Concussion history is not a predictor of computerised neurocognitive performance

Executive functions and intraindividual variability following concussion

The long-term outcomes of executive functions and intraindividual variability (IIV; i.e., trial-to-trial or across-task variability in cognitive performance) following concussion are unclear due to inconsistent and limited research findings, respectively.

OBJECTIVE

Responding to these gaps in scientific understanding, the current study aimed to assess the utility of both executive functions and IIV at predicting concussion history.

METHOD

Altogether 138 self-identified athletes (Mage = 19.9 ± 1.91 years, 60.8% female, 19.6% with one concussion, 18.1% with two or more concussions) completed three executive-related cognitive tasks (i.e., n-back, go/no-go, global-local). Ordinal logistic regression analyses examined the joint effect of person-mean and IIV as predictors of concussion status.

RESULTS

Only mean response time for the global-local task predicted the number of past concussions, while no IIV variables reached unique significance.

CONCLUSIONS

IIV research on concussion remains limited; however, the preliminary results do not indicate any additional value of IIV indices above mean performances at predicting past concussion. For executive functions, shifting appears most sensitive at detecting concussion group differences, with past researchers identifying post concussion impairment in attentional processing.

Post-concussion symptom reporting after multiple mild traumatic brain injuries

The relationship between previous mild traumatic brain injury/injuries (MTBI) and recovery from a subsequent MTBI may be complex. The present study investigated three factors hypothesized to influence this relation: (1) the number of prior MTBIs, (2) the interval between MTBIs, and (3) the certainty level of previous MTBIs. The study design was retrospective cross-sectional. Participants (N=105) were evaluated at a concussion clinic on average 1 month after sustaining an MTBI, defined by World Health Organization diagnostic criteria. Approximately half the sample had at least one previous MTBI. Subgroups with 0, 1, or 2+ previous MTBIs did not differ in levels of current post-concussion symptom reporting on the British Columbia Post-Concussion Symptom Inventory. Time since the most recent previous MTBI was significantly associated with current post-concussion symptom reporting. This relation was best characterized as logarithmic; i.e., the impact of previous MTBI(s) lessens exponentially as time elapses to a subsequent MTBI. Defining previous MTBIs with a higher certainty level (i.e., probable versus possible) was not consistently associated with greater post-concussion symptom reporting. In conclusion, participants with multiple MTBIs did not report more post-concussion symptoms than those with no history of MTBI. Previous MTBI(s), however, were associated with increased symptom reporting from a subsequent MTBI to the extent they occurred closer in time. Having one or two previous remote MTBIs was not associated with worse outcome from subsequent MTBI in this sample.

The relation of mild traumatic brain injury to chronic lapses of attention

We assessed the extent to which failures in sustained attention were associated with chronic mild traumatic brain injury (mTBI) deficits in cognitive control among college-age young adults with and without a history of sport-related concussion. Participants completed the ImPACT computer-based assessment and a modified flanker task. Results indicated that a history of mTBI, relative to healthy controls, was associated with inferior overall flanker task performance with a greater number of omission errors and more frequent sequentially occurring omission errors. Accordingly, these findings suggest that failures in the ability to maintain attentional vigilance may, in part, underlie mTBI-related cognition deficits.

Sport as Laboratory: Lessons Learned From Baseline and Postconcussion Assessment Research

Knowledge and awareness of sport concussion has been forwarded by research modeled on the neuropsychological testing paradigm associated with Barth’s “sport as laboratory” assessment model. The purpose of this paper is to elucidate lessons learned from that research. Key considerations for planning and implementing large-scale studies of concussion in sport while making adequate provision for the clinical needs of concussed athletes are reviewed. Toward that end, logistical, methodological, and ethical considerations are discussed within the context of research conducted in a university setting. Topics addressed include culture of sport and risk; research planning and design; communication with strategic partners; defining injury; choosing a test battery; data management, outcomes, and analyses; dissemination of results; and finally, clinical and ethical implications that may arise during the research enterprise. The paper concludes with a summary of the main lessons learned and directions for future research.

Normative Data in a Sample of Canadian University Athletes Using ANAM Tests

The baseline / postconcussion neuropsychological (NP) assessment model has been shown to be of clinical value and currently contributes significant information in sport concussion evaluation. Computerized NP batteries are now widely used in elite sport environments and are rapidly becoming more commonly utilized at the community level. With the growth of computerized NP testing, it is important to identify and understand unique characteristics with respect to baseline NP performance. The Automated Neuropsychological Assessment Metrics (ANAM) is a library of computerized NP tests designed to detect speed and accuracy of attention, memory, and thinking ability. This article describes baseline ANAM test scores in a sample of Canadian university athletes and explores the following two factors: (a) performance differences between male and female student-athletes using ANAM tests and (b) the relationship between self-reported history of concussion and baseline NP performance.

Cognitive decline and aging: the role of concussive and subconcussive impacts

Concussion has been viewed historically as a transient injury with no evidence supporting the existence of persistent effects. However, our recent work demonstrates electroencephalographic and motor control changes in otherwise healthy individuals with a history of concussion. We therefore hypothesize that concussive and subconcussive head impacts set about a cascade of pathological events that accelerates declines in cognitive function typically associated with the aging process.

Cerebral Concussion in Sport: An Overview

Sports-related concussions are ubiquitous in contact and collision sports at all levels of play and across a broad age range. Once thought to be a nuisance injury, it is now recognized that these brain injuries may lead to chronic neurocognitive impairment if not managed properly. This paper provides a broad overview of the research and clinical data that have emerged in this rapidly growing area. Included in the review are discussions of injury definition, pathophysiology, signs and symptoms, epidemiology, potential long-term consequences, assessment, and psychological factors. Issues of prevention and education are discussed in light of further increasing awareness of this injury.

Possible lingering effects of multiple past concussions

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.

Rotational head kinematics in football impacts: an injury risk function for concussion

Recent research has suggested a possible link between sports-related concussions and neurodegenerative processes, highlighting the importance of developing methods to accurately quantify head impact tolerance. The use of kinematic parameters of the head to predict brain injury has been suggested because they are indicative of the inertial response of the brain. The objective of this study is to characterize the rotational kinematics of the head associated with concussive impacts using a large head acceleration dataset collected from human subjects. The helmets of 335 football players were instrumented with accelerometer arrays that measured head acceleration following head impacts sustained during play, resulting in data for 300,977 sub-concussive and 57 concussive head impacts. The average sub-concussive impact had a rotational acceleration of 1230 rad/s(2) and a rotational velocity of 5.5 rad/s, while the average concussive impact had a rotational acceleration of 5022 rad/s(2) and a rotational velocity of 22.3 rad/s. An injury risk curve was developed and a nominal injury value of 6383 rad/s(2) associated with 28.3 rad/s represents 50% risk of concussion. These data provide an increased understanding of the biomechanics associated with concussion and they provide critical insight into injury mechanisms, human tolerance to mechanical stimuli, and injury prevention techniques.

Long-term consequences: effects on normal development profile after concussion

Each year in the United States, approximately 1.7 million people are diagnosed with a traumatic brain injury (TBI), about 75% of which are classified as mild TBIs or concussions. Although symptoms typically resolve in a matter of weeks, both children and adults may suffer from postconcussion syndrome for months or longer. A progressive tauopathy, chronic traumatic encephalopathy, is believed to stem from repeated brain trauma. Alzheimer-like dementia, Parkinsonism, and motor neuron disease are also associated with repetitive brain trauma. Effective diagnoses, treatments, and education plans are required to reduce the future burden and incidence of long-term effects of head injuries.

Development of the STAR evaluation system for football helmets: integrating player head impact exposure and risk of concussion

In contrast to the publicly available data on the safety of automobiles, consumers have no analytical mechanism to evaluate the protective performance of football helmets. The objective of this article is to fill this void by introducing a new equation that can be used to evaluate helmet performance by integrating player head impact exposure and risk of concussion. The Summation of Tests for the Analysis of Risk (STAR) equation relates on-field impact exposure to a series of 24 drop tests performed at four impact locations and six impact energy levels. Using 62,974 head acceleration data points collected from football players, the number of impacts experienced for one full season was translated to 24 drop test configurations. A new injury risk function was developed from 32 measured concussions and associated exposure data to assess risk of concussion for each impact. Finally, the data from all 24 drop tests is combined into one number using the STAR formula that incorporates the predicted exposure and injury risk for one player for one full season of practices and games. The new STAR evaluation equation will provide consumers with a meaningful metric to assess the relative performance of football helmets.

The pediatric athlete: younger athletes with sport-related concussion

Although much of the lay media attention surrounding sport-related concussion (SRC) focuses on professional athletes, SRC is a common injury in pediatric sports. The anatomy, biomechanics, and response to injury of the developing pediatric brain differ from those of the adult. Similarly, the neurocognitive abilities of the child are developing more rapidly than in an adult. The effects of concussive brain injury on the life of a child are different from those of an adult. This article focuses on the aspects of SRC that are specific to the younger athletes.

Working memory capacity among collegiate student athletes: effects of sport-related head contacts, concussions, and working memory demands

OBJECTIVE

To measure working memory capacity among a cohort of collegiate athletes and to compare results between athletes competing in head-contact-prone sports with those not subject to repeated head contacts. A secondary objective was to determine the effect of sport-related concussion on working memory capacity.

DESIGN

Ambidirectional cohort study.

SETTING

Athletics department at an American university.

PARTICIPANTS

Student athletes competing in various sports.

INTERVENTIONS

None.

MAIN OUTCOME MEASUREMENT

Automated operation span test scores.

RESULTS

Working memory capacity is not impaired in student athletes who participate in head-contact-prone sports or in student athletes with a history of diagnosed concussion, even those who are multiconcussed. Our results suggest that athletes competing in sports that impose significant working memory loading score higher on the automated operation span test than do other athletes.

CONCLUSIONS

Further research is required to determine the value of measuring working memory capacity in acutely concussed, symptomatic athletes.

Reduced processing speed in rugby union players reporting three or more previous concussions

The issue pertaining to the effect of multiple self-reported sports-related concussions on cognitive function is controversial. Although this topic has received increased attention in the literature recently, the issue remains unresolved. Evidence supporting a detrimental cognitive effect has been reported at a sub-concussive level and following one, two, and three or more previous concussions. However, numerous studies have been unable to replicate these findings. Additionally, discrepancies between neuropsychological testing formats have been identified, where studies utilizing traditional tests tend to support the notion of detrimental cognitive effects whereas studies with computerized tests have tended to demonstrate no effect. The present study sought to examine possible detrimental cognitive effects in a sample of adult male rugby union players who reported a history of three or more concussions (n = 34) compared with those who reported no previous concussions (n = 39). A computerized neuropsychological battery and a traditional neuropsychological measure of processing speed were administered for this purpose. Findings revealed that there were differences between groups on two processing speed measures from both traditional and computerized tests. Athletes with a history of multiple concussions performed significantly lower on these measures than those with no history of concussion. These results provide further evidence to suggest that a history of three or more self-reported concussions in active athletes may have a detrimental effect on cognitive function. Future research may focus on identifying moderating factors in an attempt to resolve some of the conflicting findings and identify potential athletes at risk for sustaining cognitive deficits.

Neuropsychological performance following a history of multiple self-reported concussions: a meta-analysis

Debate continues about the long-term neuropsychological impact of multiple mild traumatic brain injuries (MTBI). A meta-analysis of the relevant literature was conducted to determine the impact of having a history of more than one self-reported MTBI (versus just one MTBI) across seven cognitive domains, as well as symptom complaints. The analysis was based on 8 studies, all conducted with athletes, involving 614 cases of multiple MTBI and 926 control cases of a single MTBI. The overall effect of multiple MTBI on neuropsychological functioning was minimal and not significant (d = 0.06). However, follow-up analyses revealed that multiple self-reported MTBI was associated with poorer performance on measures of delayed memory and executive functioning. The implications and limitations of these findings are discussed.

Impact of Prior Concussions on Health-Related Quality of Life in Collegiate Athletes

OBJECTIVE

To investigate how self-reported sport-related concussion history affects health-related quality of life in collegiate athletes.

DESIGN

Cross sectional.

SETTING

Division I university, Division II university, and a junior college.

PARTICIPANTS

Three hundred two collegiate athletes (210 men, 92 women).

ASSESSMENT OF RISK FACTORS

Participants completed a demographic information sheet and concussion history form; they were then grouped by number of previous self-reported concussions, designated as 0, 1-2, or 3+.

MAIN OUTCOME MEASURES

The Medical Outcomes Short Form (SF-36) and the Headache Impact Test (HIT-6).

RESULTS

Significant differences between groups were found for the bodily pain, vitality, and social functioning subscales of the SF-36. The 3+ group had significantly lower scores for bodily pain (48.1 ± 8.9) compared with the 1-2 group (P = 0.028, 52.1 ± 7.7) and 0 group (P < 0.01, 53.5 ± 8.3), for vitality (52.4 ± 8.4) compared with the 0 group (P = 0.011, 55.9 ± 8.6), and for social functioning (48.5 ± 9.4) compared with the 1-2 group (P = 0.028, 51.6 ± 7.3) and 0 group (P = 0.003, 51.9 ± 8.1). Significant differences were noted on the HIT-6 total score. The 3+ group reported greater impact of headache (46.7 ± 6.4) than the 1-2 group (P = 0.05, 44.6 ± 6.4) and 0 group (P < 0.001, 42.9 ± 5.8). The 1-2 group also had higher HIT-6 scores than the 0 group (P = 0.033).

CONCLUSIONS

Results suggest that a collegiate athlete's perception of bodily pain, vitality, social functioning, and headache is adversely affected by previous sport-related concussions. However, by incorporating general and specific outcome measures into the standard evaluation of sport-related concussion, the clinician can better determine how the athlete is responding to treatment and recovery.

The persistent effects of concussion on neuroelectric indices of attention

Mild traumatic brain injuries (mTBIs) that result from participation in sports are a major public health issue affecting 1.6-3.8 million individuals annually. The injury has been postulated as transient and void of long-term consequences when rapidly diagnosed and properly managed. Emerging evidence, however, has suggested an increased risk for late life cognitive dysfunction in those with previous injuries. The purpose of this investigation was to evaluate young adults with and without a history of concussion using a standard clinical assessment and highly sensitive electrophysiological measures for persistent changes in cognitive functioning.Ninety participants (19.7+\- 1.3 years; 44 without mTBI and 46 with previous mTBI) were evaluated using the ImPACT and event-related brain potentials (ERPs) that were recorded during a three-stimulus oddball task. Those with a history of concussion reported an average of 3.4 years post-injury. No significant differences were found between groups on the ImPACT. Significant decrements in the N2 and P3b amplitudes of the stimulus-locked ERP were noted for those with a history relative to those without a history of concussion. Although the previously concussed participants performed equal to those without injury on the clinical cognitive assessment, these findings support the notion that sport mTBI can no longer be thought of as a transient injury resulting in short-lived neurological impairment. It is not clear if these persistent deficits will manifest into clinical pathologies later in life.

Incidence, risk, and protective factors of mild traumatic brain injury in a cohort of Australian nonprofessional male rugby players

BACKGROUND

Mild traumatic brain injury (mTBI) is an emerging public health issue in high-contact sports. Understanding the incidence along with the risk and protective factors of mTBI in high-contact sports such as rugby is paramount if appropriate preventive strategies are to be developed.

PURPOSE

To estimate the incidence and identify the risk and protective factors of mTBI in Australian nonprofessional rugby players.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

A cohort of 3207 male nonprofessional rugby players from Sydney, Australia, was recruited and followed over 1 or more playing seasons. Demographic information, history of recent concussion, and information on risk and protective factors were collected. The incidence of mTBI was estimated and the putative risk and protective factors were modeled in relation to mTBI.

RESULTS

The incidence of mTBI was 7.97 per 1000 player game hours, with 313 players (9.8%) sustaining 1 or more mTBIs during the study. Players who reported always wearing protective headgear during games were at a reduced risk (incident rate ratio [IRR], 0.57; 95% confidence interval [CI], 0.40-0.82) of sustaining an mTBI. In contrast, the likelihood of mTBI was almost 2 times higher among players who reported having sustained either 1 (IRR, 1.75; 95% CI, 1.11-2.76) or more mTBIs (IRR, 1.65; 95% CI, 1.11-2.45) within the 12 months before recruitment.

CONCLUSION

Nonprofessional rugby has a high incidence of mTBI, with the absence of headgear and a recent history of mTBI associated with an increased risk of subsequent mTBI. These findings highlight that both use of headgear and the management of prior concussion would likely be beneficial in reducing the likelihood of mTBI among nonprofessional rugby players, who compose more than 99% of rugby union players in Australia.

The role of concussion history and gender in recovery from soccer-related concussion

BACKGROUND

This study was designed to investigate differences in recovery in male and female soccer athletes.

HYPOTHESES

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.

STUDY DESIGN

Cohort study (prognosis): Level of evidence, 2.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

What are the real risks of sport-related concussion, and are they modifiable?

Over the past two decades, the management of sport-related concussion has been the topic of increased attention in the scientific literature and in the popular media. Despite a proliferation of competing guidelines for concussion management, the widespread use of neuropsychological "baseline" testing designed to monitor postinjury recovery, and several prospective controlled studies of the natural history of concussion, there has been virtually no attempt to quantify the risks associated with sport-related concussion or to determine whether these risks are modifiable via management strategies. Using American football as a model, the short- and long-term risks of sport-related concussion are reviewed. It is concluded that serious short-term consequences of sport-related concussion are extremely rare and unlikely to be significantly modified via management strategies that rely on baseline testing. Other less serious short-term adverse outcomes are also quite rare, transient, and not likely to be altered by specific management guidelines. The long-term consequences of multiple sport-related head trauma remain unclear but are potentially of greater public health concern and should be the focus of increased research. Based on available evidence, there is little rationale for the use of rigid strategies or guidelines in the place of individual clinical decision-making in the management of these injuries.

History of multiple self-reported concussions is not associated with reduced cognitive abilities

OBJECTIVE

The long-term impact of sports-related concussion is uncertain. Several studies using traditional neuropsychological measures have found a relationship between a previous history of concussion and reduced cognitive abilities. In contrast, studies using computerized neuropsychological measures have typically found no relationship between concussion history and cognition. In the present study, we examined the association between a self-reported concussion history and cognition using traditional and computer-based neuropsychological tests.

METHODS

A computerized neuropsychological battery was administered to a sample of 858 collegiate male athletes. Of this sample, 298 athletes reported a history of concussion. A traditional neuropsychological battery was administered to a separate sample of 479 male collegiate athletes, 187 of whom reported a history of concussion. Finally, both a computerized and a traditional neuropsychological battery were administered to a third distinct sample of 175 male collegiate athletes, 57 of whom reported a history of concussion. Concussion history was assessed via self-report. None of the athletes had been concussed in the 6 months before testing.

RESULTS

No significant association was found between self-reported concussion history and performance on either computerized or traditional neuropsychological tests.

CONCLUSION

Findings suggest that athletes who report a distant history of concussion have minimal enduring neurocognitive deficits. Given conflicting findings in the literature, prospective studies that attempt to identify moderating factors are necessary to help determine who is at risk for long-term cognitive difficulties after concussion.

Sport-related concussion

Sport-related concussion is a common injury in children and adolescents. Athletes seldom report concussive symptoms, which makes the diagnosis a challenge. The management of sport-related concussion has changed significantly over the last several years. The previously used grading systems and return-to-play guidelines have been abandoned in favor of more individualized assessment and management. Neuropsychological testing is being used more frequently to assist in management. After recovery, it is recommended that an athlete's return-to-play progress in a gradual, stepwise fashion while being monitored by a health care provider. Proper assessment and management of a sport-related concussion is crucial, because repeat concussions can result in decreased neurocognitive functioning, increased symptomatology, and, at times, catastrophic outcomes.

Concussion history and postconcussion neurocognitive performance and symptoms in collegiate athletes

CONTEXT

Athletes are at an inherent risk for sustaining concussions. Research examining the long-term consequences of sport-related concussion has been inconsistent in demonstrating lingering neurocognitive decrements that may be associated with a previous history of concussion.

OBJECTIVE

To determine the relationship between concussion history and postconcussion neurocognitive performance and symptoms in collegiate athletes.

DESIGN

Repeated-measures design.

SETTING

Multi-center analysis of collegiate athletes.

PATIENTS OR OTHER PARTICIPANTS

Fifty-seven concussed collegiate athletes (36 without concussion history, 21 with a history of 2 or more concussions).

INTERVENTION(S)

All subjects were administered an Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neurocognitive test battery, which measures verbal memory, visual memory, reaction time, and visual processing speed and 22 concussion symptoms.

MAIN OUTCOME MEASURE(S)

Subjects who sustained a concussion were administered 2 follow-up tests at days 1 and 5 postinjury. Independent variables were history of concussion (no history of concussion, 2 or more concussions) and time (baseline, day 1 postconcussion, or day 5 postconcussion).

RESULTS

A within-subjects effect (time) on ImPACT performance (P < .001), a between-subjects multivariate effect of group (P < .001), and a group-by-time interaction (P = .034) were noted. Athletes with a concussion history performed significantly worse on verbal memory (P = .01) and reaction time (P = .023) at day 5 postconcussion compared with athletes who did not report a previous concussion. No significant group differences were seen at day 5 postinjury on visual memory (P = .167), processing speed (P = .179), or total concussion symptoms (P = .87).

CONCLUSIONS

Concussed collegiate athletes with a history of 2 or more concussions took longer to recover verbal memory and reaction time than athletes without a history of concussion.

Differential rate of recovery in athletes after first and second concussion episodes

OBJECTIVE

Clinical observations suggest that a history of previous concussions may cause a slower recovery of neurological function after recurrent concussion episodes. However, direct examination of this notion has not been provided. This report investigates the differential rate of restoring the visual-kinesthetic integration in collegiate athletes experiencing single versus recurrent concussion episodes.

METHODS

One hundred sixty collegiate athletes were tested preseason using multimodal research methodology. Of these, 38 experienced mild traumatic brain injury (MTBI) and were tested on Days 10, 15, and 30 after injury. Nine of these MTBI patients experienced a second MTBI within 1 year after the first brain injury and were retested. The postconcussion symptoms checklist, neuropsychological evaluations, and postural responses to visual field motion were recorded using a virtual reality environment.

RESULTS

All patients were asymptomatic at Day 10 of testing and were cleared for sport participation based on clinical symptoms resolution. Balance deficits, as evident by incoherence with visual field motion postural responses, were present at least 30 days after injury (P < 0.001). Most importantly, the rate of balance symptoms restoration was significantly reduced after a recurrent, second concussion (P < 0.001) compared with those after the first concussion.

CONCLUSION

The findings of this study confirm our previous research indicating the presence of long-term residual visual-motor disintegration in concussed individuals with normal neuropsychological measures. Most importantly, athletes with a history of previous concussion demonstrate significantly slower rates of recovery of neurological functions after the second episode of MTBI.

Management of pediatric mild traumatic brain injury: a neuropsychological review from injury through recovery

Little scientific attention has been aimed at the non-acute clinical care of pediatric mild TBI. We propose a clinical management model focused on both evaluation and intervention from the time of injury through recovery. Intervention strategies are outlined using a framework encompassing four relevant domains: the individual youth, family, school, and athletics. Clinical management has primary value in its potential to speed recovery, minimize distress during the recovery process, and reduce the number of individuals who subjectively experience longer lasting postconcussive problems. With proper management, most children and adolescents sustaining an uncomplicated mild TBI can be expected to recover fully.

Prolonged neuropsychological impairments following a first concussion in female university soccer athletes

OBJECTIVE

Although research is accumulating on the cognitive sequelae from sports-related concussions in men, little to nothing is known about the prolonged cognitive outcome after a concussion in women. This point is important because recent evidence suggests that female athletes are at greater risk of sustaining a concussion.

DESIGN

We assessed cognitive functioning after a first concussion in female soccer players, 6 to 8 months after their injury. The first-time concussed athletes were compared with a group of age-matched teammates who had never experienced a concussion.

SETTING AND PARTICIPANTS

A total of 22 female university-level soccer players participated in the study.

MAIN OUTCOME MEASUREMENTS

Paper-and-pencil and computerized tasks were used to assess different neuropsychological functions.

RESULTS

Short- and long-term verbal memory, attention, and simple reaction time were normal. In contrast, compared with the control group, the concussed athletes were significantly slower on tasks that required decision making (complex reaction time), inhibition and flexibility (Stroop), and planning (Tour of London task).

CONCLUSIONS

The results of this study suggest that cognitive functions related to cognitive processing speed are most vulnerable to a sports-related concussion and are still impaired for a half year after injury in university-level female soccer players.