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Roya Saffary, Lawrence S. Chin, and Robert C. Cantu

Sports-related activities account for an estimated 10% of head and spinal cord injuries. In recent years, concussion in particular has garnered more interest in the medical field as well as the media. Reports of athletes suffering from long-term cognitive deficits and Parkinsonian symptoms have sparked concern in a disease process that has often been underestimated or ignored. As more reports surface, the desperate need for a better understanding of the neuropathology has been made clear. In addition to the concern for acute injury, long-term sequelae such as chronic traumatic encephalopathy (CTE) are feared consequences of concussive injuries. Research studies have shown significant overlap in the neuropathology between CTE and chronic neurodegenerative processes such as Alzheimer’s disease (AD). In particular, tau protein deposition has been found to be present in both disease processes and may play an important part in the clinical findings observed. The present review discusses concussion and our current understanding of pathological findings that may underlie the clinical features associated with concussive injuries and resulting chronic traumatic encephalopathy.

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John L. Woodard and Annalise A.M. Rahman

Recent progress in technology has allowed for the development and validation of computer-based adaptations of existing pencil-and-paper neuropsychological measures and comprehensive cognitive test batteries. These computer-based assessments are frequently implemented in the field of clinical sports psychology to evaluate athletes’ functioning postconcussion. These tests provide practical and psychometric advantages over their pencil-and-paper counterparts in this setting; however, these tests also provide clinicians with unique challenges absent in paper-and-pencil testing. The purpose of this article is to present advantages and disadvantages of computer-based testing, generally, as well as considerations for the use of computer-based assessments for the evaluation of concussion among athletes. Furthermore, the paper provides suggestions for further development of computerized assessment of sports concussion given the limitations of the current technology.

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Michael Hutchison, Paul Comper, Lynda Mainwaring, and Doug Richards

The baseline / postconcussion neuropsychological (NP) assessment model has been shown to be of clinical value and currently contributes significant information in sport concussion evaluation. Computerized NP batteries are now widely used in elite sport environments and are rapidly becoming more commonly utilized at the community level. With the growth of computerized NP testing, it is important to identify and understand unique characteristics with respect to baseline NP performance. The Automated Neuropsychological Assessment Metrics (ANAM) is a library of computerized NP tests designed to detect speed and accuracy of attention, memory, and thinking ability. This article describes baseline ANAM test scores in a sample of Canadian university athletes and explores the following two factors: (a) performance differences between male and female student-athletes using ANAM tests and (b) the relationship between self-reported history of concussion and baseline NP performance.

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Lynda Mainwaring, Paul Comper, Michael Hutchison, and Doug Richards

Knowledge and awareness of sport concussion has been forwarded by research modeled on the neuropsychological testing paradigm associated with Barth’s “sport as laboratory” assessment model. The purpose of this paper is to elucidate lessons learned from that research. Key considerations for planning and implementing large-scale studies of concussion in sport while making adequate provision for the clinical needs of concussed athletes are reviewed. Toward that end, logistical, methodological, and ethical considerations are discussed within the context of research conducted in a university setting. Topics addressed include culture of sport and risk; research planning and design; communication with strategic partners; defining injury; choosing a test battery; data management, outcomes, and analyses; dissemination of results; and finally, clinical and ethical implications that may arise during the research enterprise. The paper concludes with a summary of the main lessons learned and directions for future research.