Comparison of Preseason, Midseason, and Postseason Neurocognitive Scores in Uninjured Collegiate Football Players

Miller, Jennifer R.; Adamson, Gregory J.; Pink, Marilyn; Sweet, John C.

doi:10.1177/0363546507300261

Cited by 104 publications

(75 citation statements)

References 33 publications

(98 reference statements)

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“…32 The current study seems to contradict previous results and suggests that there may be a change in neurocognitive and balance performance following a football game or as a result of the repetitive contact that occurs throughout a season. The difference in findings may be attributed to the fact that the previous study 32 collected postseason data within 2 weeks of the final game of the season, whereas the current study collected data within 48 hours of the final game.…”

Section: Discussion Econtrasting

confidence: 99%

Prevalence of Neurocognitive and Balance Deficits in Collegiate Football Players Without Clinically Diagnosed Concussion

Mulligan¹,

Boland²,

Payette³

2012

Journal of Orthopaedic & Sports Physical Therapy

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Study Design Prospective cohort. Objectives To identify the prevalence of neurocognitive and balance deficits in collegiate football players 48 hours following competition. Background Neurocognitive testing, balance assessments, and subjective report of symptoms are a test battery commonly used to examine athletes suspected of having sustained a concussion. Previous literature suggests that many concussions go unreported. Little research exists examining the prevalence of neurocognitive or balance deficits in athletes who do not report concussion-like symptoms to a healthcare provider. Methods Forty-five Division IA collegiate football players participated in this study. Preseason baseline scores using the Balance Error Scoring System, the Immediate Post-Concussion Assessment and Cognitive Testing, and the Postconcussion Symptom Scale were compared to posttest results obtained 48 hours following a game. Prevalence of symptoms was analyzed and reported. Results Thirty-two (71%) of the 45 athletes tested demonstrated at least 1 deficit in either the Postconcussion Symptom Scale, Balance Error Scoring System, or at least 1 composite score of the Immediate Post-Concussion Assessment and Cognitive Testing. Nineteen of the 32 subjects demonstrated a change in 2 or more categories of neurocognitive and balance function. Conclusion In a cohort of football players tested 48 hours following their last game of the season, who did not seek medical attention related to a concussion, a significant number demonstrated limitations in neurocognitive and balance performance, suggesting that further research may need to be performed to improve recognition of an athlete's deficits and to improve the ability to assess concussion. Level of Evidence Differential diagnosis/symptom prevalence, level 3b. J Orthop Sports Phys Ther 2012;42(7):625–632, Epub 24 April 2012. doi:10.2519/jospt.2012.3798

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Section: Discussion Econtrasting

confidence: 99%

Prevalence of Neurocognitive and Balance Deficits in Collegiate Football Players Without Clinically Diagnosed Concussion

Mulligan¹,

Boland²,

Payette³

2012

Journal of Orthopaedic & Sports Physical Therapy

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“…24,27 This study concurs with previous studies in the literature that conclude that there is currently no single direct measure of recovery after concussion and that clinical decisions should be made based on multifactorial input including concussion history, symptoms, balance, and cognitive function. 2,14,21 A limitation of this study was the lack of compliance of HCEP participants with objective baseline testing and retesting at the requested intervals. Although general trends in the objective testing data demonstrated the utility of the objective testing tools, the lack of participant compliance made it difficult to document a complete data set of the objective measurements for comparison purposes.…”

Section: Discussionmentioning

confidence: 99%

Return to play after an initial or recurrent concussion in a prospective study of physician-observed junior ice hockey concussions: implications for return to play after a concussion

Echlin¹,

Tator

Cusimano

et al. 2010

FOC

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Object The authors investigated return-to-play duration for initial and recurrent concussion in the same season in 2 teams of junior (16–21-year-old) ice hockey players during a regular season. Methods The authors conducted a prospective cohort study during 1 junior regular season (2009–2010) of 67 male fourth-tier ice hockey players (mean age 18.2 ± 1.2 years [SD], range 16–21 years) from 2 teams. Prior to the start of the season, every player underwent baseline assessments that were determined using the Sideline Concussion Assessment Tool 2 (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). The study protocol also required players who entered the study during the season to complete a baseline SCAT2 and ImPACT. If the protocol was not followed, the postinjury test results of a player without true baseline test results were compared with previously established age- and sex-matched group normative levels. Each game was directly observed by a physician and at least 1 neutral nonphysician observer. Players suspected of suffering a concussion were evaluated by the physician during the game. If a concussion was diagnosed, the player underwent clinical evaluation at the physician's office within 24 hours. The return-to-play decision was based on clinical evaluation guided by the Zurich return-to-play protocol (contained in the consensus statement of international expert opinion at the 3rd International Conference on Concussion in Sport held in Zurich, November 2008). This clinical evaluation and return-to-play protocol was augmented by the 2 tests (SCAT2 and ImPACT) also recommended by the Zurich consensus statement, for which baseline values had been obtained. Results Seventeen players sustained a physician-observed or self-reported, physician-diagnosed concussion during a physician-observed ice hockey game. The mean clinical return-to-play duration (in 15 cases) was 12.8 ± 7.02 days (median 10 days, range 7–29 days); the mean number of physician office visits by players who suffered a concussion (15 cases) was 2.1 ± 1.29 (median 1.5 visits). Five of the 17 players who sustained a concussion also suffered a recurrent or second concussion. One of the 5 individuals who suffered a repeat concussion sustained his initial concussion in a regular season game that was not observed by a physician, and as a result this single case was not included in the total of 21 concussions. This initial concussion of the player was identified during baseline testing 2 days after the injury and was subsequently medically diagnosed and treated. The mean interval between the first and second concussions in these 5 players was 78.6 ± 39.8 days (median 82 days), and the mean time between the return-to-play date of the first and second concussions was 61.8 ± 39.7 days (median 60 days). Conclusions The mean rates of return to play for single and recurrent concussions were higher than rates cited in recent studies involving sport concussions. The time interval between the first and second concussions was also greater than previously cited. This difference may be the result of the methodology of direct independent physician observation, diagnosis, and adherence to the Zurich return-to-play protocol.

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“…33 Similar findings were reported in another study of college football players, according to both Sideline Assessment of Concussion and Immediate PostConcussion Assessment and Cognitive Testing scores. 50 Although there may be a dose response with regard to impacts that must be considered over the course of a player's career, the measures of neurological function used may not have been sensitive enough to detect subclinical neurological dysfunction in athletes sustaining many repetitive subconcussive impacts.…”

Section: 75mentioning

confidence: 99%

“…46 In contrast, Miller et al, who used Standardized Assessment of Concussion and computerized neuropsychological testing in Division III football players, found no difference among preseason baseline, midseason, and postseason assessments in the players who did not sustain a concussion. 50 Thus, there may be specific neuropsychological metrics that are better suited or more sensitive in detecting the effects of repetitive subconcussion forces. Perhaps the symptoms or sequelae of repetitive subconcussion require a greater amount of time to develop than a single season.…”

Section: 75mentioning

confidence: 99%

Role of subconcussion in repetitive mild traumatic brain injury

Bailes

Petraglia

Omalu

et al. 2013

JNS

443

340

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Research now suggests that head impacts commonly occur during contact sports in which visible signs or symptoms of neurological dysfunction may not develop despite those impacts having the potential for neurological injury. Recent biophysics studies utilizing helmet accelerometers have indicated that athletes at the collegiate and high school levels sustain a surprisingly high number of head impacts ranging from several hundred to well over 1000 during the course of a season. The associated cumulative impact burdens over the course of a career are equally important. Clinical studies have also identified athletes with no readily observable symptoms but who exhibit functional impairment as measured by neuropsychological testing and functional MRI. Such findings have been corroborated by diffusion tensor imaging studies demonstrating axonal injury in asymptomatic athletes at the end of a season. Recent autopsy data have shown that there are subsets of athletes in contact sports who do not have a history of known or identified concussions but nonetheless have neurodegenerative pathology consistent with chronic traumatic encephalopathy. Finally, emerging laboratory data have demonstrated significant axonal injury, blood-brain barrier permeability, and evidence of neuroinflammation, all in the absence of behavioral changes. Such data suggest that subconcussive level impacts can lead to significant neurological alterations, especially if the blows are repetitive. The authors propose “subconcussion” as a significant emerging concept requiring thorough consideration of the potential role it plays in accruing sufficient anatomical and/or physiological damage in athletes and military personnel, such that the effects of these injuries are clinically expressed either contemporaneously or later in life.

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Comparison of Preseason, Midseason, and Postseason Neurocognitive Scores in Uninjured Collegiate Football Players

Abstract: A diminution in SAC or ImPACT scores in concert with clinical symptoms and findings should be interpreted as evidence of a postconcussive event.

Cited by 104 publications

References 33 publications

Prevalence of Neurocognitive and Balance Deficits in Collegiate Football Players Without Clinically Diagnosed Concussion

Prevalence of Neurocognitive and Balance Deficits in Collegiate Football Players Without Clinically Diagnosed Concussion

Return to play after an initial or recurrent concussion in a prospective study of physician-observed junior ice hockey concussions: implications for return to play after a concussion

Role of subconcussion in repetitive mild traumatic brain injury

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