Article

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

ABSTRACT

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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    • "Decrements in test performance or greater intraindividual variability in performance may indicate prolonged or persisting impairment (Collie, Makdissi, et al., 2006; Majerske et al., 2008). Despite some critical views towards baseline testing (Mayers & Redick, 2012; Randolph, 2011; Randolph, Lovell, & Laker, 2011; Randolph, McCrea, & Barr, 2005), it has been strongly recommended by many supporting studies (McCrory et al., 2013; Shuttleworth-Edwards, 2009, 2011). When properly used and interpreted, baseline testing may add useful information to the management of sport concussion by giving access to preinjury levels of cognitive functioning (McCrory et al., 2013; Shuttleworth-Edwards, 2011). "
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    ABSTRACT: Introduction: Mild traumatic brain injuries (MTBI) or concussions often result in problems with attention, executive functions, and motor control. For better identification of these diverse problems, novel approaches integrating tests of cognitive and motor functioning are needed. The aim was to characterize minor changes in motor and cognitive performance after sports-related concussions with a novel test battery, including balance tests and a computerized multilimb reaction time test. The cognitive demands of the battery gradually increase from a simple stimulus response to a complex task requiring executive attention. Method: A total of 113 male ice hockey players (mean age = 24.6 years, SD = 5.7) were assessed before a season. During the season, nine concussed players were retested within 36 hours, four to six days after the concussion, and after the season. A control group of seven nonconcussed players from the same pool of players with comparable demographics were retested after the season. Performance was measured using a balance test and the Motor Cognitive Test battery (MotCoTe) with multilimb responses in simple reaction, choice reaction, inhibition, and conflict resolution conditions. Results: The performance of the concussed group declined at the postconcussion assessment compared to both the baseline measurement and the nonconcussed controls. Significant changes were observed in the concussed group for the multilimb choice reaction and inhibition tests. Tapping and balance showed a similar trend, but no statistically significant difference in performance. Conclusion: In sports-related concussions, complex motor tests can be valuable additions in assessing the outcome and recovery. In the current study, using subtasks with varying cognitive demands, it was shown that while simple motor performance was largely unaffected, the more complex tasks induced impaired reaction times for the concussed subjects. The increased reaction times may reflect the disruption of complex and integrative cognitive function in concussions.
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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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    ABSTRACT: Athletic head trauma (both concussive and sub-concussive) is common among adolescents. Head trauma often is followed by motion sickness-like symptoms, by changes in cognitive performance, and by changes in standing body sway. We evaluated adolescent female boxers who did and did not report motion sickness after a bout (i.e., a boxing match), together with a control group of non-boxers. We asked whether pre-bout body sway would differ between boxers who experienced post-bout motion sickness and those who did not. In addition, we asked whether pre-bout cognitive performance would differ between non-boxers and boxers with and without post-bout motion sickness. Seven of twenty boxers reported motion sickness after a bout. Pre-bout measures of cognitive performance and body sway were different in boxers who reported post-bout motion sickness than in boxers without post-bout sickness or controls. The results suggest that susceptibility to motion sickness-like symptoms in adolescent female boxers may be manifested in characteristic patterns of body sway and cognitive performance. It may be possible to use pre-bout data to predict susceptibility to post-bout symptoms.
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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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    ABSTRACT: The purpose of this study was to use centre of pressure (COP) measurements to determine if static balance deficits had recovered when concussed athletes were cleared to return to play. Nine concussed varsity football players were matched with nine teammates who served as controls. Static balance in the anterior-posterior (A/P) and medial-lateral (M/L) directions was assessed during quiet stance with eyes open and eyes closed. Results showed that concussed football players displayed greater A/P COP displacements in the acute phase, which recovered by RTP; however, COP velocity remained elevated compared to controls even at RTP, particularly in the A/P direction. This balance control deficit in the A/P direction may suggest vestibular impairment, likely due to poor sensorimotor integration of the lateral vestibulospinal tract. The observed persistence of balance control deficits in concussed football players at RTP are usually undetected by traditional assessments because the current study used higher-order COP analysis. Future RTP balance measures may want to incorporate higher-order measures of balance.
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