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

Abstract

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...