Standard regression-based methods for measuring recovery after sport-related concussion

Abstract

Clinical decision making about an athlete's return to competition after concussion is hampered by a lack of systematic methods to measure recovery. We applied standard regression-based methods to statistically measure individual rates of impairment at several time points after concussion in college football players. Postconcussive symptoms, cognitive functioning, and balance were assessed in 94 players with concussion (based on American Academy of Neurology Criteria) and 56 noninjured controls during preseason baseline testing, and immediately, 3 hr, and 1, 2, 3, 5, and 7 days postinjury. Ninety-five percent of injured players exhibited acute concussion symptoms and impairment on cognitive or balance testing immediately after injury, which diminished to 4% who reported elevated symptoms on postinjury day 7. In addition, a small but clinically significant percentage of players who reported being symptom free by day 2 continued to be classified as impaired on the basis of objective balance and cognitive testing. These data suggest that neuropsychological testing may be of incremental utility to subjective symptom checklists in identifying the residual effects of sport-related concussion. The implementation of neuropsychological testing to detect subtle cognitive impairment is most useful once postconcussive symptoms have resolved. This management model is also supported by practical and other methodological considerations.

Neuropsychological Outcomes of U.S. Veterans with Report of Remote Blast-Related Concussion and Current Psychopathology

“…Although available findings to date suggest that injury severity (mild, moderate, severe), more than injury mechanism (blast-associated vs. not), is the greater determinant of cognitive outcomes in OEF/OIF TBI samples (Belanger et al, 2009), the reality is that the natural history of BRC has yet to be established. Until longitudinal examination of neuropsychological performances is conducted on a much larger scale and with much larger OEF/OIF samples, as has been conducted in sports concussion samples (e.g., McCrea et al, 2005), the nature of cognitive recovery following BRC will remain unclear. For now, paired with the findings of other research groups (Brenner et al, 2010;Nelson et al, 2009), present findings suggest that blast-related MTBI does not typically result in chronic objective cognitive impairments.…”

Summary of evidence-based guideline update: Evaluation and management of concussion in sports

“…The SAC is likely to identify the presence of concussion in the early stages postinjury (sensitivity 80%-94%, specificity 76%-91%) (multiple Class III studies). 8,25,26,[34][35][36][37] Neuropsychological testing. Instruments for neuropsychological testing are divided into 2 types on the basis of their method of administration: paper-and-pencil and computer.…”

Head-Impact–Measurement Devices: A Systematic Review

“…9 This metabolic disruption lasts about a week, mirroring the timeline of clinical symptom recovery. 10,11 In animal models, researchers 12 have demonstrated that a second concussion during this period of brain vulnerability creates greater metabolic and cognitive impairment for a longer time. Similar findings of vulnerability and impaired recovery have also been shown in male athletes.…”