Standard regression-based methods for measuring recovery after sport-related concussion

Neuroscience Center, Waukesha Memorial Hospital, Waukesha, WI 53188, USA.
Journal of the International Neuropsychological Society (Impact Factor: 2.96). 02/2005; 11(1):58-69. DOI: 10.1017/S1355617705050083
Source: PubMed


Clinical decision making about an athlete's return to competition after concussion is hampered by a lack of systematic methods to measure recovery. We applied standard regression-based methods to statistically measure individual rates of impairment at several time points after concussion in college football players. Postconcussive symptoms, cognitive functioning, and balance were assessed in 94 players with concussion (based on American Academy of Neurology Criteria) and 56 noninjured controls during preseason baseline testing, and immediately, 3 hr, and 1, 2, 3, 5, and 7 days postinjury. Ninety-five percent of injured players exhibited acute concussion symptoms and impairment on cognitive or balance testing immediately after injury, which diminished to 4% who reported elevated symptoms on postinjury day 7. In addition, a small but clinically significant percentage of players who reported being symptom free by day 2 continued to be classified as impaired on the basis of objective balance and cognitive testing. These data suggest that neuropsychological testing may be of incremental utility to subjective symptom checklists in identifying the residual effects of sport-related concussion. The implementation of neuropsychological testing to detect subtle cognitive impairment is most useful once postconcussive symptoms have resolved. This management model is also supported by practical and other methodological considerations.

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    • "We used a version of Graded Symptoms Checklist or GSC. The GSC is commonly used for early assessment of head trauma in children and adolescents (e.g., Grubenhoff et al. 2010) and in college football players (McCrea et al. 2005). "
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    • "Scoring System (BESS) is a component of the Sport Concussion Assessment Tool 2 (SCAT2) that reveals static balance deficits immediately after concussion; however these deficits typically recover within 3–5 days post injury [2]. Recent evidence suggests that learning effects [4] and decreased sensitivity over time [5] challenge the BESS reliability [3]. More objective measures to assess the recovery of balance impairments post-concussion are therefore warranted. "
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    • "In general, the findings on acute recovery have been favorable. A 2003 report was the first to plot the continuous time course of acute recovery within several days after concussion, indicating that more than 90% of athletes reported a symptom recovery within 1 week (McCrea et al., 2003, 2005). Several other prospective studies have since consistently demonstrated that the overwhelming majority of athletes achieve a complete recovery in symptoms, cognitive functioning, postural stability, and other functional impairments over a period of approximately one to two weeks following concussion (Belanger & Vanderploeg, 2005; Broglio & Puetz, 2008; Collins et al., 1999; Guskiewicz et al., 2003; Macciocchi, Barth, Alves, Rimel, & Jane, 1996). "
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