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The Ability of Baseline and Normative Neurocognitive Testing to Identify Cognitive Impairments Following Concussion: A Critically Appraised Topic

Nicholas M. Hattrup, Rebekah L. Gardiner, Hannah Gray, Cailee E. Welch Bacon, and Tamara C. Valovich McLeod

gold standard for the diagnosis of concussion, the use of multiple assessment tools (e.g., symptom checklist, neurocognitive testing, balance assessment, and vestibular/oculomotor assessment) are encouraged to identify the various impairments following a concussion. 1 However, certain recommendations

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A Prospective Evaluation on the Effects of One High School Football Season on Neurocognitive Test Scores in High School Football Athletes

Rachele E. Vogelpohl, Rachel A. Lindsey, Christopher D. Stickley, Ronald K. Hetzler, Whitney Williams, and Iris F. Kimura

Subconcussive head impacts do not result in outward signs of neurological dysfunction, however they may have an effect on neurocognitive function. Limited research has indicated that negative changes in neurocognitive function occurs in high school football athletes as a result of one season of football. The purpose of this study was to prospectively evaluate the effects of one season of high school football on neurocognitive test scores. Results revealed a significant group and time interaction effect (p < .001) for the Verbal Memory composite score of the ImPACT test. Further analysis revealed a significant difference in the Verbal Memory score between groups at postseason (p < .01), with the football group scoring lower than the low contact group. It appears that one season of high school football may have a negative effect on the Verbal Memory composite score of the ImPACT test in high school football athletes.

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Neurocognitive Testing Following Resolution of Concussion Symptoms

James R. Day, Matthew R. Hanson, and Melody J. Reding

Edited by Michael G. Dolan

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Clinical Management of Sport-Related Concussion: Developing a Roadmap to a Successful Outcome

Kevin Guskiewicz and Elizabeth Teel

In order to promote the most successful outcomes following concussion, a multifaceted team of individuals is required for appropriate injury diagnosis and management. This review explores the primary roles of sports medicine personnel in the concussion diagnosis and management process. We will discuss the psychometric properties, including sensitivity, specificity, and clinical utility, of on-field/sideline, laboratory, and neurophysiological assessment tools. Additionally, we will discuss the roles of other kinesiology experts in concussion management and recovery, and their importance to concussion research. By developing a thorough and consistent roadmap for concussion management, clinicians and researchers will be capable of providing athletes with the most successful outcomes.

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Assessment and Training of Visuomotor Reaction Time for Football Injury Prevention

Gary B. Wilkerson, Kevin A. Simpson, and Ryan A. Clark

Context:

Neurocognitive reaction time has been associated with musculoskeletal injury risk, but visuomotor reaction time (VMRT) derived from tests that present greater challenges to visual stimulus detection and motor response execution may have a stronger association.

Objective:

To assess VMRT as a predictor of injury and the extent to which improvement may result from VMRT training.

Design:

Cohort study.

Setting:

University athletic performance center.

Participants:

76 National Collegiate Athletic Association Division-I FCS football players (19.5 ± 1.4 y, 1.85 ± 0.06 m, 102.98 ± 19.06 kg).

Interventions:

Preparticipation and postseason assessments. A subset of players who exhibited slowest VMRT in relation to the cohort’s postseason median value participated in a 6-wk training program.

Main Outcome Measures:

Injury occurrence was related to preparticipation VMRT, which was represented by both number of target hits in 60 s and average elapsed time between hits (ms). Receiver operating characteristic analysis identified the optimum cut point for a binary injury risk classification. A nonparametric repeated-measures analysis of ranks procedure was used to compare posttraining VMRT values for slow players who completed at least half of the training sessions (n = 15) with those for untrained fast players (n = 27).

Results:

A preparticipation cut point of ≤85 hits (≥705 ms) discriminated injured from noninjured players with odds ratio = 2.30 (90% confidence interval, 1.05–5.06). Slow players who completed the training exhibited significant improvement in visuomotor performance compared with baseline (standardized response mean = 2.53), whereas untrained players exhibited a small performance decrement (group × trial interaction effect, L2 = 28.74; P < .001).

Conclusions:

Slow VMRT appears to be an important and modifiable injury risk factor for college football players. More research is needed to refine visuomotor reaction-time screening and training methods and to determine the extent to which improved performance values can reduce injury incidence.

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The Relationship Between Neurocognitive Function and Biomechanics: A Critically Appraised Topic

Ke’La Porter, Carolina Quintana, and Matthew Hoch

neurocognitive test • Participants completed a sports-related task (ie, jumping/landing, cutting) with lower-extremity biomechanical analysis (ie, kinematics, kinetics) • Participants were recreational or competitive athletes with no current injuries • Studies published in English • Studies that were level 3

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The Influence of Race on Time to Symptom Resolution Following Sport Concussion in Collegiate Athletes

Angelina M. Domena, Daniel J. Rosenblum, Catherine C. Donahue, and Jacob E. Resch

socioeconomic status (SES) may interact with concussion. 7 – 12 Related research has suggested that SES and race may be more important than commonly used covariates such as concussion history or sport type when predicting baseline computerized neurocognitive test performance. 8 While mixed overall, previous

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Differences in Neurocognitive Functions Between Healthy Controls and Anterior Cruciate Ligament-Reconstructed Male Athletes Who Passed or Failed Return to Sport Criteria: A Preliminary Study

Maryam Kiani Haft Lang, Razieh Mofateh, Neda Orakifar, and Shahin Goharpey

likelihood of a second ACL injury. 4 The aforementioned clearly indicates that there may be a mismatch between the contents of current RTS tests and the demands that an athlete will face after RTS. It also indicates the value of adding neurocognitive tests to RTS protocol. Although many researchers have

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The Relationship Between Impact Force, Neck Strength, and Neurocognitive Performance in Soccer Heading in Adolescent Females

Gregory M. Gutierrez, Catherine Conte, and Kristian Lightbourne

Head impacts are common in contact sports, but only recently has there been a rising awareness of the effects of subconcussive impacts in adolescent athletes. A better understanding of how to attenuate head impacts is needed and therefore, this study investigated the relationship between neck strength, impact, and neurocognitive function in an acute bout of soccer heading in a sample of female high school varsity soccer players. Seventeen participants completed the ImPACT neurocognitive test and had their isometric neck strength tested (flexion, extension, and bilateral flexion) before heading drills. Each participant was outfitted with custom headgear with timing switches and a three-dimensional accelerometer affixed to the back of the head, which allowed for measurement of impact during heading. Participants performed a series of 15 directional headers, including 5 forward, 5 left and 5 right headers in a random order, then completed the ImPACT test again. Neurocognitive tests revealed no significant changes following heading. However, there were statistically significant, moderate, negative correlations (r = −0.500:−0.757, p < .05) between neck strength and resultant header acceleration, indicating that those with weaker necks sustained greater impacts. This suggests neck strengthening may be an important component of any head injury prevention/reduction program.

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Neurocognitive Reaction Time Predicts Lower Extremity Sprains and Strains

Gary B. Wilkerson

Context:

Prevention of a lower extremity sprain or strain requires some basis for predicting that an individual athlete will sustain such an injury unless a modifiable risk factor is addressed.

Objective:

To assess the possible existence of an association between reaction time measured during completion of a computerized neurocognitive test battery and subsequent occurrence of a lower extremity sprain or strain.

Design:

Prospective cohort study.

Setting:

Preparticipation screening conducted in a computer laboratory on the day prior to initiation of preseason practice sessions.

Participants:

76 NCAA Division I-FCS football players.

Main Outcome Measures:

Lower extremity sprains and strains sustained between initiation of preseason practice sessions and the end of an 11-game season. Receiver operating characteristic analysis identified the optimal reaction time cut-point for discrimination between injured versus noninjured status. Stratified analyses were performed to evaluate any differential influence of reaction time on injury incidence between starters and nonstarters.

Results:

A total of 29 lower extremity sprains and strains were sustained by 23 of the 76 players. A reaction time cut-point of ≥ .545 s provided good discrimination between injured and noninjured cases: 74% sensitivity, 51% specificity, relative risk = 2.17 (90% CI: 1.10, 4.30), and odds ratio = 2.94 (90% CI: 1.19, 7.25).

Conclusions:

Neurocognitive reaction time appears to be an indicator of elevated risk for lower extremity sprains and strains among college football players, which may be modifiable through performance of exercises designed to accelerate neurocognitive processing of visual input.