Role of Neuropsychologists in the Evaluation and Management of Sport-Related Concussion: An Inter-Organization Position Statement

Echemendía, Ruben J.; McCrea, Michael; Broshek, Donna K.; Gioia, Gérard A.; Sautter, Scott W.; Macciocchi, Stephen N.; Barr, William

doi:10.1093/arclin/acr077

Cited by 38 publications

(21 citation statements)

References 35 publications

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“…Despite the widespread use of computerized neurocognitive tools to evaluate patients with acute concussion, neuropsychological assessment of athletes with PCS is best accomplished by the use of multiple test batteries that examine domains such as concentration, memory, attention, processing speed, and executive function and are tailored to the patient’s persistent symptoms and the time course of injury (79). Clinical neuropsychologists are the only health-care professionals who are equipped with the clinical training, experience, and armamentarium of neuropsychological testing instruments that can provide comprehensive assessment of neurocognitive functioning in this patient population (80). Not only can the results of formal neuropsychological testing help to quantify the impact of TBI on subtle aspects of brain functioning but they are often instrumental in confirming complete neurocognitive recovery and helping guide return-to-learn and return-to-play decision-making 2 .…”

Section: Supplemental Testingmentioning

confidence: 99%

“…Accumulating evidence suggests that graded aerobic treadmill testing is a safe, well-tolerated, and reliable tool to evaluate exercise tolerance and classify pediatric and adult SRC patients into operational PCS sub-types or disorders (7–9, 11, 80–82). This tool is valuable because previous work has demonstrated that evaluation of individual symptoms does not allow concussion patients to be appropriately classified into operational PCS sub-types or trajectories (82).…”

Section: Supplemental Testingmentioning

confidence: 99%

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Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach

2016

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Historically, patients with sports-related concussion (SRC) have been managed in a uniform fashion consisting mostly of prescribed physical and cognitive rest with the expectation that all symptoms will spontaneously resolve with time. Although this approach will result in successful return to school and sports activities in the majority of athletes, an important proportion will develop persistent concussion symptoms characteristic of post-concussion syndrome (PCS). Recent advances in exercise science, neuroimaging, and clinical research suggest that the clinical manifestations of PCS are mediated by unique pathophysiological processes that can be identified by features of the clinical history and physical examination as well as the use of graded aerobic treadmill testing. Athletes who develop PCS represent a unique population whose care must be individualized and must incorporate a rehabilitative strategy that promotes enhanced recovery of concussion-related symptoms while preventing physical deconditioning. In this review, we present our evolving evidence-based approach to evaluation and management of athletes with PCS that aims to identify the pathophysiological mechanisms mediating persistent concussion symptoms and guides the initiation of individually tailored rehabilitation programs that target these processes. In addition, we outline the important qualified roles that multi-disciplinary healthcare professionals can play in the management of this patient population, and discuss where future research efforts must be focused to further evaluate this evolving pathophysiological approach.

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Section: Supplemental Testingmentioning

confidence: 99%

Section: Supplemental Testingmentioning

confidence: 99%

Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach

2016

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“…13 In addition to completing the legal documentation, the treating physician should consider a neuropsychology referral to aid the process, because an expert in neuropsychological testing can identify areas of cognitive difficulty and make specific recommendations for academic accommodations. 1,4,7,14 A 504 Plan does not provide additional funding to the school to offset the cost of its implementation and does not require written notice for significant changes. It also does not require the school district to pay the fees if a family requests an Independent Educational Evaluation (IEE; ie, second opinion), although it does require a formal appeal to resolve eligibility disputes.…”

Section: Plansmentioning

confidence: 99%

CHOA Concussion Consensus

Popoli

Burns

Meehan

et al. 2013

Clin Pediatr (Phila)

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Concussion research generally centers on physical challenges, though aspects such as social functioning and returning to school also warrant attention in pediatric populations. Restoring academic performance postconcussion remains a challenge. Here we provide recommendations addressing a uniform policy for pediatric concussion patients in academic institutions. Tools that may minimize difficulty with academic re-entry include independent educational evaluations, individualized educational programs (IEPs), student support teams (SSTs), letters of academic accommodation, time off, and 504 Plans. Recognition and treatment is crucial for symptom relief and prevention of functional disruption, as is specialist referral during the acute window. We recommend early intervention with a letter of academic accommodation and SST and suggest that 504 Plans and IEPs be reserved for protracted or medically complicated cases. Students with concussion should be observed for anxiety and depression because these symptoms can lead to prolonged recovery, decreased quality of life, and other social challenges.

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“…▸ Comprehensive NP evaluation is helpful in the post-concussion management of athletes with persistent symptoms or complicated courses [1]. " American Academy of Clinical Neuropsychology (AACN), American Board of Professional Neuropsychology (ABN), Division 40 (Neuropsychology) of the American Psychological Association (APA), and the National Academy of Neuropsychology (NAN) stated that neuropsychologists should be included among the licensed healthcare professionals authorized to evaluate, clinically manage, and provide return to play clearance for athletes who sustain a SRC [18]. "…”

Section: Final Pointsmentioning

confidence: 99%

Sport-Related Concussion and Neuropsychological Testing: Shaken or Stirred?

Sisodia¹,

Kumar

2013

J Sports Med Doping Stud

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Concussion is a traumatically induced transient disturbance of brain function and involves a complex pathophysiological process at the less-severe end of brain injury spectrum. Sport-Related Concussion (SRC) is increasingly been recognized as an individual entity globally. Whilst the neurological effects of SRC are well known, neuropsychological testing and its implications in SRC remain to elude sports medicine professionals with a dilemma of to do or not do? This editorial aimed to address this issue speculating from an evidence-informed viewpoint. An overview of definition, history and development of neuropsychological testing, its uses and issues related to its interpretation are discussed in this paper, with implications for future research. DefinitionAmerican Medical Society for Sports Medicine(AMSSM) defined Concussion "as a traumatically induced transient disturbance of brain function and involves a complex pathophysiological process, which is a subset of Mild Traumatic Brain Injury (MTBI) and is generally selflimited and at the less-severe end of the brain injury spectrum [1]. " Prevalence of Sport-Related Concussion (SRC) varies depending upon type of sport, but is eventually occurring in all types of sport especially more so in football, soccer, and baseball [2]. History and DevelopmentThe earliest understanding of SRC as an acceleration-deceleration injury was explained by using the model of Newtonian Physics to objectively measure the forces applied to the brain during accelerationdeceleration injuries, and to predict functional outcome, such as neurocognitive status, recovery curves, and return to play from the obtained data [3,4].From the bench to the bedside, the evidence points out both basic science and clinical controversies existed in SRC where the former included labeling the condition as a 'functional brain injury' rather than structural or pathological brain damage, while the latter involved issues with definition, injury severity grading, classification, and understanding of clinical symptoms and motor/convulsive squeal [5]. Evaluation of ConcussionEvaluation of symptom severity, neuro cognitive function and postural stability forms a comprehensive part of assessment of sportspersons with concussion [6]. However, a plethora of diagnostic measures were reported in literature namely; structural imaging (computerized tomography, magnetic resonance imaging, diffusion tensor imaging), functional imaging (single photon emission computerized tomography, positron emission tomography, functional magnetic resonance imaging), spectroscopy (magnetic resonance spectroscopy, near infrared spectroscopy), balance testing (Balance Error Scoring System, Sensory Organization Test, gait testing, virtual reality), electrophysiological tests (electroencephalography, evoked potentials, event related potentials, magneto encephalography, heart rate variability), genetics (apolipoprotein E4, channelopathies) and blood markers (S100, neuron-specific enolase, cleaved Tau protein, glutamate) [7]. Treatment o...

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Role of Neuropsychologists in the Evaluation and Management of Sport-Related Concussion: An Inter-Organization Position Statement

Cited by 38 publications

References 35 publications

Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach

Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach

CHOA Concussion Consensus

Sport-Related Concussion and Neuropsychological Testing: Shaken or Stirred?

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