Neuropsychological evaluation in the diagnosis and management of sports-related concussion☆

Moser, Rosemarie Scolaro; Echemendía, Ruben J.; Lovell, Mark R.; Schatz, Philip; Webbe, Frank M.; Ruff, Ronald M.; Barth, Jeffrey T.; Policy, Nan; Broshek, Donna K.; Bush, Shane S.; Koffler, Sandra P.; Reynolds, Cecil R.; Silver, Cheryl H.

doi:10.1016/j.acn.2007.09.004

Cited by 152 publications

(83 citation statements)

References 62 publications

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“…Consequently, our use of source studies restricted to TBI defined by LOC would have missed many sports-related concussions. In this regard, our methods are consistent with the Center for Disease Prevention and Control, which, even though there are approximately 300,000 sports-related concussions each year in the USA [23], does not include sports-related concussions in its published prevalence data for TBI. It is also important to note that approximately 80% of all TBIs are classified as mild and often do not result in LOC [4].…”

Section: Discussionsupporting

confidence: 56%

Prevalence of Traumatic Brain Injury in the General Adult Population: A Meta-Analysis

Frost

Farrer²,

Primosch³

et al. 2012

Neuroepidemiology

275

155

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Traumatic brain injury (TBI) is a significant public-health concern. To understand the extent of TBI, it is important to assess the prevalence of TBI in the general population. However, the prevalence of TBI in the general population can be difficult to measure because of differing definitions of TBI, differing TBI severity levels, and underreporting of sport-related TBI. Additionally, prevalence reports vary from study to study. In this present study, we used meta-analytic methods to estimate the prevalence of TBI in the adult general population. Across 15 studies, all originating from developed countries, which included 25,134 adults, 12% had a history of TBI. Men had more than twice the odds of having had a TBI than did women, suggesting that male gender is a risk factor for TBI. The adverse behavioral, cognitive and psychiatric effects associated with TBI coupled with the high prevalence of TBI identified in this study indicate that TBI is a considerable public and personal-health problem.

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Section: Discussionsupporting

confidence: 56%

Prevalence of Traumatic Brain Injury in the General Adult Population: A Meta-Analysis

Frost

Farrer²,

Primosch³

et al. 2012

Neuroepidemiology

275

155

View full text Add to dashboard Cite

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“…[17][18][19] Therefore, objective and quantitative diagnostic tools that are more sensitive and specific to concussive injury are needed. Researchers have investigated more objective measures for concussion diagnosis, including balance testing, 20 neuropsychological testing, 21 and advanced imaging. 22 Whereas these measures assess the clinical symptoms of concussion, no measure can identify the concussed athlete while on the field or be used as a preventive tool.…”

mentioning

confidence: 99%

Head-Impact–Measurement Devices: A Systematic Review

O’Connor

Rowson

Duma

et al. 2017

Journal of Athletic Training

154

117

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Context: With an estimated 3.8 million sport-and recreation-related concussions occurring annually, targeted prevention and diagnostic methods are needed. Biomechanical analysis of head impacts may provide quantitative information that can inform both prevention and diagnostic strategies.Objective: To assess available head-impact devices and their clinical utility.Data Sources: We performed a systematic search of the electronic database PubMed for peer-reviewed publications, using the following phrases: accelerometer and concussion, head impact telemetry, head impacts and concussion and sensor, head impacts and sensor, impact sensor and concussion, linear acceleration and concussion, rotational acceleration and concussion, and xpatch concussion. In addition to the literature review, a Google search for head impact monitor and concussion monitor yielded 15 more devices.Study Selection: Included studies were performed in vivo, used commercially available devices, and focused on sportrelated concussion.Data Extraction: One author reviewed the title and abstract of each study for inclusion and exclusion criteria and then reviewed each full-text article to confirm inclusion criteria. Controversial articles were reviewed by all authors to reach consensus.Data Synthesis: In total, 61 peer-reviewed articles involving 4 head-impact devices were included. Participants in boxing, football, ice hockey, soccer, or snow sports ranged in age from 6 to 24 years; 18% (n ¼ 11) of the studies included female athletes. The Head Impact Telemetry System was the most widely used device (n ¼ 53). Fourteen additional commercially available devices were presented.Conclusions: Measurements collected by impact monitors provided real-time data to estimate player exposure but did not have the requisite sensitivity to concussion. Proper interpretation of previously reported head-impact kinematics across age, sport, and position may inform future research and enable staff clinicians working on the sidelines to monitor athletes. However, head-impact-monitoring systems have limited clinical utility due to error rates, designs, and low specificity in predicting concussive injury.

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“…Since then, baseline assessment has been termed essential 2 and the criterion standard for concussion-management programs. 3 Baseline testing followed by serial neuropsychological evaluations until the athlete's performance has returned to baseline or better represents a formal standard of best practice espoused by many professional associations and multiprofessional panels, including the American Academy of Pediatrics, 4 National Academy of Neuropsychology, 5 and National Athletic Trainers' Association. 6 The alternative approach to assessing an athlete's posttraumatic performance requires comparison with a normative sample.…”

mentioning

confidence: 99%

Sport and Team Differences on Baseline Measures of Sport-Related Concussion

Zimmer

Piecora

Schuster

et al. 2013

Journal of Athletic Training

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Context: With the advent of the National Collegiate Athletic Association's (NCAA's) mandating the presence and practice of concussion-management plans in collegiate athletic programs, institutions will consider potential approaches for concussion management, including both baseline and normative comparison approaches.Objective: To examine sport and team differences in baseline performance on a computer-based neurocognitive measure and 2 standard sideline measures of cognition and balance and to determine the potential effect of premorbid factors sex and height on baseline performance.Design: Cross-sectional study. Main Outcome Measure(s): The computerized Concussion Resolution Index (CRI), the Standardized Assessment of Concussion (Form A; SAC), and the Balance Error Scoring System (BESS).Results: Players on the men's basketball team tended to perform worse on the baseline measures, whereas soccer players tended to perform better. We found a difference in total BESS scores between these sports (P ¼ .002). We saw a difference between sports on the hard-surface portion of the BESS (F 6,347 ¼ 3.33, P ¼ .003, g p 2 ¼ 0.05). No sport, team, or sex differences were found with SAC scores (P . .05). We noted differences between sports and teams in the CRI indices, with basketball, particularly the men's team, performing worse than soccer (P , .001) and softball/baseball (P ¼ .03). When sex and height were considered as possible sources of variation in BESS and CRI team or sport differences, height was a covariate for the team (F 1,385 ¼ 5.109, P ¼ .02, g p 2 ¼ 0.013) and sport (F 1,326 ¼ 11.212, P ¼ .001, g p 2 ¼ 0.033) analyses, but the interaction of sex and sport on CRI indices was not significant in any test (P . .05).Conclusions: Given that differences in neurocognitive functioning and performance among sports and teams exist, the comparison of posttraumatic and baseline assessment may lead to more accurate diagnoses of concussion and safer returnto-participation decision making than the use of normative comparisons.Key Words: traumatic brain injuries, baseline assessment, Concussion Resolution Index, Standardized Assessment of Concussion, Balance Error Scoring System Key PointsAssessment of posttraumatic performance in concussion-management programs should be informed by appreciation that premorbid differences related to sport and team membership may exist. Caution should be taken in relying on only 1 or 2 measures because these may be compromised by predictable sport and team differences and demographic factors. Scores on a baseline measure of postural stability (Balance Error Scoring System) and on the computerized Concussion Resolution Index differed by sport, team, and in some cases sex. Differences on the Balance Error Scoring System were correlated with height: taller athletes tended to perform worse than shorter athletes.

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Neuropsychological evaluation in the diagnosis and management of sports-related concussion☆

Cited by 152 publications

References 62 publications

Prevalence of Traumatic Brain Injury in the General Adult Population: A Meta-Analysis

Prevalence of Traumatic Brain Injury in the General Adult Population: A Meta-Analysis

Head-Impact–Measurement Devices: A Systematic Review

Sport and Team Differences on Baseline Measures of Sport-Related Concussion

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