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Tracking recovery from concussion using ImPACT: applying reliable change methodology
... The order of the tests was not randomized due to the authors' intention of determining the impact of the English test on non-native English speakers. The authors' felt exposure to the test in the native language may have impacted the English scores even though the two-week period has shown a minimal practice effect [8,13]. The two-week testing period was selected secondary to its use in previous research. ...
... composite but no effect on the other reported scores [8,13]. ...
... The reliability [49][50][51][52] and validity [26,53,54] of the cognitive composite scores and the Postconcussion Symptom Scale [55][56][57], and the sensitivity of the battery to the acute effects of concussion [14,15,50,[58][59][60][61][62] have been examined in a number of studies. In three studies, the test-retest reliability of ImPACT over brief [49,50] and long [52] retest intervals was considered adequate, and in one study stability was poor [51]. ...
... The reliability [49][50][51][52] and validity [26,53,54] of the cognitive composite scores and the Postconcussion Symptom Scale [55][56][57], and the sensitivity of the battery to the acute effects of concussion [14,15,50,[58][59][60][61][62] have been examined in a number of studies. In three studies, the test-retest reliability of ImPACT over brief [49,50] and long [52] retest intervals was considered adequate, and in one study stability was poor [51]. In regards to concurrent validity, the ImPACT composites measuring speed and reaction time showed medium correlations with the Symbol Digit Modalities Test, Trails B, and Digit Symbol [26,53,54], and the memory composites showed medium to large correlations with the Brief Visuospatial Memory Test [26,53,54]. ...
Background. The literature on lingering or "cumulative" effects of multiple concussions is mixed. The purpose of this study was to examine whether athletes with a history of three or more concussions perform more poorly on neuropsychological testing or report more subjective symptoms during a baseline, preseason evaluation. Hypothesis. Athletes reporting three or more past concussions would perform more poorly on preseason neurocognitive testing. Study Design. Case-control study. Methods. An archival database including 786 male athletes who underwent preseason testing with a computerized battery (ImPACT) was used to select the participants. Twenty-six athletes, between the ages of 17 and 22 with a history of three or more concussions, were identified. Athletes with no history of concussion were matched, in a case-control fashion, on age, education, self-reported ADHD, school, sport, and, when possible, playing position and self-reported academic problems. Results. The two groups were compared on the four neuropsychological composite scores from ImPACT using multivariate analysis of variance followed by univariate ANOVAs. MANOVA revealed no overall significant effect. Exploratory ANOVAs were conducted using Verbal Memory, Visual Memory, Reaction Time, Processing Speed, and Postconcussion Scale composite scores as dependent variables. There was a significant effect for only the Verbal Memory composite. Conclusions. Although inconclusive, the results suggest that some athletes with multiple concussions could have lingering memory deficits.
... The ImPACT test is a valid and reliable measure of neurocognitive performance related to concussion. Using reliable change indices, repeated administrations over a 2-week period revealed no practice effects (Iverson, Lovell, Collins, & Norwig, 2002). In another study, Iverson, Lovell, and Collins (2005) reported 1-week testretest reliability coefficients for the composite scores as follows: 0.70 for verbal memory, 0.67 for visual memory, 0.79 for reaction time, and 0.86 for processing speed; within-subject comparisons revealed significant test-retest differences for only the processing speed composite scores. ...
... The results of the study indicated that there were no neurocognitive differences between African American and White participants at baseline. This finding together with previous research (e.g., Iverson et al., 2002Iverson et al., , 2005Schatz et al., 2006) on the validity of computerized neurocognitive concussion testing suggest that the ImPACT was a culturally equivalent and effective pre-morbid measure of neurocognitive performance across the two racial-ethnic groups in the current study. Also, in spite of the fact that the current normative data for the ImPACT computerized neurocognitive concussion testing were based on a primarily White sample, the current study's findings do not support the creation of separate normative values for African Americans, as there were no baseline differences between the groups. ...
The purpose of the current study was to explore potential differences in pre- and post-concussion performance on a computerized neurocognitive concussion test between African American and White high-school and collegiate student-athletes. A prospective case-control design was used to compare baseline and 2- and 7-day post-concussion computerized neurocognitive performance and symptoms between 48 White and 48 African American athletes matched for age, gender, and concussion history. The Immediate Post-Concussion Assessment Cognitive Test (ImPACT) version 2.0 (NeuroHealth System, LLC, Pittsburgh, PA, USA) computer software program was used to assess neurocognitive function (i.e., verbal and visual memory, motor processing speed, and reaction time) and concussion symptoms. Regardless of race/ethnicity, there were significant decrements in computerized neurocognitive performance and increased symptoms following a concussion for the entire sample. African Americans and Whites did not differ significantly on baseline or post-concussion verbal memory, visual memory, reaction time, and total reported symptoms. However, African American participants were 2.4× more likely to have at least one clinically significant cognitive decline on ImPACT at 7 days post-concussion and scored lower at 7 days post-concussion compared with baseline on processing speed than White participants. The authors concluded that the baseline ImPACT test was culturally equivalent and construct valid for use with these two racial/ethnic groups. However, in contrast, the findings support deleterious performance for the African American athletes compared with the White athletes on the ImPACT post-concussion evaluation that is of critical clinical relevance and warrants further research.
... The dependent measure is the total score derived from this 21-item scale. The reliability [31,32] and concurrent validity [33,34] of the cognitive composite scores and the Post-Concussion Symptom Scale [35][36][37] and the sensitivity of the battery to the acute effects of concussion [28,30,32,38,39] has been examined in a number of studies. ...
... These were calculated through a modification of the method proposed by Jacobson and Truax [40]. This methodology has been used extensively in clinical psychology [41][42][43][44][45][46][47], clinical neuropsychology [48][49][50][51][52][53] and sports neuropsychology [1,31,54]. The reliable change methodology allows the clinician to estimate measurement error surrounding testre-test difference scores. ...
The purpose of this study was to illustrate the serial use of computerized neuropsychological screening with ImPACT to monitor recovery in a clinical case series of injured athletes.
Amateur athletes with concussions (n= 30, average age= 16.1, SD= 2.1 years) underwent pre-season testing and three post-concussion evaluations within the following intervals: 1-2 days, 3-7 days (M= 5.2 days) and 1-3 weeks (M= 10.3 days). The study selection criteria increased the probability of including athletes with slow recovery.
Repeated measures ANOVAs revealed significant main effects for all five composite scores (verbal memory, visual memory, reaction time, processing speed and total symptoms). In group analyses, performance decrements and symptoms relating to concussion appeared to largely resolve by 5 days post-injury and fully resolve by 10 days. Athletes' scores were examined individually using the reliable change methodology. At 1 day post-injury, 90% had two or more reliable declines in performance or increases in symptom reporting. At 10 days, 37% were still showing two or more reliable changes from pre-season levels.
This study illustrates the importance of analysing individual athletes' test data because group analyses can obscure slow recovery in a substantial minority of athletes.
... These results align with previous findings in which Blacks scored lower than Whites on neuropsychological measures assessing language, attention, processing speed, constructional skill, and select executive skills [12]. However, our findings contradict previous research regarding neurocognitive assessment differences at baseline between White and Black athletes [28,[34][35][36]. Kontos and colleagues [28] reported that there were no differences between White and Black athletes on baseline neurocognitive measures using the ImPACT Test Battery. ...
Background:
National Collegiate Athletic Association (NCAA) concussion guidelines state that all NCAA athletes must have a concussion baseline test prior to commencing their competitive season. To date, little research has examined potential racial differences on baseline neurocognitive performance among NCAA athletes. The purpose of this study was to investigate differences between Black and White collegiate athletes on baseline neurocognitive performance and self-reported symptoms.
Methods:
A total of 597 collegiate athletes (400 White, 197 Black) participated in this study. Athletes self-reported their race on the demographic section of their pre-participation physical examination and were administered the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) neurocognitive battery in a supervised, quiet room. Controlling for sex, data were analyzed using separate one-way analyses of covariance (ANCOVAs) on symptom score, verbal and visual memory, visual motor processing speed, and reaction time composite scores.
Results:
Results revealed significant differences between White and Black athletes on baseline symptom score (F (1,542) = 5.82, p = .01), visual motor processing speed (F (1,542) = 14.89, p < .001), and reaction time (F (1,542) = 11.50, p < .01). White athletes performed better than Black athletes on baseline visual motor processing speed and reaction time. Black athletes reported higher baseline symptom scores compared to Whites. There was no statistical difference between race on verbal memory (p = .08) and that on visual memory (p = .06).
Conclusions:
Black athletes demonstrated disparities on some neurocognitive measures at baseline. These results suggest capturing an individual baseline on each athlete, as normative data comparisons may be inappropriate for athletes of a racial minority.
... There are techniques available for calculating clinically meaningful change in neurocognitive test scores over time. For example, researchers in clinical neuropsychology (Chelune, Naugle, Luders, Sedlak, & Awad, 1993;Heaton et al., 2001;Iverson, 1998Iverson, , 1999Iverson, , 2001Temkin, Heaton, Grant, & Dikmen, 1999) and sports neuropsychology (Barr & McCrea, 2001; Hinton-Bayre, Geffen, Geffen, McFarland, & Friis, 1999;Iverson, Lovell, Collins, & Norwig, 2002) have recommend computing reliable change estimates through a modification of the method proposed by Jacobson and Truax (1991). The reliable change methodology, which is calculated using the standard deviations from time 1 and 2 and the test-retest coefficient, allows the clinician to estimate measurement error surrounding test-retest difference scores and determine if there has been a clinically meaningful change. ...
... The test stimuli are randomized from one testing session to another. This allows for the test battery to be used repeatedly over short intervals, while controlling for practice effects (Iverson, Lovell, Collins, & Norwig, 2002;Maroon et al., 2000). Most examiners can administer the battery after a few hours of instruction and review of materials, and little supervision of the test-taker is required (Maroon et al., 2000). ...
... The largest decline in performance was at the 36-h testing, with a mean decline of 8.4 points. It should be noted, however, that the 90% confidence interval for change on this measure was reported to be 12.82 points (9). This would suggest that, even at the 36-h test interval, the majority of the injured athletes were within the 90% testretest confidence interval of measurement reliability. ...
Baseline neuropsychological testing is mandated at various levels of play for hundreds of thousands of athletes each year. This paper reviews the risks associated with sport-related concussion, and the clinical validity and reliability data for the most commonly used baseline test, the ImPACT program. There is no evidence to suggest that the use of baseline testing alters any risk from sport-related concussion, nor is there even a good rationale as to how such tests might influence outcome. Given the poor sensitivity and low reliability of these measures, they have an associated high false negative rate (i.e., classifying a player's neurocognitive status is normal, when in fact, it is not). The use of baseline neuropsychological testing, therefore, is not likely to diminish risk, and to the extent that there is a risk associated with "premature" return-to-play, the use of these measures even may increase that risk in some cases.
... 17 Using reliable change indices (RCI), repeated administrations over a 2-week period revealed no practice effects. 18 Schatz et al documented a combined sensitivity of 81.9% for ImPACT indices and total symptom score, and a specificity of 89.4%; the positive likelihood ratio was approximately 8:1, and the negative likelihood ratio was 2:1. ...
The purpose of this study was to examine, using a dose-response model, sex differences in computerised neurocognitive performance among athletes with a history of multiple concussions.
Retrospective with randomly selected concussion cases from four levels/numbers of previous concussion.
Multicentre analysis of NCAA student-athletes.
Subjects included a total of 100 male and 88 female NCAA athletes.
Sex and four mutually exclusive groups of self-reported concussion history: (1) no history of concussion, (2) one previous concussion, (3) two previous concussions, (4) three or more previous concussions.
Neurocognitive performance as measured by a computerised neurocognitive test battery (Immediate Postconcussion Assessment Cognitive Testing (ImPACT)).
A dose-response gradient was found for two or more previous concussions and decreased neurocognitive performance. Females with a history of two and three or more concussions performed better than males with a history of two (p=0.001) and three or more concussions (p=0.012) on verbal memory. Females performed better than males with a history of three or more concussions (p=0.021) on visual memory. Finally, there was a significant difference for sex on both motor processing speed and reaction-time composite scores. Specifically, males performed worse than females on both processing speed (p=0.029) and reaction time (p=0.04).
The current study provided partial support for a dose-response model of concussion and neurocognitive performance decrements beginning at two or more previous concussions. Sex differences should be considered when examining the effects of concussion history on computerised neurocognitive performance.
... Reliable change estimates were derived from a modification of the method proposed by Jacobson and Truax (1991). This methodology has been used extensively in clinical psychology (Hageman & Arrindell, 1993; Hsu, 1989; Jacobson & Revenstorf, 1988; Jacobson, Roberts, Berns, & McGlinchey, 1999; Ogles, Lambert, & Masters, 1996; Speer, 1992; Speer & Greenbaum, 1995), clinical neuropsychology (Chelune, Naugle, Luders, Sedlak, & Awad, 1993; Heaton et al., 2001; Iverson, 1998 Iverson, , 1999 Iverson, , 2001 Temkin, Heaton, Grant, & Dikmen, 1999), and sports neuropsychology (Barr & McRea, 2001; Hinton-Bayre, Geffen, Geffen, McFarland, & Friis, 1999; Iverson et al., 2002c). The reliable change methodology allows the clinician to estimate measurement error surrounding test-retest difference scores. ...
The purpose of this study was to examine the psychometric characteristics of Version 2.0 of ImPACT (Immediate Postconcussion Assessment and Cognitive Testing). The focus was on the stability of the test scores and the calculation of reliable change confidence intervals for the test-retest difference scores. A sample of 56 nonconcussed adolescents and young adults completed the test battery on two occasions. Test-retest coefficients, reliable change difference scores, and confidence intervals for measurement error are provided. These reliable change parameters were applied to a second sample of 41 concussed amateur athletes who were tested preseason and within 72 hr of injury. Applying these confidence intervals allows more precise determinations of deterioration, improvement, and recovery in the initial days following concussion.
... 4 Using reliable change indices, repeated administrations over a 2-week period revealed no practice effects. 2 Correlations between ImPACT visual and verbal memory composites with the Brief Visual Spatial Memory Test-Revised total score (r = 0.50) and the delayed recall score (r = 0.85) have been established 21 ; the processing speed composite was shown to correlate with the Trailmaking Tests A (r 20.49) and B (r 20.60), and the Symbol-Digit Modalities test (r = 0.68). More recently, Schatz et al 20 examined the sensitivity and specificity of the ImPACT test on individuals diagnosed as having a concussion. ...
To examine the effects of a maximal exercise test on cognitive function in recreational athletes.
A repeated-measures design was used to compare baseline with post-cognitive function and fatigue symptoms after a maximal exercise test.
Division 1 American Midwestern University, (Michigan State University, Michigan, USA).
102 male and female recreational athletes.
Participants in the experimental group (n = 54) were asked to perform a maximal treadmill exercise test to maximal oxygen uptake (VO2 max). Participants in the control group were asked to rest for 15 min.
All participants were administered a neuropsychological test battery called Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) before and after exercise to measure neurocognitive function and fatigue symptoms.
Results revealed a significant group (control, experimental) x time (baseline, post-test 1, post-test 2) interaction for verbal memory composite scores (p = 0.025). Specifically, verbal memory composite scores decreased in the experimental group from baseline to post-test 1 (p = 0.00). These values returned to baseline 3 days after the VO2 max test (p = 0.00). Further analysis on verbal memory composite scores demonstrated significant differences on immediate recall memory (p = 0.00) and delayed recall memory (p = 0.00). No significant differences were observed for visual memory (p = 0.54), motor processing speed (p = 0.68) and reaction time (p = 0.44) composite scores between the experimental and control groups.
The results of this study suggest that a maximal exercise test attenuated a limiting effect on cognitive function. When utilising a neuropsychological test battery to evaluate a patient who has sustained a head injury, the test should not be administered immediately after a practice or a game session.
... 35 Test-retest reliability for ImPACT was assessed for 8 days, across 4 administrations, yielding correlation coefficients ranging from 0.66 to 0.85 for the verbal memory index, 0.75 to 0.88 for the processing speed index, and 0.62 to 0.66 for the reaction time index. 27 Using reliable change indices, repeated administrations for a 2-week period revealed no practice effects. 24 In another study, 1-week test-retest reliability coefficients were as follows: 0.70 for verbal memory; 0.67 for visual memory; 0.79 for reaction time; and 0.86 for processing speed, with significant testretest differences for only the processing speed composite scores 36 within subject comparisons. ...
Biomechanical analyses suggest that the loss of neuromuscular control is associated with noncontact anterior cruciate ligament sprains; however, previous research has not explored the link between neurocognitive function and unintentional knee injuries.
To determine if athletes who suffer a noncontact anterior cruciate ligament injury demonstrate decreased baseline neurocognitive performance when compared with matched controls.
Case control study; Level of evidence, 3.
The baseline scores from a computerized neurocognitive test battery (ImPACT) were analyzed to compare verbal memory, visual memory, processing speed, and reaction time. Eighty intercollegiate athletes who, subsequent to testing, experienced noncontact anterior cruciate ligament injuries, were matched with 80 controls based on height, weight, age, gender, sport, position, and years of experience at the collegiate level.
Statistical differences were found between the noncontact anterior cruciate ligament injury group and the matched controls on all 4 neurocognitive subtests. Noncontact anterior cruciate ligament-injured athletes demonstrated significantly slower reaction time (F(1,158) = 9.66, P = .002) and processing speed (F(1,158) = 12.04, P = .001) and performed worse on visual (F(1,158) = 19.16, P = .000) and verbal memory (F(1,158) = 4.08, P = .045) composite scores when compared with controls.
Neurocognitive differences may be associated with the loss of neuromuscular control and coordination errors, predisposing certain intercollegiate athletes to noncontact anterior cruciate ligament injuries.
Objective: The objective of the study was to investigate the neurocognitive effects of repetitive concussive events in players of club level Rugby Union (hereafter rugby) over the course of one rugby season. Participants and Method: Amateur adult club level rugby players (n = 20) who were not formally diagnosed with a concussion during the season, were compared with a non-contact control group (n = 22) of equivalent age, years of education and estimated IQ, at three test intervals: pre-, mid-and postseason. Measures included the ImPACT Verbal and Visual Memory, Visual Motor Speed and Reaction Time composites, and the Purdue Pegboard. Independent and dependent statistical analyses were employed to compare the rugby versus control group neurocognitive test profiles across the three test intervals. Video analyses documented the tackling events for the players during all matches across the rugby season. Results: The results implicated vulnerability amongst club rugby players on the motor and speeded tasks, with less robust indications on the memory tasks. Tackling analyses revealed a sobering seasonal average of more than one hundred tackles per player, excluding any contact practice sessions, and five observed incidences of unreported concussion. Conclusions: The results implicate deleterious neurocognitive effects in participants of a sport such as rugby due to repetitive head jarring incidents that are intrinsic to the game, and not always recognized. For enhanced sensitivity to neurocognitive effects, test refinements on the Memory Composite of the ImPACT test are proposed, and the inclusion of a test of hand motor function.
To extend previous research designs and examine cognitive performance up to 30 days postconcussion.
A prospective cohort design was used to examine 2000 athletes from 8 mid-Michigan area high schools to compare baseline neurocognitive performance with postconcussion neurocognitive performance. All concussed athletes were readministered the Immediate Post Assessment and Cognitive Test (ImPACT) at 2, 7, 14, 21, and 30 days postconcussion.
A total of 72 high school athletes (aged 15.8 ± 1.34 years) sustained a concussion. A significant within-subjects effect for reaction time (F = 10.01; P = 0.000), verbal memory (F = 3.05; P = 0.012), motor processing speed (F = 18.51; P = 0.000), and total symptoms following an injury (F = 16.45; P = 0.000) was found. Concussed athletes demonstrated a significant decrease in reaction time up to 14 days postconcussion (P = 0.001) compared with baseline reaction time. Reaction time returned to baseline levels at 21 days postinjury (P = 0.25). At 7 days postinjury, impairments in verbal memory (P = 0.003) and motor processing speed (P = 0.000) were documented and returned to baseline levels by 14 days postinjury. Concussed athletes self-reported significantly more symptoms at 2 days postconcussion (P = 0.000) and exhibited a resolution of symptoms by 7 days postinjury (P = 0.06).
High school athletes could take up to 21 days to return to baseline levels for reaction time. These data support current recommendations for the conservative management of concussion in the high school athlete.
Several published meta-analyses indicate that mild traumatic brain injury (MTBI) is associated with a favourable course of recovery over a period of days-to-weeks, with no indication of permanent impairment on neuropsychological testing by 3 months post-injury in group studies. These meta-analyses provide important but not definitive information relating to outcome from MTBI in individual patients. The purpose of this paper was to illustrate that a sub-group of patients with residual cognitive deficits could exist, yet be obscured using group inferential statistics.
A sample of 30 concussed amateur athletes and a hypothetical sample of 30 adults who had sustained MTBIs were used to illustrate these statistical issues. In both groups, a minority of subjects with residual cognitive deficits were not identified using group statistics.
It is important to appreciate that MTBI meta-analyses represent an aggregation of effect sizes derived from multiple groups across multiple studies. Therefore, this methodology could, theoretically, obscure small sub-group or individual effects. Implications for interpreting meta-analyses are discussed.
Computerized programs are widely used as part of the overall medical management of concussion in order to monitor recovery and facilitate safe return-to-play decisions. Typically, neurocognitive profiles of concussed athletes are compared with baseline and/or normative data in the absence of baseline scores. However, the cultural equivalence of performance on neuropsychological tests cannot be assumed and has not been sufficiently researched. The purpose of this study was to investigate the neuropsychological test profiles of the ImPACT (Immediate Postconcussion Assessment and Cognitive Testing) on age-matched South African (SA) rugby and US football players. Participants included 11 257 English-speaking, predominantly white male athletes from multiple SA and US schools and sports organizations in 3 age groups: 11 to 13 years (SA, n = 301; US, n = 775); 14 to 16 years (SA, n = 997; US, n = 4081); and 17 to 21 years (SA, n = 319; US, n = 4784). ImPACT neurocognitive composite scores (verbal and visual memory, visual motor speed, reaction time, impulse control) and the ImPACT total symptom score, derived from the initial baseline testing, were used for comparison purposes between the targeted groups. Independent t-test comparisons revealed overall equivalence between the SA and US athletes on the neurocognitive measures, but they also revealed consistently higher symptom scores for SA athletes in association with clinically relevant effect sizes. It was concluded that US neurocognitive normative data on the ImPACT test are appropriate for use on South African athletes whose first language is English, whereas culture-specific sensitivity for symptom reporting on this same population should be taken into consideration for management purposes. It is argued that neurocognitive equivalence is less likely to apply in educationally disadvantaged populations. The use of registered psychologists is deemed necessary to provide contextualized interpretations of computerized test scores, thereby protecting against misdiagnosis that may occur within the concussion management arena via actuarial approaches that fail to take sociocultural complexities into account.
Investigate the relationship between on-field markers of concussion severity and postinjury neuropsychological and symptom presentation in an athlete-specific population.
Case control study.
Multicenter analysis of high school and college athletes.
A total of 78 athletes sustaining sports-related concussion were selected from a larger sample of 139 concussed athletes. ASSESSMENT OF PREDICTOR VARIABLES: On-field presence of disorientation, posttraumatic amnesia, retrograde amnesia, and loss of consciousness.
ImPACT, a computerized neuropsychological test battery, was administered pre-season and, on average, 2 days postinjury. Good postinjury presentation (n = 44) was defined as no measurable change, relative to baseline, in terms of both ImPACT memory and symptom composite scores. Poor presentation (n = 34) was defined as a 10-point increase in symptom reporting and 10-point decrease in memory functioning (exceeding the 80% confidence interval for measurement error on ImPACT). Athletes failing to meet good or poor selection criteria (n = 61) were not included in the analysis.
Odds ratios revealed that athletes demonstrating poor presentation at 2 days postinjury were over 10 times more likely (P < 0.001) to have exhibited retrograde amnesia following concussive injury when compared with athletes exhibiting good presentation. Similarly, athletes with poor presentation were over 4 times more likely (P < 0.013) to have exhibited posttraumatic amnesia and at least 5 minutes of mental status change. There were no differences between good and poor presentation groups in terms of on-field loss of consciousness.
The presence of amnesia, not loss of consciousness, appears predictive of symptom and neurocognitive deficits following concussion in athletes. Athletes presenting with on-field amnesia should undergo comprehensive and individualized assessment prior to returning to sport participation. Continued refinement of sports concussion grading scales is warranted in lieu of consistent findings that brief loss of consciousness is not predictive of concussion injury severity.
Sports medicine clinicians and the general public are interested in the possible cumulative effects of concussion.
To examine whether athletes with a history of one or two previous concussions differed in their preseason neuropsychological test performances or symptom reporting. Method: Participants were 867 male high school and university amateur athletes who completed preseason testing with ImPACT version 2.0. They were sorted into three groups on the basis of number of previous concussions. There were 664 athletes with no previous concussions, 149 with one previous concussion, and 54 with two previous concussions. Multivariate analysis of variance was conducted using the verbal memory, visual memory, reaction time, processing speed, and postconcussion symptom composite scores as dependent variables and group membership as the independent variable.
There was no significant multivariate effect, nor were there any significant main effects for individual scores. There was no measurable effect of one or two previous concussions on athletes' preseason neuropsychological test performance or symptom reporting.
If there is a cumulative effect of one or two previous concussions, it is very small and undetectable using this methodology.
The purpose of this study was to compare concussion rates and recovery times for athletes wearing newer helmet technology compared to traditional helmet design.
This was a three-year, prospective, naturalistic, cohort study. Participants were 2,141 high school athletes from Western Pennsylvania. Approximately half of the sample wore the Revolution helmet manufactured by Riddell, Inc. (n = 1,173) and the remainder of the sample used standard helmets (n = 968). Athletes underwent computerized neurocognitive testing through the use of ImPACT at the beginning of the study. Following a concussion, players were reevaluated at various time intervals until recovery was complete.
In the total sample, the concussion rate in athletes wearing the Revolution was 5.3% and in athletes wearing standard helmets was 7.6% [chi (1, 2, 141) = 4.96, P < 0.027]. The relative risk estimate was 0.69 (95% confidence interval = 0.499- 0.958). Wearing the Revolution helmet was associated with approximately a 31% decreased relative risk and 2.3% decreased absolute risk for sustaining a concussion in this cohort study. The athletes wearing the Revolution did not differ from athletes wearing standard helmets on the mechanism of injury (e.g., head-to-head strike), on-field concussion markers (e.g., amnesia or loss of consciousness), or on-field presentation of symptoms (e.g., headaches, dizziness, or balance problems).
Recent sophisticated laboratory research has better elucidated injury biomechanics associated with concussion in professional football players. This data has led to changes in helmet design and new helmet technology, which appears to have beneficial effects in reducing the incidence of cerebral concussion in high school football players.
To investigate sex differences in baseline neuropsychological function and concussion symptoms between male and female collegiate athletes.
A post-test only design was used to examine baseline neuropsychological test scores and concussion symptoms. A total of 1209 NCAA Division I collegiate athletes from five northeastern universities in the USA completed a baseline ImPACT test. ImPACT, a computerised neuropsychological test battery, was administered during an athlete's pre-season.
Female athletes performed significantly better than male athletes on baseline verbal memory scores (p = 0.001), while male athletes performed significantly better than female athletes on baseline visual memory scores (p = 0.001). Female athletes endorsed a significant number of mild baseline symptoms as compared to male athletes.
Male and female athletes exhibit differences on baseline neuropsychological test performance and concussion symptoms.
Following the Second International Conference on Concussion in Sport in 2005, a summary agreement statement was published that introduced new terminology for sport-related concussions. This new classification system is binary (ie, "simple" versus "complex" concussions). Athletes who are slow to recover (ie, >10 days) are classified as having complex concussions. The purpose of this study was to determine if high school football players, retrospectively classified as having a simple or a complex concussion, could be differentiated in the first 48 after injury on the basis of symptom reporting or neuropsychological testing.
Case-control study.
Pennsylvania high school football programs.
The total sample consisted of 114 concussed high school football players who were identified through a 3 year prospective cohort study.
All completed a computerized neuropsychological screening evaluation within 72 hours of injury. They were followed clinically until they recovered and were cleared to return to play. They were classified retrospectively as having a simple (n = 55) or complex (n = 59) concussion based on their recovery times.
Neurocognitive test performance and symptom ratings.
Within 72 hours after injury, athletes with complex concussions performed more poorly on neuropsychological testing and reported more symptoms than those with simple concussions. Athletes with complex concussions who were slow to recover were 18 times more likely to have 3 unusually low neuropsychological test scores than those with simple concussions (95% CI = 2.3-144.9). Athletes with previous concussions did not recover more slowly.
This study provides evidence that supports and refutes the clinical usefulness of the new simple-complex concussion classification system.
To investigate in recreational runners the 3 month prognosis of and medical consumption caused by running injuries occurring shortly before or during a marathon. Possible prognostic factors for persistent complaints were also evaluated.
Prospective cohort study.
Rotterdam, the Netherlands.
One hundred sixty-five recreational marathon runners who reported a new running injury in the month before or during the Rotterdam Marathon 2005 and who were available for follow-up. ASSESSMENT OF DETERMINANTS: Demographic, running (training distance, frequency and duration, experience, etc), lifestyle (other sports, smoking), and injury-related factors were collected at baseline.
Persistent complaints of running injuries occurring in the month before or during the Rotterdam marathon at 3 month follow-up. Potential prognostic factors for persistent complaints were analyzed by multivariate logistic regression.
At 3 month follow-up, 25.5% of the 165 injured runners reported persistent complaints; they had little pain during exercise and almost no pain in rest. Of all 165 male runners, 27 (16.4%) visited a general practitioner because of their running injury and 40 (24.2%) visited a physiotherapist (218 times in total). Persistent complaints at 3 month follow-up were associated with non-musculoskeletal comorbidities [odds ratio (OR), 3.23; confidence interval (CI), 1.24-8.43], and calf injuries (OR, 0.37; CI, 0.13-1.05).
One quarter of the runners had persistent complaints of their marathon-related running injury at 3 month follow-up. However, the clinical and social consequences of the injuries seem to be relatively mild. Non-musculoskeletal comorbidities at baseline are related to poor recovery, whereas recovery is also location specific.
Our purpose was to determine whether sex differences exist with respect to post-concussion symptoms and neurocognitive function in concussed collegiate athletes.
A prospective dependent-sample cohort design was used to compare baseline and post-concussion neuropsychological test scores and endorsed symptoms as functions of serial post-concussion assessment with respect to time and sex. The Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) battery was administered to a multicenter analysis group of 79 concussed athletes. This computerized neuropsychological test was given to the athletes during the preseason and, on average, 2 and 8 days postinjury.
Multivariate analyses revealed no significant between-group differences on baseline test performance with respect to sex on any of the ImPACT composite scores or on the total symptom score. Multivariate analyses of post-concussion data revealed a significant main effect of time on ImPACT scores, but no main effect of sex was identified, and no time-by-sex interaction existed. Post hoc analysis revealed that concussed female athletes performed significantly worse than concussed male athletes on visual memory tasks (P = 0.001), and analysis of endorsed post-concussion symptoms revealed that concussed men were significantly more likely than concussed women to report post-concussion symptoms of vomiting (P = 0.001) and sadness (P = 0.017). Athletes' scores were examined individually using the reliable-change methodology. At 2 days post-injury, 58% of concussed athletes had one or more reliable incidents of performance decline or increases in symptom reporting. At 8 days post-concussion, 30% of concussed athletes were still showing one or more reliable change from preseason values.
College athletes exhibit differences on visual memory composite scores and symptoms post-concussion as a function of sex. These data support the importance of evaluating neuropsychological status and post-concussion symptoms in concussed athletes. In addition, these data illustrate the importance of analyzing an individual athlete's recovery pattern, because individual differences in recovery trajectories may be overshadowed by global norm-group comparisons.
University rugby players were compared with IQ-equivalent noncontact sports controls on memory and attentional tasks at the pre- and postseason intervals. Results revealed significant lowering for rugby players relative to controls at the postseason interval for attentional tasks with a speeded visuomotor component (ImPACT Visual Motor Speed; Trail Making Test, TMT, A and B). There was a practice effect for controls only between the pre- and postseason intervals for attentional tasks that commonly reveal improvements after a long retest interval (TMT A and B; Digits Backwards). Medium to large effect sizes implicate clinically relevant cognitive vulnerability for university-level rugby players in association with years of exposure to repetitive concussive injury.
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