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: 4.36). 06/2009; 37(9):1699-704. DOI: 10.1177/0363546509332497
Source: PubMed


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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    • "Specifically, the investigators reported that females endorsed a higher total symptom score than males at all time points that were examined (i.e., baseline and 2, 7, and 14 days postconcussion). Though this finding is important , and consistent with several previous studies (Broshek et al., 2005; Colvin et al., 2009; Preiss- Farzanegan, Chapman, Wong, Wu, & Bazarian, 2009), specificity is lacking regarding symptom types and severity responsible for the reported group differences. Although there are some advantages to evaluating total symptom scores—namely, the PCSS total score is quick and easy to calculate and to compare to other variables of interest—the total score, as noted above, does not allow for a complete understanding of athletes' symptom-reporting patterns. "
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    ABSTRACT: Self-report measures such as the Post-Concussion Symptom Scale (PCSS) are frequently used during baseline and postconcussion testing to evaluate athletes' symptom profiles. However, the common approach of evaluating the total symptom score and/or symptom clusters may not allow for a complete understanding of the nature of athletes' symptom reporting patterns. The primary objective of this study was to apply three "global indices of distress" variables, derived from the Symptom Checklist-90-Revised (SCL-90-R) framework, to the PCSS at baseline and postconcussion. We aimed to evaluate the utility of these symptom indices in relation to four PCSS symptom clusters and the total PCSS symptom score. Participants included college athletes evaluated at baseline (N = 846) and postconcussion (N = 86). Athletes underwent neuropsychological testing at both time points, including completion of the PCSS and a paper/pencil and computerized test battery. Eight symptom indices were derived from the PCSS, and a postconcussion neurocognitive composite score was calculated. Results showed that there were significant mean increases from baseline to postconcussion on four of the eight symptom indices evaluated. Furthermore, a significant proportion of athletes showed no change from baseline to postconcussion when evaluating the total symptom score, but showed at least a one standard deviation increase in symptom reporting from baseline to postconcussion when evaluating at least one other symptom index (i.e., a global index of distress or symptom cluster). Finally, the three global indices of distress variables, two of the four symptom clusters, and the total symptom score significantly predicted a postconcussion neurocognitive composite score, such that greater postconcussion symptoms were associated with lower postconcussion neurocognitive performance. These findings suggest that, in addition to evaluating the postconcussion total symptom score, there may be value in examining more specific symptom indices such as the global indices of distress variables and symptom clusters.
    Full-text · Article · Aug 2015 · Journal of Clinical and Experimental Neuropsychology
    • "Females tend to report more post-concussion symptoms than males (Covassin et al., 2013;Covassin et al., 2012;Covassin, Schatz, & Swanik, 2007;Frommer et al., 2011), however these differences are not as robust or consistent on more objective assessments. Studies utilizing computerized neurocognitive testing have documented lower post-concussion neurocognitive performance for females compared to males (Colvin et al., 2009;Covassin et al., 2013;Covassin et al., 2012;Covassin et al., 2007), however these post-concussion sex differences have not been consistently supported (Zuckerman et al.). In addition, post-concussion sex differences have not been supported on measures of postural stability (Covassin et al., 2012). "

    No preview · Article · Jan 2015 · Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders
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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.
    Full-text · Article · Nov 2014
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