Neuropsychological Assessment for Sports Related Concussion Post 2

Tuesday, May 10, 2011 4:52
Posted in category Health News

If an athlete sustains a concussion during the season, he or she is evaluated immediately after the injury. He or she is also evaluated at set intervals after the injury — for example, day three, five and seven — to determine when and if, he or she can return to preinjury performance levels. Multiple, post-injury assessments allow the neuropsychologist to determine “recovery curves” for both cognitive and self-reported concussion symptoms. The athletic trainer and/or sports medicine physician consults the neuropsychologist after each evaluation. This information allows them to make more informed and individualized decisions for the injured player.

Research Implications
In addition to providing useful clinical information, neuropsychological testing has provided a vehicle for research regarding concussion recovery and determining specific groups of athletes who may be at risk for poor outcomes. A recent, multicenter study, published in the Journal of the American Medical Association, which utilized neuropsychological measures in college football players, highlighted the following:
Neuropsychological tests are sensitive to measuring concussion effects.

Athletes suffering two or more concussions in their past performed more poorly on attention and problem solving tests compared to athletes who had no prior concussions.

A history of learning disability was linked with a poor outcome following concussion, especially in an athlete who has suffered two or more prior concussions.

The recovery of cognitive function following a concussion was not immediate and deficits were present in some athletes up to seven days following injury.
Future Directions in Sports Neuropsychological Assessment
The use of neuropsychological assessment as a supplement in managing the concussed athlete continues to expand. The implementation of the following programs should, in the future, lead to research-based directives for return-to-play:
The National Hockey League mandates baseline neuropsychological testing for all athletes and the majority of National Football League programs implement the outlined protocol.

Many college football, hockey and soccer programs recommend the use of neuropsychological testing for help with clinical decision-making.

A concussion safety program, using neuropsychological measures, is currently being implemented with a number of high schools in the mid-West.
Until these directives are accomplished, the following should be emphasized when managing sports-related concussion:
Physicians should carefully assess every athlete with a concussion.

No athlete should be allowed to return to play while still exhibiting concussion signs or symptoms.

Regular, ongoing and repeated examination of the athlete should be conducted following injury. This evaluation should involve a thorough assessment of the athlete’s symptoms and mental status changes.

To date, the widespread use of neuropsychological testing has been somewhat limited because the technology is not available to the general public. For this reason, a computerized version of neuropsychological tests has recently been developed, which will allow for more cost-effective evaluation of at-risk athletes.

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