, represents a clinician with appropriate training and clinical experiences to competently treat athletes within the realms of neuropsychology, sport psychology, and clinical psychology. It is important to note that although this case represents a provider with areas of training that may not be shared by all
Zachary C. Merz, Joanne E. Perry and Michael J. Ross
Christine M. Salinas and Frank M. Webbe
This paper aims to familiarize readers with the contemporary scientific literature available on sports concussion as it relates to populations divergent from adult males who play football and hockey. Herein, we focus on important issues such as age, gender, culture, language, sport type, and premorbid conditions (such as learning disabilities [LD] and attention deficit/hyperactive disorder [ADHD]) that can influence concussion incidence, severity, and recovery.
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.
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.
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.
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.
Charles H. Tator
There has been a remarkable increase in the past 10 years in the awareness of concussion in the sports and recreation communities. Just as sport participants, their families, coaches, trainers, and sports organizations now know more about concussions, health care professionals are also better prepared to diagnose and manage concussions. As has been stated in the formal articles in this special issue on sport-related concussion, education about concussion is one of the most important aspects of concussion prevention, with the others being data collection, program evaluation, improved engineering, and introduction and enforcement of rules. Unfortunately, the incidence of concussion appears to be rising in many sports and thus, additional sports-specific strategies are required to reduce the incidence, short-term effects, and long term consequences of concussion. Enhanced educational strategies are required to ensure that individual participants, sports organizations, and health care professionals recognize concussions and manage them proficiently according to internationally recognized guidelines. Therefore, this paper serves as a “brief report” on a few important aspects of concussion education and prevention.
Eric A. Roy, Liana Brown, Tammi Winchester, Paula Square, Craig Hall and Sandra Black
Apraxia is an impairment in the ability to pantomime or imitate gestures usually caused by a stroke more frequently to the left than the right hemisphere. Due to the complex nature of apraxia, disruptions to a number of different cognitive and motor processes have been proposed to underly this disorder. In order to examine disruptions to these processes the participation of a special population of people who have suffered a stroke has been enlisted. The role of memory has been particularly well elucidated in studies of this special population, as patients with left hemisphere damage exhibit a particular deficit in performing gestures from memory. In this paper, through use of a model depicting the stages involved in gestural production, the processes that might be affected at each stage by left hemisphere damage are examined. The implications of the “cognitive neuropsychology” approach for incorporating special populations into research in the movement sciences are considered.
Goal-directed movement is possible because the cortical regions regulating movement have continuous access to visual information. Extensive research from the various domains of motor control (i.e., neurophysiology, neuropsychology, and psychophysics) has documented the extent to which the unremitting availability of visual information enables the sensorimotor system to facilitate online control of goal-directed limb movement. However, the control mechanism guiding appreciably more complex movements characterized by ballistic, whole-body coordination is not well understood. In the overarm throw, for example, joint rotations must be optimally timed between body segments to exploit the passive flow of kinetic energy and, in turn, maximize projectile speed while maintaining accuracy. The purpose of this review is to draw from the various research domains in motor control and speculate on the nature of the sensorimotor control mechanism facilitating overarm throwing performance.
Onno G. Meijer, Yakov M. Kots and V. Reggie Edgerton
In 1963, an article on “Tonus” (tone), written by Nikolai A. Bernstein and Yakov M. Kots. appeared in the second edition of the Bols'aja Medicinskaja Enciclopedija [Grand Medical Encyclopedia]. The paper is now published for the first time in the English language, with Mark L. Latash as translator. In accordance with then contemporary neurophysiology and neuropsychology, the paper presented “tone” as a graded phenomenon (as opposed to all-or-none), serving to prepare the segmental level for phasic contractions. Influenced by Granit and Matthews, the authors proposed that the suprasegmental level controls the threshold and the slope of the stretch reflex. In their introduction to the present edition, the editors understand this proposal in the context of low-dimensional control, that is. control in terms of one or a few variables (as opposed to central commands specifying all the details). Selected episodes from the history of low dimensional control and its logical counterpart, spinal intelligence, are used to illustrate how difficult these ideas were to accept. As so often in new scientific developments, confusion was the rule, and in this respect the paper on “Tonus” is no exception. In the epilogue, Kots gives his personal memories of the context in which the paper was written. At the time, he was working on “equitonometry” (equitonometric), measuring tonic balance with gravity eliminated. Results of equitonometric research quite naturally led to the idea that suprasegmental centers control the threshold and the slope of me tonic stretch reflex. As Kots remembers, that was “no big deal.”