Relationship between concussion and neuropsychological performance in college football players

Concussions in hockey: there is cause for concern

PURPOSE

The purpose of the study was to document various aspects of concussion in Canadian Amateur hockey including demographics, causes, treatment, and prevention in order to guide future recommendations on how to reduce injury.

METHODS

A detailed prospective and retrospective concussion history was obtained from British Columbia Junior Hockey League players over the course of two seasons (1998-2000).

RESULTS

Higher rates of concussions occur in games versus practice, and there was an overrepresentation of forwards injured versus defensemen or goaltenders. There was between 4.63 and 5.95 concussions per 1000 player/game hours with the average age of the first hockey-related concussion in the 15th year. The greatest cause of concussion was contact with the ice and/or the boards. Fighting was not a major cause of concussion, although other illegal actions such as elbowing were.

CONCLUSIONS

The primary recommendation to reduce the number and severity of concussions is to eliminate plays where there is a demonstrable intent to injure another player. Concussions in hockey are of considerable concern; however, there is now encouraging information with respect to the treatment of these injuries.

Mild head injury increasing the brain's vulnerability to a second concussive impact

OBJECT

Mild, traumatic repetitive head injury (RHI) leads to neurobehavioral impairment and is associated with the early onset of neurodegenerative disease. The authors developed an animal model to investigate the behavioral and pathological changes associated with RHI.

METHODS

Adult male C57BL/6 mice were subjected to a single injury (43 mice), repetitive injury (two injuries 24 hours apart; 49 mice), or no impact (36 mice). Cognitive function was assessed using the Morris water maze test, and neurological motor function was evaluated using a battery of neuroscore, rotarod, and rotating pole tests. The animals were also evaluated for cardiovascular changes, blood-brain barrier (BBB) breakdown, traumatic axonal injury, and neurodegenerative and histopathological changes between 1 day and 56 days after brain trauma. No cognitive dysfunction was detected in any group. The single-impact group showed mild impairment according to the neuroscore test at only 3 days postinjury, whereas RHI caused pronounced deficits at 3 days and 7 days following the second injury. Moreover, RHI led to functional impairment during the rotarod and rotating pole tests that was not observed in any animal after a single impact. Small areas of cortical BBB breakdown and axonal injury. observed after a single brain injury, were profoundly exacerbated after RHI. Immunohistochemical staining for microtubule-associated protein-2 revealed marked regional loss of immunoreactivity only in animals subjected to RHI. No deposits of beta-amyloid or tau were observed in any brain-injured animal.

CONCLUSIONS

On the basis of their results, the authors suggest that the brain has an increased vulnerability to a second traumatic insult for at least 24 hours following an initial episode of mild brain trauma.

Concussions among university football and soccer players: a pilot study

OBJECTIVE

A pilot study to examine the incidence and characteristics of concussions for one season of university football and soccer.

DESIGN

Retrospective survey.

PARTICIPANTS

60 football and 70 soccer players reporting to 1998 fall training camp. Of these, 44 football and 52 soccer players returned a completed questionnaire.

MAIN OUTCOME MEASURES

Based on self-reported symptoms, calculations were made to determine the number of concussions experienced during the previous season, the duration of symptoms, the time for return to play and any associated risk factors for concussions.

RESULTS

Of all the athletes who returned completed questionnaires, 34.1% of the football players and 46.2% of the soccer players had experienced symptoms of a concussion during the previous season. Only 16.7% of the concussed football players and 29.2% of the concussed soccer players realized they had suffered a concussion. All of the concussed football players and 75.0% of the concussed soccer players experienced more than one concussion during the season. The symptoms from the concussion lasted for at least 1 day in 28.6% of the football players and 18.1% of the soccer players. Variables that increased the odds of suffering a concussion during the previous season for football and soccer players included a past history of a recognized concussion.

CONCLUSION

More university soccer players than football players may be experiencing sport related concussions. Variables that seem to increase the odds of suffering a concussion during the previous season for football and soccer players include a history of a recognized concussion. Despite being relatively common, many players may not recognize the symptoms of a concussion.

Heading and head injuries in soccer

In the world of sports, soccer is unique because of the purposeful use of the unprotected head for controlling and advancing the ball. This skill obviously places the player at risk of head injury and the game does carry some risk. Head injury can be a result of contact of the head with another head (or other body parts), ground, goal post, other unknown objects or even the ball. Such impacts can lead to contusions, fractures, eye injuries, concussions or even, in rare cases, death. Coaches, players, parents and physicians are rightly concerned about the risk of head injury in soccer. Current research shows that selected soccer players have some degree of cognitive dysfunction. It is important to determine the reasons behind such deficits. Purposeful heading has been blamed, but a closer look at the studies that focus on heading has revealed methodological concerns that question the validity of blaming purposeful heading of the ball. The player's history and age (did they play when the ball was leather and could absorb significant amounts of water), alcohol intake, drug intake, learning disabilities, concussion definition and control group use/composition are all factors that cloud the ability to blame purposeful heading. What does seem clear is that a player's history of concussive episodes is a more likely explanation for cognitive deficits. While it is likely that the subconcussive impact of purposeful heading is a doubtful factor in the noted deficits, it is unknown whether multiple subconcussive impacts might have some lingering effects. In addition, it is unknown whether the noted deficits have any affect on daily life. Proper instruction in the technique is critical because if the ball contacts an unprepared head (as in accidental head-ball contacts), the potential for serious injury is possible. To further our understanding of the relationship of heading, head injury and cognitive deficits, we need to: learn more about the actual impact of a ball on the head, verify the exposure to heading at all ages and competitive levels, determine stable estimates of concussive injury rates across the soccer spectrum, conduct prospective longitudinal studies on soccer players focusing on exposure, injury and cognition, and determine the minimum safe age to begin instruction on the skill of heading. Only then will we be able to speak with some authority on the issue of heading and head injuries in soccer.

The cumulative effect of repetitive concussion in sports

The increased popularity of contact sports worldwide exposes a large number of participants to both acute and chronic traumatic brain injury. Chronic traumatic brain injury (CTBI) represents the cumulative, long-term neurological consequences of repetitive concussive and subconcussive blows to the brain. Although this condition has been described primarily in boxing, it may be anticipated in other contact sports such as soccer, football, ice hockey, and the martial arts. Since treatment options in CTBI are relatively limited, the prevention of CTBI is of paramount importance. Minimizing the frequency and severity of acute brain injury in sport will be instrumental in accomplishing this goal. The prevention of CTBI will need to be sport specific and will undoubtedly rely on limiting the exposure of high-risk athletes, utilizing of protective equipment, enforcing strict rule adherence, training and supervising athletes, and increasing medical surveillance.

The assessment of sport-related concussion: the evidence behind neuropsychological testing and management

Because of the lack of valid evidence to support the current recommendations for the management of mild traumatic brain injury (concussion), many physicians, athletic trainers, coaches, and athletes have called into question the way concussions are treated in athletics. This review article discusses the current evidence for the management of concussion in high school, college, and professional sports. A complete review of the epidemiologic and neuropsychological studies to date is presented and critically reviewed, as are other assessment and management tools in concussion. The appropriate use of neuropsychological testing, grading scales, and return-to-play recommendations are discussed in depth based on the current evidence. Additionally, areas requiring further research are identified and future trends are briefly discussed.

Standardized mental status assessment of sports concussion

Neurocognitive status is often considered the domain of neurologic functioning most sensitive to change following concussion, but the effects are often subtle and difficult to detect on routine clinical examination. Recent efforts have focused on the development of brief, standardized methods of mental status assessment for use by sports medicine clinicians to quantify the acute neurocognitive effects of concussion and objectively track postinjury recovery. Research has demonstrated the reliability, validity, and sensitivity of these measures in detecting concussion in athletes and providing empirical data for consideration in the context of other examination findings, neuropsychologic test data, and neuroimaging results. Standardized measures of mental status and other postconcussive symptoms are valuable tools to assist clinicians in the assessment and management of concussion, but should not be used as a replacement for medical evaluation or viewed as a stand-alone means for determining readiness to return to competition after injury.

Postural stability assessment following concussion: one piece of the puzzle

Clinicians regularly assess concussion according to the symptoms that an athlete manifests at the time of injury, as well as during subsequent evaluations. The subjectivity involved with symptom assessment, however, often leaves the clinician without a clear picture of the athlete's true mental status. Neuropsychologic testing has become very popular in the sports medicine community for assessing the cognitive domain of neurologic functioning, and postural stability testing is gaining credence for assessing the motor domain. The objective of this review was to determine the efficacy of postural stability testing as an adjunct to concussion assessment of athletes. Multiple studies, using both sophisticated force plate technology, as well as those using less sophisticated clinical balance tests, have identified postural stability deficits lasting several days following sport-related concussion. It appears that postural stability testing provides a useful tool for objectively assessing the motor domain of neurologic functioning, and should be considered a reliable and valid adjunct to the assessment of athletes suffering from concussion. Although symptom severity, neurocognitive function, and postural stability are often affected initially following concussion, they are not necessarily related or even affected to the same degree.

Mild traumatic brain injury in sports: neuropsychology's contribution to a developing field

Mild traumatic brain injuries are common at all levels of athletic competition. Although once considered a "routine part of the game," a significant amount of attention has recently been placed on these injuries at the professional, college, and high school levels. This paper reviews the epidemiology of sports-related brain injuries, the pathophysiology of the injuries, and the role of neuropsychology in this newly emerging area. Issues related to the adequacy of neuropsychological test instruments and approaches are discussed in light of future directions for research.

Do football helmets reduce acceleration of impact in blunt head injuries?

Several recent studies suggest that acceleration of the head at impact during sporting activities may have a detrimental effect on cognitive function. Reducing acceleration of impact in these sports could reduce neurologic sequelae.

OBJECTIVE

To measure the effectiveness of a regulation football helmet to reduce acceleration of impact for both low- and moderate-force impacts.

METHODS

An experimental paired study design was used. Male volunteers between 16 and 30 years of age headed soccer balls traveling approximately 35 miles per hour bareheaded and with a helmet. An intraoral accelerometer worn inside a plastic mouthpiece measured acceleration of the head. The helmet also had an accelerometer placed inside the padding. For more forceful impacts, cadaver heads, both with and without helmets, were instrumented with intraoral (IO) and intracranial (IC) accelerometers and struck with a pendulum device. Simultaneous IO and IC accelerations were measured and compared between helmeted and unhelmeted cadaver heads. The main outcome was mean peak acceleration of the head and/or brain associated with low- and moderate-force impacts with and without protective headgear.

RESULTS

Mean peak Gs, measured by the mouthpiece accelerometer, were significantly reduced when the participants heading soccer balls were wearing a helmet (7.7 Gs with vs 19.2 Gs without, p = 0.01). Wearing a helmet also significantly lowered the peak Gs measured intraorally and intracranially in cadavers subjected to moderate-force pendulum impacts: 28.7 Gs with vs 62.6 Gs without, p < 0.001; and 56.4 Gs with vs 81.6 Gs without, p < 0.001, respectively.

CONCLUSIONS

A regulation football helmet substantially reduced the peak Gs associated with "heading" a soccer ball traveling at moderately high velocities. A helmet was also effective in reducing the peak acceleration both intraorally and intracranially for impacts significantly more forceful than heading a soccer ball.

Incidence of concussion in high school football players of Ohio and Pennsylvania

Football injuries account for more concussions than any other sport in North America. A 1977 survey of high school football players in Minnesota found that 19% of players reported at least one concussion (characterized by loss of awareness) during a season. These results have not been confirmed in subsequent studies. This study sought to estimate the incidence of concussion among high school football players in our region, establish the frequency of the most common symptoms, and determine the duration of subsequent restriction from participation in the sport. The athletic boards of area high schools distributed a three-page survey to 450 high school football players. Of the 450 surveys distributed, 234 (52%) were returned, only 1 of which was excluded because of contradictory information. The incidence of concussion in football players was 47.2% (110/233, P < .001 versus a previously determined rate of 19%). Eighty-one of 233 players (34.9%) had multiple concussions. A total of 376 concussions were reported. The distribution of severity of the 376 reported concussive events was grade I, 87.8%; grade II, 9.9%; and grade III, 2.4%. Only 12 athletes were required to stop play for one or more games. The incidence of high school football players sustaining a concussion is much higher than previously established. The majority of these are mild (grade I) concussions. Further research is needed since multiple low-grade concussions may incur cumulative neuropsychologic impairments.

Educating students with TBI: themes and recommendations

Ten educational consultants and researchers, each with extensive experience working with children with traumatic brain injury (TBI) in school settings, identified seven themes related to serving this population in public schools. These themes are discussed under the headings (1) incidence of TBI and prevalence of persistent educational disability, (2) diversity and central tendencies within the population, (3) assessment, (4) intervention and support in school settings, (5) training and support for educators, (6) intervention and support for families, and (7) systems change and flexibility. For each theme, a set of recommendations is provided, forming an educational research and policy agenda for pediatric TBI.

Pediatric minor head trauma

Head trauma is one of the most common childhood injuries, annually accounting for more than 500,000 emergency department visits, 95,000 hospital admissions, 7,000 deaths, and 29,000 permanent disabilities; hospital care costs alone exceed $1 billion annually. The majority of patients have minor head trauma, and, although most of these injuries are insignificant, minor head trauma causes a large number of intracranial injuries. The largest reduction in head trauma mortality rates results from preventing deterioration and secondary brain injury in patients with minor or moderate head injuries who initially appear to be at low risk. The goal of the clinician, therefore, is to identify those at risk for intracranial injury and subsequent deterioration, while limiting unnecessary imaging procedures. This article reviews the current data and practice in assessing and treating minor head trauma in children.

Head injury in athletes

HEAD INJURIES INCURRED during athletic endeavors have been recorded since games were first held. During the last century, our level of understanding of the types of cerebral insults, their causes, and their treatment has advanced significantly. Because of the extreme popularity of sports in the United States and worldwide, the implications of athletic head injury are enormous. This is especially true considering the current realization that mild traumatic brain injury (MTBI) or concussion represents a major health consideration with more long-ranging effects than previously thought. When considering athletic injuries, people who engage in organized sports, as well as the large number of people who engage in recreational activities, should be considered. There are 200 million international soccer players, a group increasingly recognized to be at risk for MTBI. The participation in contact sports of a large number of the population, especially youth, requires a careful and detailed analysis of injury trends and recommended treatment. There are numerous characteristics of this patient population that make management difficult, especially their implicit request to once again be subjected to potential MTBI by participating in contact sports. Recent research has better defined the epidemiological issues related to sports injuries involving the central nervous system and has also led to classification and management paradigms that help guide decisions regarding athletes' return to play. We currently have methods at our disposal that greatly assist us in managing this group of patients, including improved recognition of the clinical syndromes of MTBI, new testing such as neuropsychological assessment, radiographic evaluations, and a greater appreciation of the pathophysiology of concussive brain injury. The potential for long-term consequences of repetitive MTBI has been recognized, and we no longer consider the "dinged" states of athletic concussions to have the benign connotations they had in the past. We review the historical developments in the recognition and care of athletes with head injuries, the current theory of the pathophysiology and biomechanics of these insults, and the recommended management strategy, including return-to-play criteria.

Neuropsychological test performance prior to and following sports-related mild traumatic brain injury

OBJECTIVE

To examine the utility of neuropsychological tests in assessing college athletes prior to and following a sports-related mild Traumatic Brain Injury (mTBI).

DESIGN

A prospective study of college athletes who sustained mTBI while engaged in sport. Preinjury baseline neuropsychological test data were obtained for athletes at risk for mTBI. Following an mTBI, the athlete and his or her matched noninjured control were evaluated at 2 hours, 48 hours, 1 week, and I month postinjury.

SETTING

Male and female athletes from a Division I college.

PARTICIPANTS

Male and female athletes from the football, men's ice hockey, men's and women's soccer, and men's and women's basketball teams at Penn State University. A total of 29 injured and 20 noninjured athletes participated in the study.

INTERVENTIONS

Neuropsychological test batteries were administered at baseline and serially following mTBI.

MAIN OUTCOME MEASURES

Post-Concussion Symptom Checklist, Hopkins Verbal Learning Test, Symbol Digit Modalities Test, Stroop Color-Word Test, Trail Making Test, VIGIL/W, List Learning, Digit Span, Penn State Cancellation Test, and Controlled Oral Word Association.

RESULTS

Neuropsychological test data yielded significant differences between injured athletes and controls at 2 hours and 48 hours following cerebral concussion; injured athletes performing significantly worse than controls. Injured athletes reported a significantly greater number of postconcussion symptoms 2 hours following injury but not at the 48-hour assessment. No multivariate group differences were found at 1 week, but univariate analyses suggested significant differences on a few measures. At 1 month postinjury, a statistically significant difference was found on one measure with injured athletes marginally outperforming controls.

CONCLUSIONS

Neuropsychological tests are useful in the detection of cognitive impairment following mTBI. The test data appear to be more effective than subjective report of symptoms in differentiating between injured and noninjured athletes at 48 hours postinjury. Although significant individual variability existed, most injured athletes recovered within 1 week of injury. A battery of tests, rather than any single test, is necessary to capture the variability that exists among injured athletes.

Intellectual and emotional functioning in college students following mild traumatic brain injury in childhood and adolescence

OBJECTIVE

To investigate whether college students with a history of mild traumatic brain injury (TBI) in childhood or adolescence show residual deficits in intellectual functioning, approaches to studying, or emotional stability.

DESIGN

Participants with a history of mild TBI and two control groups.

SETTING

Volunteers were recruited from students taking an introductory psychology course.

PARTICIPANTS

79 students with a history of mild TBI, 75 students with a history of general anesthesia, and 93 students with no history of either TBI or general anesthesia.

MAIN OUTCOME MEASURES

Participants carried out tests of verbal memory, nonverbal memory, verbal fluency, and nonverbal fluency; in addition, they completed a short form of the Approaches to Studying Inventory and the Symptom Checklist-90-Revised (SCL-90-R).

RESULTS

In comparison with the two control groups, the students with a history of mild TBI produced similar scores on the cognitive tests and similar orientations to studying. However, they showed a significantly higher level of emotional distress on the SCL-90-R.

CONCLUSION

College students with a history of mild TBI in childhood or adolescence are intellectually unimpaired and approach their studying in a similar manner to their uninjured classmates. Nevertheless, they report more severe distress in terms of their general personal and emotional functioning.

The adolescent preparticipation physical examination. Is it helpful?

The preparticipation examination (PPE) is a widely practiced method of screening athletes for medical limitations before sports participation. Although the PPE is widely implemented, there is little consistency regarding content or method in providing this important service. This lack of uniformity undermines the overall effectiveness of the PPE. The history, efficiency, and nature of athletic screening in adolescents are discussed in this article, and specific suggestions are offered on how the examination might be improved in the future. As sports participation among teens continues to change--in number of participants and in athlete-demographics--and as the field of sports medicine expands equally rapidly, the adolescent PPE, the commonest interaction between adolescent patients and the medical system, should be updated.

Injury severity and neuropsychological and balance outcomes of four college athletes

Recent evidence suggests significant short-term neurocognitive deficits following mild traumatic brain injury (MTBI) in sports. However, sequelae of mild head injuries is complicated by many factors including a history of multiple head injuries and injury severity. Few studies have considered the influence these variables may have on proper classification of a MTBI and their meaning for return-to-play guidelines. This study presents the short-term neuropsychological and balance outcomes of four college athletes who sustained mild head injuries of different severity (grade I, grade II, grade III and multiple head injured with a grade II based on American Academy of Neurology guidelines). The results demonstrated that self-report symptoms of concussion were slow to resolve in the grade III and multiple concussed individuals. For neuropsychological testing, Trails A & B, Symbol Digit Modalities Test and Digits Span Backwards were the most sensitive in identifying differences between the injuries. For balance assessments using the Neurocom Smart Balance System, the Sensory Organization Test and Reaction Time were also important variables in detecting differences among the various injuries. When these data are used together, it can assist physicians in determining safe return-to-play for athletes who sustain MTBI. There are contradindications in the numerous grading systems and return-to-play guidelines for MTBI. The results from this study provides new evidence which can be assimilated into a valid grading scale for MTBI sustained in sport.

Lower cognitive performance of older football players possessing apolipoprotein E epsilon4

OBJECTIVE

To determine whether the cognitive status of professional football players varies as a function of age and apolipoprotein E (APOE) genotype.

METHODS

Fifty-three active players underwent APOE and neuropsychological assessments. Players were grouped according to age (proxy indicator of high/low exposure to contact) and the presence/absence of at least one copy of the epsilon4 allele. Outcome measures were overall cognitive performance and scores in cognitive domains.

RESULTS

As a group, older players possessing APOE epsilon4 exhibited significantly lower cognitive test scores than did all other players studied, including non-epsilon4-possessing players and younger epsilon4-carriers. Measures of general cognitive functioning, information-processing speed and accuracy, and attention were related to poorer performance among the epsilon4-carrying players. In an analysis of variance model, the interaction between APOE genotype and age was significant (P = 0.004). As determined using linear regression, age accounted for 34% of the variance in the memory index among APOE epsilon4-possessing players but did not contribute significantly to variance among the non-epsilon4-possessing players. Older APOE epsilon4-carriers were significantly overrepresented among players whose scores indicated possible cognitive impairment, with the criterion of performing two or more standard deviations below the general normal values in a summary index of general cognitive functioning.

CONCLUSION

Older professional football players who possessed the APOE epsilon4 allele scored lower on cognitive tests than did players without this allele or less experienced players of any genotype. The cognitive status of professional athletes with repeated exposure to head trauma may therefore be influenced by age, inherited factors such as APOE genotype, and cumulative exposure to contact.

Cerebral concussion in athletes: evaluation and neuropsychological testing

OBJECTIVE

To conduct a topic review of studies related to cerebral concussion in athletes, as an aid to improving decision-making and outcomes.

METHODS

We review the literature to provide an historical perspective on the incidence and definition of and the management guidelines for mild traumatic brain injury in sports. In addition, metabolic changes resulting from cerebral concussion and the second-impact syndrome are reviewed, to provide additional principles for decision-making. Neuropsychological testing, as it applies to athletes, is discussed in detail, to delineate baseline assessments, the characteristics of the neuropsychological evaluation, the neuropsychological tests used, and the methods for in-season identification of cerebral concussion. Future directions in the management of concussions are presented.

RESULTS

The incidence of cerebral concussions has been reduced from approximately 19 per 100 participants in football per season to approximately 4 per 100, i.e., 40,000 to 50,000 concussions per year in football alone. The most commonly used definitions of concussion are those proposed by Cantu and the American Academy of Neurology. Each has associated management guidelines. Concussion or loss of consciousness occurs when the extracellular potassium concentration increases beyond the upper normal limit of approximately 4 to 5 mmol/L, to levels of 20 to 50 mmol/L, inhibiting the action potential and leading to loss of consciousness. This phenomenon helps to explain the delayed effects of symptoms after trauma.

CONCLUSION

Neuropsychological testing seems to be an effective way to obtain useful data on the short-term and long-term effects of mild traumatic brain injury. Moreover, knowledge of the various definitions and management strategies, as well as the utility of neuropsychological testing, is essential for those involved in decision-making with athletes with mild traumatic brain injuries.

Sports related mild traumatic brain injury in adolescents

While head injuries are not common in youth sports, they may have catastrophic results. Concussion is also referred to as mild traumatic brain injury (MTBI). Although the occurrence of head injuries has been studied more extensively in American football, the findings have wider application for any MTBI. Recently, more attention has been directed at other sports in which both boys and girls participate. The diagnosis of MTBI is based on subjective findings and subtle changes in mental status. Other cerebral injuries requiring emergent or urgent neurosurgical attention should be ruled out. Objective tests such as CT scans and Magnetic Resonance Imaging (MRI) are usually without significant findings in MTBI. Neuropsychological testing may demonstrate areas of deficiencies, however, results may be difficult to interpret because of confounding factors. Complications following MTBI have been known to occur. The most catastrophic of these is second impact syndrome. There are a variety of guidelines for return to play following a concussion, which have been designed in an effort to avoid problems such as second impact syndrome. These guidelines are based more on clinical experience than on scientific evidence. Education, good training and coaching techniques, improved equipment, and rule changes and enforcement, can all help in curbing the sports related head injuries in adolescents.

The acute neuropsychological effects of heading in soccer: a pilot study

OBJECTIVE

The main objective of this study was to prospectively examine the acute effects of heading in soccer on cognitive function.

DESIGN

This was a prospective cross-over study using a brief neuropsychological battery to assess cognitive function. The tests were performed before and after two separate practice sessions, with athletes serving as their own controls.

SETTING

Male and female Division I college athletes.

PARTICIPANTS

Members of the men's and women's varsity collegiate Penn State University soccer teams. Forty-four males and 56 females entered and finished the study. All athletes had a normal physical examination.

INTERVENTIONS

Before and after both practice sessions, all athletes had a brief battery of neuropsychological tests and a symptom checklist.

MAIN OUTCOME MEASURES

Neuropsychological tests symptom checklist compared at baseline with those after the practice sessions.

RESULTS

There were no significant differences in pretest scores between groups and no difference on posttest scores between heading and nonheading groups. A significant difference was detected using MANOVA (p = < 0.001) between pre- and posttest scores for measures of attention and concentration, indicating a practice effect. A gender-specific effect in one test measuring attention and concentration was found. There was no difference in symptoms before and after heading as compared with exertional controls.

CONCLUSIONS

In this study, soccer players heading the ball does not appear to lead to acute changes in cognitive function as assessed by a brief neuropsychological battery. There are practice effects that occur with repetitive neuropsychological testing and gender differences with certain tests.

Hitting in amateur ice hockey: not worth the risk

The "big hit" is glorified in professional ice hockey. But body checking is unnecessary for the quality of the game and demonstrably dangerous for most amateur players at the youth, high school, and college levels.