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

Abstract

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

Balance Performance in Collegiate Athletes: A Comparison of Balance Error Scoring System Measures

“…It is generally agreed that a comprehensive battery of neurological function and clinical balance tests needs to be administered to assess, diagnose and predict the prognosis of a concussed athlete [27]. One of the many ways to assess an athlete's return to play following a concussion is to assess their mechanical impairments, which includes motor control and postural stability issues [24,28,29]. The measures collected in our study can be used in addition to and in support of the recommended battery of tests already used for concussion management (i.e., the reaction time test, the cognition test, balance assessments) [28], especially in establishing baseline measures.…”

“Ref, Is This the Final?” Concussion Issues at the 2014 FIFA Men’s World Cup: A Case Study

“…(p. 643) As a result, the symptoms of a concussion may not emerge until several minutes or even hours after the concussive incident (Marar, McIlvain, Fields, & Comstock, 2012). Although the athlete may feel dazed or "out-of-it," increased adrenaline from the pressure of game-time situations, such as described by Kramer, Pereira and Mascherano may not allow an athlete to relate to an evolving concussive injury to a specific hit or collision (Mulligan, Boland, & Payette, 2012). In addition, because concussions may cloud short-term memory, athletes who become concussed may not recall the level of an impact when symptoms ultimately emerge (Harmon et al, 2013).…”

“…In addition, because concussions may cloud short-term memory, athletes who become concussed may not recall the level of an impact when symptoms ultimately emerge (Harmon et al, 2013). Thus, the athlete may not seek care from health professionals if they are unable to recognize or associate their symptoms with concussive event (Mulligan et al, 2012).…”

Does Game Participation Impact Cognition and Symptoms in Elite Football Players?

“…7 A second study comparing athletes (none with a diagnosed concussion) in contact sports (hockey and football) with athletes in noncontact sports found that at postseason testing, a higher proportion of athletes in contact sports had impairments on select memory tests. 8 A small sample of high school football players (4 of 11) demonstrated significant impairments on tests of neurophysiological and neurocognitive functioning within 72 hours after game participation. 9 Finally, 1 other study demonstrated no difference on a screening assessment of cognitive and balance functioning at 3 time intervals during the season.…”