before or after also completing a group or unsupervised test. CBB scores from the same individuals were not significantly different across test settings. Effect sizes ranged in magnitude from .09 to .12 for supervised versus unsupervised tests and from .01 to .37 for individual versus group tests across CBB tasks. These results suggest that cognitive testing with the CBB in alternate settings can provide valid cognitive data comparable to data obtained during individually supervised testing.
    The Clinical Neuropsychologist 05/2015; 29(4):542-58. DOI:10.1080/13854046.2015.1054437 · 1.72 Impact Factor
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    • "Blood biomarkers in human mTBI 2012). It has been suggested that an mTBI that occurs in sports is typically referred to as a concussion (Moser et al., 2007). In an attempt at clarity and unification, a definition has been put forth by the American Congress of Rehabilitation Medicine (ACRM) that is endorsed by both the Centre of Disease Control and Prevention (CDC) and the World Health Organization (WHO). "
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    ABSTRACT: Traumatic Brain Injury (TBI) is a global health concern. The majority of TBI's are mild, yet our ability to diagnose and treat mild traumatic brain injury (mTBI) is lacking. This deficiency results from a variety of issues including the difficulty in interpreting ambiguous clinically presented symptoms, and ineffective imaging techniques. Thus, researchers have begun to explore cellular and molecular based approaches to improve both diagnosis and prognosis. This has been met with a variety of challenges, including difficulty in relating biological markers to current clinical symptoms, and overcoming our lack of fundamental understanding of the pathophysiology of mTBI. However, recent adoption of high throughput technologies and a change in focus from the identification of single to multiple markers has given just optimism to mTBI research. The purpose of this review is to highlight a number of current experimental peripheral blood biomarkers of mTBI, as well as comment on the issues surrounding their clinical application and utility.
    Frontiers in Neurology 05/2013; 4:44. DOI:10.3389/fneur.2013.00044
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    • "From 1997 to 2007, visits to emergency departments for sports concussion doubled in the 8–13 year old group; in 14–19 year olds, the incidence had increased by more than 200% (Bakhos et al., 2010). National organizations have established position statements regarding the identification and management of concussion (AAN, 1997, 2010; Guskiewicz et al., 2004; Moser et al., 2007). The Centers of Disease Control and Prevention have introduced educational programming and materials for schools, physicians, teams, and the general public in an effort to aggressively address this problem (CDC, 2010). "
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    ABSTRACT: Over the past decade, there has been a considerable increase in research on, and media attention to, sports-related concussion. However, despite accurate diagnosis, effective treatment and management of sports-related concussion have remained a challenge. There are approximately 1.8 million traumatic brain injuries in the United States annually (Faul et al., 2010) and emergency department pediatric visits for suspected concussion have doubled in the past decade (Bakhos et al., 2010). However, health care providers and medical researchers have yet to offer an effective, reliable evidence-based treatment for concussive brain injury. The Zurich 2008 Consensus Statement on Concussion in Sport codified the prescription for cognitive and physical rest immediately following a concussion based on clinical acumen and common sense (McCrory et al., 2009). Currently, rest is the considered the best immediate treatment for concussion. Other supportive and anecdotal treatments are often applied throughout the post-concussive recovery process to address persistent symptoms. The need for empirical research to translate current guidelines for rest into evidence-based treatment protocols is essential. A recent study evaluated the efficacy of comprehensive rest and concluded that such rest may be helpful whether applied soon after a concussion or weeks to months later (Moser et al., 2012). Here, we present a case illustrating the effectiveness of rest in a youth athlete, commenced after experiencing 13 months of post-concussion symptoms. There appears to be value in applying a specific period of cognitive and physical rest following concussion, whether immediately or later in the recovery phase.
    Frontiers in Neurology 12/2012; 3:171. DOI:10.3389/fneur.2012.00171
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