“Concussion” is all over the news, and—yes—it has implications for combating chronic diseases such as obesity and diabetes. Many parents are pushing their children away from collision sports such as football, hockey, and lacrosse because they fear the risk of chronic neurodegenerative problems later in life. However, there is good logic in emphasizing the importance of physical activities such as collision type sports, during the developmental years. Physical educators, researchers, policy makers, and coaches must work together to encourage safe play and rules changes that can keep youth and adolescents active in sports that build character, discipline, and teach teamwork. Understanding the complexity of the highly adaptable adolescent brain both prior to and following sport-related concussion is critically important in accomplishing this goal.
Michael McCrea and Matthew R. Powell
This article reviews the essential components of a practical, evidenced-based approach to the management of sport-related concussion in an ambulatory care setting. The model presented is based on the core philosophy that concussion assessment and management be approached from the biopsychosocial perspective, which recognizes the medical/physiological, psychological, and sociological factors that influence recovery and outcome following concussion. Based on the biopsychosocial paradigm, we outline a care delivery model that emphasizes an interdisciplinary approach in which the clinical neuropsychologist is a key participant. We discuss the importance of nonmedical, psychoeducational interventions introduced during the acute phase to facilitate recovery after sport-related concussion. Finally, using the local experience of our “Concussion Clinic” as a backdrop, we offer two separate case studies that demonstrate the value of this model in evaluating and managing athletes after sport-related concussion. The overall objective of this paper is to provide an adaptable template that neuropsychologists and other healthcare providers can use to improve the overall care of athletes with sport-related concussion and civilians with mild traumatic brain injury.
Anneke G. van der Niet, Joanne Smith, Jaap Oosterlaan, Erik J.A. Scherder, Esther Hartman, and Chris Visscher
The objective of this study was to analyze the effects of a physical activity program including both aerobic exercise and cognitively engaging physical activities on children’s physical fitness and executive functions. Children from 3 primary schools (aged 8–12 years) were recruited. A quasi-experimental design was used. Children in the intervention group (n = 53; 19 boys, 34 girls) participated in a 22-week physical activity program for 30 min during lunch recess, twice a week. Children in the control group (n = 52; 32 boys, 20 girls) followed their normal lunch routine. Aerobic fitness, speed and agility, and muscle strength were assessed using the Eurofit test battery. Executive functions were assessed using tasks measuring inhibition (Stroop test), working memory (Visual Memory Span test, Digit Span test), cognitive flexibility (Trailmaking test), and planning (Tower of London). Children in the intervention group showed significantly greater improvement than children in the control group on the Stroop test and Digit Span test, reflecting enhanced inhibition and verbal working memory skills, respectively. No differences were found on any of the physical fitness variables. A physical activity program including aerobic exercise and cognitively engaging physical activities can enhance aspects of executive functioning in primary school children.
Megan Elizabeth Evelyn Mormile, Jody L. Langdon, and Tamerah Nicole Hunt
graded symptom checklists, sideline balance testing, and multiple cognitive tests that determine a neuropsychological assessment battery. All position statements recommend the use of baseline neuropsychological testing for thorough concussion assessment, which attempts to quantify the preinjury status of
Nicholas E. Fears and Jeffrey J. Lockman
understanding of handwriting substantially, but fall short of providing a full account of handwriting development. Educational and Neuropsychological Assessments In the education literature, investigators have used standardized achievement and neuropsychological tests to determine factors related to school
Christopher P. Tomczyk, George Shaver, and Tamerah N. Hunt
between anxiety and cognitive performance, 4 – 7 limited research exists examining anxiety and neuropsychological testing within the concussion protocol. 5 However, the effects of anxiety on various neuropsychological assessments have been examined in healthy athlete populations outside the concussion
Marissa A. Gogniat, Catherine M. Mewborn, Talia L. Robinson, Kharine R. Jean, and L. Stephen Miller
neuropsychological testing, physical activity measurements, and magnetic resonance imaging. Participants were eligible if they had no self-reported neurological (eg, Alzheimer’s and Parkinson’s) or psychiatric disorders; were right-handed; native English speakers; and were compatible with the magnetic resonance
Martina Micai, Maria Kavussanu, and Christopher Ring
Poor executive function has been linked to increased antisocial and aggressive behavior in clinical and nonclinical populations. The present study investigated the relationship between executive and nonexecutive cognitive function and antisocial behavior in sport as well as reactive and proactive aggression. Cognitive function was assessed in young adult male and female athletes using the Cambridge Neuropsychological Test Automated Battery (CANTAB). Antisocial behavior in sport and aggression were assessed via self-report instruments and were found to be positively correlated. Executive function (but not nonexecutive function) scores were negatively correlated with both self-reported antisocial behavior and aggression in males but not females. Our findings suggest that prefrontal deficits among male athletes could contribute to poor impulse control and difficulty in anticipating the consequences of their antisocial and aggressive behavior.
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.
James W.G. Thompson and David Hagedorn
Sports-related concussions are complex injuries with biomechanical and biochemical etiology that present with central and autonomic nervous system dysfunction. Current methods for assessing concussions and basing return-to-play decisions rely on symptom resolution, rating scales, and neuropsychological testing, all of which are indirect measures of injury severity and detect functional capabilities but do not directly measure injury location or severity. In addition, these downstream measures are susceptible to false negatives because compensatory mechanism, such as unmasking and redundancies in brain circuitry can return functional capabilities before injury resolution. The multifactorial nature of concussion necessitates rapid, inexpensive, and easily applied multimodal analysis methods that can offer greater sensitivity and specificity. This article discusses how new approaches utilizing electrophysiology (e.g., QEEG, ERP, ECG, HRV), quantified balance measures, and biochemistry are necessary to advance the science of concussion assessment, treatment, recovery projections, and return-to-play decisions. These additional assessment tools offer a more direct window into the severity and location of the injury, real-time measures of brain function, and the ability to measure the multiple body systems negatively affected by concussion.