Article

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

ABSTRACT

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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    • "Typically, athletes are tested at the beginning of a season to obtain a baseline estimate of cognitive abilities. Players who sustain a concussion are then tested again, usually after symptoms have abated with postinjury data being compared to " baseline " data (Moser et al., 2007). The inclusion of neuropsychological testing in many concussion management protocols may help to ensure that athletes' cognitive abilities are similar to baseline levels before returning to competition. "
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    ABSTRACT: Computerized neuropsychological tests are frequently used to assist in return-to-play decisions following sports concussion. However, due to concerns about test reliability, the Centers for Disease Control and Prevention recommends yearly baseline testing. The standard practice that has developed in baseline/postinjury comparisons is to examine the difference between the most recent baseline test and postconcussion performance. Drawing from classical test theory, the present study investigated whether temporal stability could be improved by taking an alternate approach that uses the aggregate of 2 baselines to more accurately estimate baseline cognitive ability. One hundred fifteen English-speaking professional hockey players with 3 consecutive Immediate Postconcussion Assessment and Testing (ImPACT) baseline tests were extracted from a clinical program evaluation database overseen by the National Hockey League and National Hockey League Players' Association. The temporal stability of ImPACT composite scores was significantly increased by aggregating test performance during Sessions 1 and 2 to predict performance during Session 3. Using this approach, the 2-factor Memory (r = .72) and Speed (r = .79) composites of ImPACT showed acceptable long-term reliability. Using the aggregate of 2 baseline scores significantly improves temporal stability and allows for more accurate predictions of cognitive change following concussion. Clinicians are encouraged to estimate baseline abilities by taking into account all of an athlete's previous baseline scores.
    No preview · Article · Jan 2016 · Applied Neuropsychology: Adult
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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.
    Full-text · Article · May 2015 · The Clinical Neuropsychologist
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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.
    Full-text · Article · May 2013 · Frontiers in Neurology
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