Skip to main content
SpringerLink
Log in

Neuropsychological Testing in Sports Concussion Management: An Evidence-Based Model when Baseline Is Unavailable

  • Chapter
  • First Online:
Concussions in Athletics

Abstract

Since Barth and colleagues’ seminal study used baseline neuropsychological testing as a model for sports concussion management, many collegiate sports medicine programs have adopted variations of their approach. However, no evidence-based strategy has yet been clearly articulated for the use of neuropsychological tests in concussion management that involves consideration of cases in which no baseline testing has been conducted. In this chapter, we articulate an evidence-based model for neuropsychological sports concussion management in collegiate athletes for cases in which baseline data are not available. The model involves an algorithm that is based upon base rates of impairment in a typical neurocognitive sports concussion battery, with decision rules that differ slightly for males and females. Although we use our population of collegiate athletes and the tests we administer as a framework to provide concrete values to the proposed algorithm, our evidence-based model could easily be applied to other sports concussion populations and neurocognitive test batteries. Our proposed neuropsychological concussion management guidelines provide an evidence-based model, while at the same time remain consistent with trends in the literature, suggesting that increasingly individualistic clinical concussion management approaches are most prudent.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 159.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 209.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Barth JT, Alves WM, Ryan TV, Macciocchi SN, Rimel RW, Jane JA, et al. Mild head injury in sports: neuropsychological sequelae and recovery of function. In: Levin HS, Eisenberg HM, Benton AL, editors. Mild Head Injury. New York: Oxford University Press; 1989. p. 257–75.

    Google Scholar 

  2. Guskiewicz KM, Bruce SL, Cantu RC, Ferrara MS, Kelly JP, McCrea M, et al. Recommendations on management of sport-related concussion: summary of the National Athletic Trainers’ Association position statement. Neurosurgery. 2004;55:891–5.

    Article  PubMed  Google Scholar 

  3. Moser RS, Iverson GL, Echemendia RJ, Lovell MR, Schatz P, Webbe FM, et al. NAN position paper: neuropsychological evaluation in the diagnosis and management of sports-related concussion. Arch Clin Neuropsychol. 2007;22:909–16.

    Article  PubMed  Google Scholar 

  4. Aubry M, Cantu R, Dvorak J, Graf-Baumann T, Johnston K, Kelly J, et al. Summary and agreement statement of the first International Conference on Concussion in Sport, Vienna 2001. Br J Sports Med. 2002;36:3–7.

    Article  Google Scholar 

  5. McCrory P, Johnston K, Meeuwisse W, Aubry M, Cantu R, Dvorak J, et al. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Br J Sports Med. 2005;39:196–204.

    CAS  PubMed  Google Scholar 

  6. McCrory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M, et al. Consensus statement on concussion in sport—the 3rd International conference on concussion in sport held in Zurich, November 2008. Br J Sports Med. 2009;43(1):i76–90.

    Article  PubMed  Google Scholar 

  7. Van Kampen DA, Lovell MR, Pardini JE, Collins MW, Fu FH. The “value added” of neurocognitive testing after sports-related concussion. Am J Sports Med. 2006;30:1630–5.

    Article  Google Scholar 

  8. Randolph C, McCrea M, Barr WB. Is neuropsychological testing useful in the management of sport-related concussion? J Athl Train. 2005;40:139–54.

    PubMed Central  PubMed  Google Scholar 

  9. Randolph C. Baseline neuropsychological testing in managing sport-related concussion: does it modify risk? Curr Sports Med Rep. 2011;10:21–6.

    Article  PubMed  Google Scholar 

  10. Echemendia RJ, Bruce JM, Bailey CM, Sanders JF, Arnett PA, Vargas G. The utility of post-concussion neuropsychological data in identifying cognitive change following sports-related MTBI in the absence of baseline data. Clin Neuropsychol. 2012;26:1077–91.

    Article  PubMed  Google Scholar 

  11. Randolph C, Kirkwood MW. What are the real risks of sport-related concussion, and are they modifiable? J Int Neuropsychol Soc. 2009;15:1–9.

    Article  Google Scholar 

  12. Ellemberg D, Henry LC, Macciocchi SN, Guskiewicz KM, Broglio SP. Advances in sport concussion assessment: from behavioral to brain imaging measures. J Neurotrauma. 2009;26:2365–82.

    Article  PubMed  Google Scholar 

  13. Mayers LB, Redick TS. Clinical utility of ImPACT assessment for postconcussion return-to-play counseling: psychometric issues. J Clin Exp Neuropsychol. 2012;34:235–42.

    Article  PubMed  Google Scholar 

  14. Broglio SP, Ferrara MS, Macciocchi SN, Baumgartner TA, Elliott R. Test–retest reliability of computerized concussion assessment programs. J Athl Train. 2007;42:509–14.

    PubMed Central  PubMed  Google Scholar 

  15. Iverson GL, Lovell MR, Collins MW. Interpreting change on ImPACT following sport concussion. Clin Neuropsychol. 2003;17:460–7.

    Article  PubMed  Google Scholar 

  16. Schatz PS. Long-term test–retest reliability of baseline cognitive assessments using ImPACT. Am J Sports Med. 2010;38:47–53.

    Article  PubMed  Google Scholar 

  17. Lovell M. ImPACT version 2.0 clinical user’s manual. Pittsburgh: ImPACT Applications Inc.; 2002.

    Google Scholar 

  18. Harmon KG, Drezner JA, Gammons M, Guskiewicz KM, Halstead M, Herring SA, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. 2013;47:15–26.

    Article  PubMed  Google Scholar 

  19. Broglio SP, Macciocchi SN, Ferrara MS. Neurocognitive performance of concussed athletes when symptom free. J Athl Train. 2007;42:504–8.

    PubMed Central  PubMed  Google Scholar 

  20. Fazio VC, Lovell MR, Pardini JE, Collins MW. The relation between post concussion symptoms and neurocognitive performance in concussed athletes. NeuroRehabilitation. 2007;22:207–16.

    PubMed  Google Scholar 

  21. Echemendia RJ, Cantu RC. Return to play following brain injury. In: Lovell MR, Echemendia RJ, Barth JT, Collins MW, editors. Traumatic brain injury in sports: an international neuropsychological perspective. Lisse: Swets & Zeitlinger B.V.; 2004.

    Google Scholar 

  22. Lezak MD, Howieson DB, Loring DW. Neuropsychological assessment. 4th ed. New York: Oxford University Press; 2004.

    Google Scholar 

  23. Barwick FH, Rabinowitz AR, Arnett PA. Base rates of impaired neuropsychological test performance among healthy collegiate athletes. In revision.

    Google Scholar 

  24. Lovell M, Collins M, Podell K, Powell J, Maroon J. ImPACT: immediate post-concussion assessment and cognitive testing. Pittsburgh: NeuroHealth Systems, LLC.; 2000.

    Google Scholar 

  25. Cegalis JA, Cegalis S. The Vigil/W Continuous Performance Test (manual). New York: ForThought; 1994.

    Google Scholar 

  26. Benedict RHB, Schretlen D, Groninger L, Brandt J. Hopkins Verbal Learning Test-Revised: normative data and analysis of inter-form and test-retest reliability. Clin Neuropsychol. 1998;12(1):43–55.

    Article  Google Scholar 

  27. Benedict RHB. Brief Visuospatial Memory Test—revised: professional manual. Odessa: Psychological Assessment Resources; 1997.

    Google Scholar 

  28. Smith A. Symbol digit modalities test (SDMT) manual (revised). Los Angeles: Western Psychological Services; 1982.

    Google Scholar 

  29. Wechsler D. Wechsler Adult Intelligence Scale-III (WAIS-III). New York: Psychological Corporation; 1997.

    Google Scholar 

  30. Echemendia RJ, Putukian M, Mackin RS, Julian L, Shoss N. Neuropsychological test performance prior to and following sports-related mild traumatic brain injury. Clin J Sport Med. 2001;11:23–31.

    Article  CAS  PubMed  Google Scholar 

  31. Reynolds CR. Comprehensive trail making test (CTMT). Austin: Pro-Ed; 2002.

    Google Scholar 

  32. Trenerry MR, Crosson B, DeBoe J, Leber WR. Stroop neuropsychological screening test. Odessa: Psychological Assessment Resources; 1989.

    Google Scholar 

  33. Barkhoudarian G, Hovda DA, Giza CC. The molecular pathophysiology of concussive brain injury. Clin Sports Med. 2011;30:33–48.

    Article  PubMed  Google Scholar 

  34. Giza CC, DiFiori JP. Pathophysiology of sports-related concussion. Sports Health. 2011;3:46–51.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Giza CC, Hovda DA. The neurometabolic cascade of concussion. J Athl Train. 2001;36:228–35.

    PubMed Central  PubMed  Google Scholar 

  36. Rosenbaum AM, Arnett PA, Bailey CM, Echemendia RJ. Neuropsychological assessment of sports-related concussion: measuring clinically significant change. In: Slobounov S, Sebastianelli W, editors. Foundations of sport-related brain injuries. Norwell: Springer; 2006. p. 137–71.

    Chapter  Google Scholar 

  37. Belanger HG, Vanderploeg RD. The neuropsychological impact of sports-related concussion: a meta-analysis. J Int Neuropsychol Soc. 2005;11:345–57.

    Article  PubMed  Google Scholar 

  38. Wilde EA, McCauley SR, Barnes A, Wu TC, Chu Z, Hunter JV, et al. Serial measurement of memory and diffusion tensor imaging changes within the first week following uncomplicated mild traumatic brain injury. Brain Imaging Behav. 2012;6:319–28.

    Article  PubMed  Google Scholar 

  39. Brooks BL, Iverson GL, White T. Substantial risk of ‘accidental MCI’ in healthy older adults: base rates of low memory scores in neuropsychological assessment. J Int Neuropsychol Soc. 2007;13:490–500.

    Article  PubMed  Google Scholar 

  40. Palmer BW, Boone KB, Lesser IM, Wohl MA. Base rates of “impaired” neuropsychological test performance among healthy older adults. Arch Clin Neuropsychol. 1998;13:503–11.

    CAS  PubMed  Google Scholar 

  41. Brooks BL, Sherman EMS, Iverson GL. Healthy children get low scores too: prevalence of low scores on the NEPSY-II in preschoolers, children, and adolescents. Arch Clin Neuropsychol. 2010;25:182–90.

    Article  PubMed  Google Scholar 

  42. Covassin T, Schatz P, Swanik CB. Sex differences in neuropsychological function and post‐concussion symptoms of concussed collegiate athletes. Neurosurgery. 2007;61:345–51.

    Article  PubMed  Google Scholar 

  43. Covassin T, Elbin R, Harris W, Parker T, Kontos A. The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion. Am J Sports Med. 2012;40:1303–12.

    Article  PubMed  Google Scholar 

  44. Echemendia RJ, Iverson GL, McCrea M, Broshek DK, Gioia GA, Sautter SW, et al. Role of neuropsychologists in the evaluation and management of sport-related concussion: an inter-organization position statement. Arch Clin Neuropsychol. 2012;27:119–22.

    Article  PubMed  Google Scholar 

  45. McClincy MP, Lovell MR, Pardini J, Collins MW, Spore MK. Recovery from sports concussion in high school and collegiate athletes. Brain Inj. 2006;20:33–9.

    Article  PubMed  Google Scholar 

  46. Lovell M. The management of sports-related concussion: current status and future trends. Clin J Sport Med. 2009;28:95–111.

    Article  Google Scholar 

Download references

Acknowledgement

There are no conflicts of interest involved with this manuscript, and no sources of financial support.

Author information

Authors and Affiliations

  1. Department of Psychology, Pennsylvania State University, 352 Moore Building, University Park, PA, 16802, USA

    Peter A. Arnett Ph.D., Gray A. Vargas, Dede M. Ukueberuwa, Victoria C. Merritt & Jessica E. Meyer

  2. Department of Neurosurgery, University of Pennsylvania School of Medicine, 370 Stemmler Hall, Philadelphia, PA, 19104, USA

    Amanda R. Rabinowitz

Authors
  1. Peter A. Arnett Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amanda R. Rabinowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gray A. Vargas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dede M. Ukueberuwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Victoria C. Merritt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jessica E. Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter A. Arnett Ph.D. .

Editor information

Editors and Affiliations

  1. Professor, Director of Center for Sports Concussion Research and Services, Penn State - Hershey Medical College, University Park, Pennsylvania, USA

    Semyon M. Slobounov

  2. Kalenak Professor in Orthopaedics, Director of Athletic Medicine, Penn State - Hershey Medical College, University Park, Pennsylvania, USA

    Wayne J. Sebastianelli

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Arnett, P.A., Rabinowitz, A.R., Vargas, G.A., Ukueberuwa, D.M., Merritt, V.C., Meyer, J.E. (2014). Neuropsychological Testing in Sports Concussion Management: An Evidence-Based Model when Baseline Is Unavailable. In: Slobounov, S., Sebastianelli, W. (eds) Concussions in Athletics. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0295-8_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-0295-8_3

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-0294-1

  • Online ISBN: 978-1-4939-0295-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation