Neuropsychology Review

, Volume 23, Issue 4, pp 285–299

Acute Clinical Recovery from Sport-Related Concussion

  • Lindsay D. Nelson
  • Julie K. Janecek
  • Michael A. McCrea
Review

Abstract

Concussion is a highly prevalent injury in contact and collision sports that has historically been poorly understood. An influx of sport-concussion research in recent years has led to a dramatic improvement in our understanding of the injury’s defining characteristics and natural history of recovery. In this review, we discuss the current state of knowledge regarding the characteristic features of concussion and typical acute course of recovery, with an emphasis on the aspects of functioning most commonly assessed by clinicians and researchers (e.g., symptoms, cognitive deficits, postural stability). While prototypical clinical recovery is becoming better understood, questions remain regarding what factors (e.g., injury severity, demographic variables, history of prior concussions, psychological factors) may explain individual variability in recovery. Although research concerning individual differences in response to concussion is relatively new, and in many cases limited methodologically, we discuss the evidence about several potential moderators of concussion recovery and point out areas for future research. Finally, we describe how increased knowledge about the negative effects of and recovery following concussion has been translated into clinical guidelines for managing concussed athletes.

Keywords

Concussion Brain injury Sport injuries Neuropsychological tests 

References

  1. Alexander, M. P. (1995). Mild traumatic brain injury: pathophysiology, natural history, and clinical management. Neurology, 45, 1253–1260.PubMedCrossRefGoogle Scholar
  2. Anderson, V., Catroppa, C., Morse, S., Haritou, F., & Rosenfeld, J. (2005). Functional plasticity or vulnerability after early brain injury? Pediatrics, 116, 1374–1382. doi:10.1542/peds.2004-1728.PubMedCrossRefGoogle Scholar
  3. Aubry, M., Cantu, R., Dvorak, J., Graf-Baumann, T., Johnston, K., Kelly, J., . . . Concussion in Sport, G. (2002). Summary and agreement statement of the first International Conference on Concussion in Sport, Vienna 2001. Recommendations for the improvement of safety and health of athletes who may suffer concussive injuries. British Journal of Sports Medicine, 36, 6–10.Google Scholar
  4. Barth, J. T., Freeman, J. H., & Winters, J. E. (2000). Management of sport-related concussions. Dental Clinics of North America, 44, 67–83.PubMedGoogle Scholar
  5. Barth, J. T., Freeman, J. R., Broshek, D. K., & Varney, R. N. (2001). Acceleration-deceleration sport-related concussion: the gravity of it all. Journal of Athletic Training, 36, 253–256.PubMedPubMedCentralGoogle Scholar
  6. Bauer, R., & Fritz, H. (2004). Pathophysiology of traumatic injury in the developing brain: an introduction and short update. Experimental and Toxicologic Pathology, 56, 65–73. doi:10.1016/j.etp.2004.04.002.PubMedCrossRefGoogle Scholar
  7. Belanger, H. G., & Vanderploeg, R. D. (2005). The neuropsychological impact of sports-related concussion: a meta-analysis. Journal of the International Neuropsychological Society, 11, 345–357.PubMedCrossRefGoogle Scholar
  8. Belanger, H. G., Curtiss, G., Demery, J. A., Lebowitz, B. K., & Vanderploeg, R. D. (2005). Factors moderating neuropsychological outcomes following mild traumatic brain injury: a meta-analysis. Journal of the International Neuropsychological Society, 11, 215–227. doi:10.1017/S1355617705050277.PubMedGoogle Scholar
  9. Bijur, P. E., Haslum, M., & Golding, J. (1996). Cognitive outcomes of multiple mild head injuries in children. Journal of Developmental and Behavioral Pediatrics, 17, 143–148.PubMedGoogle Scholar
  10. Brehaut, J. C., Miller, A., Raina, P., & McGrail, K. M. (2003). Childhood behavior disorders and injuries among children and youth: a population-based study. Pediatrics, 111, 262–269.PubMedCrossRefGoogle Scholar
  11. Broglio, S. P., & Puetz, T. W. (2008). The effect of sport concussion on neurocognitive function, self-report symptoms and postural control: a meta-analysis. Sports Medicine, 38, 53–67.PubMedCrossRefGoogle Scholar
  12. Broshek, D. K., Kaushik, T., Freeman, J. R., Erlanger, D., Webbe, F., & Barth, J. T. (2005). Sex differences in outcome following sports-related concussion. Journal of Neurosurgery, 102, 856–863. doi:10.3171/jns.2005.102.5.0856.PubMedCrossRefGoogle Scholar
  13. Bruce, J. M., & Echemendia, R. J. (2004). Concussion history predicts self-reported symptoms before and following a concussive event. Neurology, 63, 1516–1518.PubMedCrossRefGoogle Scholar
  14. Cantu, R. C. (2001). Posttraumatic retrograde and anterograde amnesia: pathophysiology and implications in grading and safe return to play. Journal of Athletic Training, 36, 244–248.PubMedPubMedCentralGoogle Scholar
  15. Capruso, D. X., & Levin, H. S. (1992). Cognitive impairment following closed head injury. Neurologic Clinics, 10, 879–893.PubMedGoogle Scholar
  16. Carroll, L. J., Cassidy, J. D., Peloso, P. M., Borg, J., von Holst, H., Holm, L., . . . Pepin, M. (2004). Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine, Suppl 43, 84–105.Google Scholar
  17. Collins, M. W., Grindel, S. H., Lovell, M. R., Dede, D. E., Moser, D. J., Phalin, B. R., . . . McKeag, D. B. (1999). Relationship between concussion and neuropsychological performance in college football players. Journal of the American Medical Association, 282, 964–970.Google Scholar
  18. Collins, M. W., Lovell, M. R., Iverson, G. L., Cantu, R. C., Maroon, J. C., & Field, M. (2002). Cumulative effects of concussion in high school athletes. Neurosurgery, 51, 1175–1179.PubMedCrossRefGoogle Scholar
  19. Collins, M. W., Iverson, G. L., Lovell, M. R., McKeag, D. B., Norwig, J., & Maroon, J. (2003). On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Clinical Journal of Sport Medicine, 13, 222–229.PubMedCrossRefGoogle Scholar
  20. Colvin, A. C., Mullen, J., Lovell, M. R., West, R. V., Collins, M. W., & Groh, M. (2009). The role of concussion history and gender in recovery from soccer-related concussion. American Journal of Sports Medicine, 37, 1699–1704. doi:10.1177/0363546509332497.PubMedCrossRefGoogle Scholar
  21. Cosgrove, K. P., Mazure, C. M., & Staley, J. K. (2007). Evolving knowledge of sex differences in brain structure, function, and chemistry. Biological Psychiatry, 62, 847–855. doi:10.1016/j.biopsych.2007.03.001.PubMedCrossRefPubMedCentralGoogle Scholar
  22. Covassin, T., Swanik, C. B., & Sachs, M. L. (2003). Sex differences and the incidence of concussions among collegiate athletes. Journal of Athletic Training, 38, 238–244.PubMedPubMedCentralGoogle Scholar
  23. Covassin, T., Swanik, C. B., Sachs, M., Kendrick, Z., Schatz, P., Zillmer, E., & Kaminaris, C. (2006). Sex differences in baseline neuropsychological function and concussion symptoms of collegiate athletes. British Journal of Sports Medicine, 40, 923–927. doi:10.1136/bjsm.2006.029496.PubMedCrossRefPubMedCentralGoogle Scholar
  24. Covassin, T., Schatz, P., & Swanik, C. B. (2007). Sex differences in neuropsychological function and post-concussion symptoms of concussed collegiate athletes. Neurosurgery, 61, 345–350. doi:10.1227/01.NEU.0000279972.95060.CB.PubMedCrossRefGoogle Scholar
  25. Covassin, T., Stearne, D., & Elbin, R. (2008). Concussion history and postconcussion neurocognitive performance and symptoms in collegiate athletes. Journal of Athletic Training, 43, 119–124. doi:10.4085/1062-6050-43.2.119.PubMedCrossRefPubMedCentralGoogle Scholar
  26. Covassin, T., Elbin, R. J., Harris, W., Parker, T., & Kontos, A. (2012). The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion. American Journal of Sports Medicine, 40, 1303–1312. doi:10.1177/0363546512444554.PubMedCrossRefGoogle Scholar
  27. Davis, G. A., & Purcell, L. K. (2013). The evaluation and management of acute concussion differs in young children. British Journal of Sports Medicine. Advance online publication. doi:10.1136/bjsports-2012-092132.
  28. Davis, D. P., Serrano, J. A., Vilke, G. M., Sise, M. J., Kennedy, F., Eastman, A. B., . . . Hoyt, D. B. (2006). The predictive value of field versus arrival Glasgow Coma Scale score and TRISS calculations in moderate-to-severe traumatic brain injury. Journal of Trauma, 60, 985–990. doi:10.1097/01.ta.0000205860.96209.1c.Google Scholar
  29. Delaney, J. S., Lacroix, V. J., Leclerc, S., & Johnston, K. M. (2002). Concussions among university football and soccer players. Clinical Journal of Sport Medicine, 12, 331–338.PubMedCrossRefGoogle Scholar
  30. Delaney, J. S., Abuzeyad, F., Correa, J. A., & Foxford, R. (2005). Recognition and characteristics of concussions in the emergency department population. Journal of Emergency Medicine, 29, 189–197.PubMedCrossRefGoogle Scholar
  31. DeRoss, A. L., Adams, J. E., Vane, D. W., Russell, S. J., Terella, A. M., & Wald, S. L. (2002). Multiple head injuries in rats: effects on behavior. Journal of Trauma, 52, 708–714.PubMedCrossRefGoogle Scholar
  32. Dikmen, S., McLean, A., & Temkin, N. (1986). Neuropsychological and psychosocial consequences of minor head injury. Journal of Neurology, Neurosurgery & Psychiatry, 49, 1227–1232.CrossRefGoogle Scholar
  33. DiScala, C., Lescohier, I., Barthel, M., & Li, G. (1998). Injuries to children with attention deficit hyperactivity disorder. Pediatrics, 102, 1415–1421.PubMedCrossRefGoogle Scholar
  34. Dougan, B. K., Horswill, M. S., & Geffen, G. M. (2013). Athletes’ age, sex, and years of education moderate the acute neuropsychological impact of sports-related concussion: a meta-analysis. Journal of the International Neuropsychological Society, 19, 1–17. doi:10.1017/S1355617712001464.CrossRefGoogle Scholar
  35. Echemendia, R. J., Putukian, M., Mackin, R. S., Julian, L., & Shoss, N. (2001). Neuropsychological test performance prior to and following sports-related mild traumatic brain injury. Clinical Journal of Sport Medicine, 11, 23–31.PubMedCrossRefGoogle Scholar
  36. Ellemberg, D., Henry, L. C., Macciocchi, S. N., Guskiewicz, K. M., & Broglio, S. P. (2009). Advances in sport concussion assessment: from behavioral to brain imaging measures. Journal of Neurotrauma, 26, 2365–2382. doi:10.1089/neu.2009.0906.PubMedCrossRefGoogle Scholar
  37. Emerson, C. S., Headrick, J. P., & Vink, R. (1993). Estrogen improves biochemical and neurologic outcome following traumatic brain injury in male rats, but not in females. Brain Research, 608, 95–100.PubMedCrossRefGoogle Scholar
  38. Emery, C. A., & Meeuwisse, W. H. (2006). Injury rates, risk factors, and mechanisms of injury in minor hockey. American Journal of Sports Medicine, 34, 1960–1969. doi:10.1177/0363546506290061.PubMedCrossRefGoogle Scholar
  39. Erlanger, D., Kaushik, T., Cantu, R., Barth, J. T., Broshek, D. K., Freeman, J. R., & Webbe, F. M. (2003). Symptom-based assessment of the severity of a concussion. Journal of Neurosurgery, 98, 477–484. doi:10.3171/jns.2003.98.3.0477.PubMedCrossRefGoogle Scholar
  40. Esposito, G., Van Horn, J. D., Weinberger, D. R., & Berman, K. F. (1996). Gender differences in cerebral blood flow as a function of cognitive state with PET. Journal of Nuclear Medicine, 37, 559–564.PubMedGoogle Scholar
  41. Ewing-Cobbs, L., Prasad, M. R., Kramer, L., Cox, C. S., Jr., Baumgartner, J., Fletcher, S., . . . Swank, P. (2006). Late intellectual and academic outcomes following traumatic brain injury sustained during early childhood. Journal of Neurosurgery, 105(4 Suppl), 287–296. doi:10.3171/ped.2006.105.4.287.Google Scholar
  42. Feingold, A. (1994). Gender differences in personality: a meta-analysis. Psychological Bulletin, 116(3), 429–456.PubMedCrossRefGoogle Scholar
  43. Ferrara, M. S., McCrea, M., Peterson, C. L., & Guskiewicz, K. M. (2001). A survey of practice patterns in concussion assessment and management. Journal of Athletic Training, 36, 145–149.PubMedPubMedCentralGoogle Scholar
  44. Field, M., Collins, M. W., Lovell, M. R., & Maroon, J. (2003). Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. Journal of Pediatrics, 142, 546–553. doi:10.1067/mpd.2003.190.PubMedCrossRefGoogle Scholar
  45. Frommer, L. J., Gurka, K. K., Cross, K. M., Ingersoll, C. D., Comstock, R. D., & Saliba, S. A. (2011). Sex differences in concussion symptoms of high school athletes. Journal of Athletic Training, 46, 76–84. doi:10.4085/1062-6050-46.1.76.PubMedCrossRefPubMedCentralGoogle Scholar
  46. Gessel, L. M., Fields, S. K., Collins, C. L., Dick, R. W., & Comstock, R. D. (2007). Concussions among United States high school and collegiate athletes. Journal of Athletic Training, 42, 495–503.PubMedPubMedCentralGoogle Scholar
  47. Giza, C. C., & Hovda, D. A. (2001). The neurometabolic cascade of concussion. Journal of Athletic Training, 36, 228–235.PubMedPubMedCentralGoogle Scholar
  48. Giza, C. C., Kutcher, J. S., Ashwal, S., Barth, J., Getchius, T. S., Gioia, G. A., . . . Zafonte, R. (2013). Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 80, 2250–2257. doi:10.1212/WNL.0b013e31828d57dd.
  49. Goodwin, R. D., & Gotlib, I. H. (2004). Gender differences in depression: the role of personality factors. Psychiatry Research, 126, 135–142. doi:10.1016/j.psychres.2003.12.024.PubMedCrossRefGoogle Scholar
  50. Gosselin, N., Theriault, M., Leclerc, S., Montplaisir, J., & Lassonde, M. (2006). Neurophysiological anomalies in symptomatic and asymptomatic concussed athletes. Neurosurgery, 58, 1151–1161. doi:10.1227/01.NEU.0000215953.44097.FA.PubMedCrossRefGoogle Scholar
  51. Groswasser, Z., Cohen, M., & Keren, O. (1998). Female TBI patients recover better than males. Brain Injury, 12, 805–808.PubMedCrossRefGoogle Scholar
  52. Guskiewicz, K. M., Weaver, N. L., Padua, D. A., & Garrett, W. E., Jr. (2000). Epidemiology of concussion in collegiate and high school football players. American Journal of Sports Medicine, 28, 643–650.PubMedGoogle Scholar
  53. Guskiewicz, K. M., McCrea, M., Marshall, S. W., Cantu, R. C., Randolph, C., Barr, W., . . . Kelly, J. P. (2003). Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. Journal of the American Medical Association, 290, 2549–2555. doi:10.1001/jama.290.19.2549.Google Scholar
  54. Halstead, M. E., & Walter, K. D. (2010). Sport-related concussion in children and adolescents. Pediatrics, 126, 597–615. doi:10.1542/peds.2010-2005.PubMedCrossRefGoogle Scholar
  55. Hinton-Bayre, A. D., Geffen, G. M., Geffen, L. B., McFarland, K. A., & Friis, P. (1999). Concussion in contact sports: reliable change indices of impairment and recovery. Journal of Clinical and Experimental Neuropsychology, 21, 70–86. doi:10.1076/jcen.21.1.70.945.PubMedCrossRefGoogle Scholar
  56. Hootman, J. M., Dick, R., & Agel, J. (2007). Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. Journal of Athletic Training, 42, 311–319.PubMedPubMedCentralGoogle Scholar
  57. Iverson, G. L., Lovell, M. R., Smith, S., & Franzen, M. D. (2000). Prevalence of abnormal CT-scans following mild head injury. Brain Injury, 14, 1057–1061.PubMedCrossRefGoogle Scholar
  58. Iverson, G. L., Gaetz, M., Lovell, M. R., & Collins, M. W. (2004). Cumulative effects of concussion in amateur athletes. Brain Injury, 18, 433–443. doi:10.1080/02699050310001617352.PubMedCrossRefGoogle Scholar
  59. Jennett, B., & Teasdale, G. (1981). Management of head injuries. Philadelphia: Davis.Google Scholar
  60. Jerome, L. (2003). ADHD and driving safety. Canadian Medical Association Journal, 169, 16.PubMedPubMedCentralGoogle Scholar
  61. Kelly, J. P. (2001). Loss of consciousness: pathophysiology and implications in grading and safe return to play. Journal of Athletic Training, 36, 249–252.PubMedPubMedCentralGoogle Scholar
  62. Kelly, J. P., & Rosenberg, J. H. (1997). Diagnosis and management of concussion in sports. Neurology, 48, 575–580.PubMedCrossRefGoogle Scholar
  63. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602. doi:10.1001/archpsyc.62.6.593.PubMedCrossRefGoogle Scholar
  64. Kirkwood, M. W., Yeates, K. O., & Wilson, P. E. (2006). Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population. Pediatrics, 117, 1359–1371. doi:10.1542/peds.2005-0994.PubMedCrossRefGoogle Scholar
  65. Lau, B., Lovell, M. R., Collins, M. W., & Pardini, J. (2009). Neurocognitive and symptom predictors of recovery in high school athletes. Clinical Journal of Sport Medicine, 19, 216–221. doi:10.1097/JSM.0b013e31819d6edb.PubMedCrossRefGoogle Scholar
  66. Lau, B. C., Kontos, A. P., Collins, M. W., Mucha, A., & Lovell, M. R. (2011). Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players? American Journal of Sports Medicine, 39, 2311–2318. doi:10.1177/0363546511410655.PubMedCrossRefGoogle Scholar
  67. Lau, B. C., Collins, M. W., & Lovell, M. R. (2012). Cutoff scores in neurocognitive testing and symptom clusters that predict protracted recovery from concussions in high school athletes. Neurosurgery, 70, 371–379. doi:10.1227/NEU.0b013e31823150f0.PubMedCrossRefGoogle Scholar
  68. Lincoln, A. E., Caswell, S. V., Almquist, J. L., Dunn, R. E., Norris, J. B., & Hinton, R. Y. (2011). Trends in concussion incidence in high school sports: a prospective 11-year study. American Journal of Sports Medicine, 39, 958–963. doi:10.1177/0363546510392326.PubMedCrossRefGoogle Scholar
  69. Lipton, R. B., Scher, A. I., Kolodner, K., Liberman, J., Steiner, T. J., & Stewart, W. F. (2002). Migraine in the United States: epidemiology and patterns of health care use. Neurology, 58, 885–894.PubMedCrossRefGoogle Scholar
  70. Lovell, M. R., & Collins, M. W. (1998). Neuropsychological assessment of the college football player. The Journal of Head Trauma Rehabilitation, 13, 9–26.PubMedCrossRefGoogle Scholar
  71. Lovell, M. R., Iverson, G. L., Collins, M. W., McKeag, D., & Maroon, J. C. (1999). Does loss of consciousness predict neuropsychological decrements after concussion? Clinical Journal of Sport Medicine, 9, 193–198.PubMedCrossRefGoogle Scholar
  72. Lovell, M. R., Collins, M. W., Iverson, G. L., Field, M., Maroon, J. C., Cantu, R., . . . Fu, F. H. (2003). Recovery from mild concussion in high school athletes. Journal of Neurosurgery, 98, 296–301. doi:10.3171/jns.2003.98.2.0296.
  73. Macciocchi, S. N., Barth, J. T., Alves, W., Rimel, R. W., & Jane, J. A. (1996). Neuropsychological functioning and recovery after mild head injury in collegiate athletes. Neurosurgery, 39, 510–514.PubMedGoogle Scholar
  74. Macciocchi, S. N., Barth, J. T., Littlefield, L., & Cantu, R. C. (2001). Multiple concussions and neuropsychological functioning in collegiate football players. Journal of Athletic Training, 36, 303–306.PubMedPubMedCentralGoogle Scholar
  75. Makdissi, M., Darby, D., Maruff, P., Ugoni, A., Brukner, P., & McCrory, P. R. (2010). Natural history of concussion in sport: markers of severity and implications for management. American Journal of Sports Medicine, 38, 464–471. doi:10.1177/0363546509349491.PubMedCrossRefGoogle Scholar
  76. Marcus, S. M., Young, E. A., Kerber, K. B., Kornstein, S., Farabaugh, A. H., Mitchell, J., . . . Rush, A. J. (2005). Gender differences in depression: findings from the STAR*D study. Journal of Affective Disorders, 87, 141–150. doi:10.1016/j.jad.2004.09.008.Google Scholar
  77. McCrea, M. (2001). Standardized mental status testing on the sideline after sport-related concussion. Journal of Athletic Training, 36, 274–279.PubMedPubMedCentralGoogle Scholar
  78. McCrea, M. A. (2008). Mild traumatic brain injury and postconcussion syndrome: The new evidence base for diagnosis and treatment. New York: Oxford University Press.Google Scholar
  79. McCrea, M., Kelly, J. P., Randolph, C., Kluge, J., Bartolic, E., Finn, G., & Baxter, B. (1998). Standardized assessment of concussion (SAC): on-site mental status evaluation of the athlete. The Journal of Head Trauma Rehabilitation, 13, 27–35.PubMedCrossRefGoogle Scholar
  80. McCrea, M., Guskiewicz, K. M., Marshall, S. W., Barr, W., Randolph, C., Cantu, R. C., . . . Kelly, J. P. (2003). Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. Journal of the American Medical Association, 290, 2556–2563. doi:10.1001/jama.290.19.2556.Google Scholar
  81. McCrea, M., Hammeke, T., Olsen, G., Leo, P., & Guskiewicz, K. (2004). Unreported concussion in high school football players: implications for prevention. Clinical Journal of Sport Medicine, 14, 13–17.PubMedCrossRefGoogle Scholar
  82. McCrea, M., Guskiewicz, K., Randolph, C., Barr, W. B., Hammeke, T. A., Marshall, S. W., & Kelly, J. P. (2009). Effects of a symptom-free waiting period on clinical outcome and risk of reinjury after sport-related concussion. Neurosurgery, 65, 876–882. doi:10.1227/01.NEU.0000350155.89800.00.PubMedCrossRefGoogle Scholar
  83. McCrea, M., Guskiewicz, K., Randolph, C., Barr, W. B., Hammeke, T. A., Marshall, S. W., . . . Kelly, J. P. (2013). Incidence, clinical course, and predictors of prolonged recovery time following sport-related concussion in high school and college athletes. Journal of the International Neuropsychological Society, 19, 22–33. doi:10.1017/S1355617712000872.Google Scholar
  84. McCrory, P. R., & Berkovic, S. F. (1998). Second impact syndrome. Neurology, 50, 677–683.PubMedCrossRefGoogle Scholar
  85. McCrory, P., Collie, A., Anderson, V., & Davis, G. (2004). Can we manage sport related concussion in children the same as in adults? British Journal of Sports Medicine, 38, 516–519.PubMedCrossRefPubMedCentralGoogle Scholar
  86. McCrory, P., Johnston, K., Meeuwisse, W., Aubry, M., Cantu, R., Dvorak, J., . . . Schamasch, P. (2005). Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. British Journal of Sports Medicine, 39, 196–204. doi:10.1136/bjsm.2005.018614.
  87. McCrory, P., Meeuwisse, W., Johnston, K., Dvorak, J., Aubry, M., Molloy, M., & Cantu, R. (2009). Consensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. British Journal of Sports Medicine, 43(Suppl 1), i76–i90. doi:10.1136/bjsm.2009.058248.PubMedCrossRefGoogle Scholar
  88. McCrory, P., Meeuwisse, W. H., Aubry, M., Cantu, B., Dvorak, J., Echemendia, R. J., . . . Turner, M. (2013). Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. British Journal of Sports Medicine, 47, 250–258. doi:10.1136/bjsports-2013-092313.
  89. Meehan, W. P., 3rd, Zhang, J., Mannix, R., & Whalen, M. J. (2012). Increasing recovery time between injuries improves cognitive outcome after repetitive mild concussive brain injuries in mice. Neurosurgery, 71, 885–892. doi:10.1227/NEU.0b013e318265a439.PubMedCrossRefGoogle Scholar
  90. Meehan, W. P., 3rd, Mannix, R. C., Stracciolini, A., Elbin, R. J., & Collins, M. W. (2013). Symptom severity predicts prolonged recovery after sport-related concussion, but age and amnesia do not. Journal of Pediatrics, 163, 721–725. doi:10.1016/j.jpeds.2013.03.012.PubMedCrossRefGoogle Scholar
  91. Mittenberg, W., Wittner, M. S., & Miller, L. J. (1997). Postconcussion syndrome occurs in children. Neuropsychology, 11, 447–452.PubMedCrossRefGoogle Scholar
  92. Ommaya, A. K., & Gennarelli, T. A. (1974). Cerebral concussion and traumatic unconsciousness: correlation of experimental and clinical observations of blunt head injuries. Brain, 97, 633–654.PubMedCrossRefGoogle Scholar
  93. Ommaya, A. K., Goldsmith, W., & Thibault, L. (2002). Biomechanics and neuropathology of adult and paediatric head injury. British Journal of Neurosurgery, 16, 220–242.PubMedCrossRefGoogle Scholar
  94. Powell, J. W., & Barber-Foss, K. D. (1999). Traumatic brain injury in high school athletes. Journal of the American Medical Association, 282, 958–963.PubMedCrossRefGoogle Scholar
  95. (1997) Practice parameter: the management of concussion in sports (summary statement): report of the Quality Standards Subcommittee. Neurology, 48, 581–585.Google Scholar
  96. Prichep, L. S., McCrea, M., Barr, W., Powell, M., & Chabot, R. J. (2013). Time course of clinical and electrophysiological recovery after sport-related concussion. The Journal of Head Trauma Rehabilitation, 28, 266–273. doi:10.1097/HTR.0b013e318247b54e.PubMedCrossRefGoogle Scholar
  97. Proctor, M. R., & Cantu, R. C. (2000). Head and neck injuries in young athletes. Clinics in Sports Medicine, 19, 693–715.PubMedCrossRefGoogle Scholar
  98. Roof, R. L., & Hall, E. D. (2000a). Estrogen-related gender difference in survival rate and cortical blood flow after impact-acceleration head injury in rats. Journal of Neurotrauma, 17, 1155–1169.PubMedCrossRefGoogle Scholar
  99. Roof, R. L., & Hall, E. D. (2000b). Gender differences in acute CNS trauma and stroke: neuroprotective effects of estrogen and progesterone. Journal of Neurotrauma, 17, 367–388.PubMedCrossRefGoogle Scholar
  100. Roof, R. L., Duvdevani, R., & Stein, D. G. (1993a). Gender influences outcome of brain injury: progesterone plays a protective role. Brain Research, 607, 333–336.PubMedCrossRefGoogle Scholar
  101. Roof, R. L., Zhang, Q., Glasier, M. M., & Stein, D. G. (1993b). Gender-specific impairment on Morris water maze task after entorhinal cortex lesion. Behavioural Brain Research, 57, 47–51.PubMedCrossRefGoogle Scholar
  102. Russell, M. B., Rasmussen, B. K., Thorvaldsen, P., & Olesen, J. (1995). Prevalence and sex-ratio of the subtypes of migraine. International Journal of Epidemiology, 24, 612–618.PubMedCrossRefGoogle Scholar
  103. Ryan, L. M., & Warden, D. L. (2003). Post concussion syndrome. International Review of Psychiatry, 15, 310–316. doi:10.1080/09540260310001606692.PubMedCrossRefGoogle Scholar
  104. Schaal, K., Tafflet, M., Nassif, H., Thibault, V., Pichard, C., Alcotte, M., . . . Toussaint, J. F. (2011). Psychological balance in high level athletes: gender-based differences and sport-specific patterns. PLoS One, 6, e19007. doi:10.1371/journal.pone.0019007.
  105. Slobounov, S., Slobounov, E., Sebastianelli, W., Cao, C., & Newell, K. (2007). Differential rate of recovery in athletes after first and second concussion episodes. Neurosurgery, 61, 338–344. doi:10.1227/01.NEU.0000280001.03578.FF.PubMedCrossRefGoogle Scholar
  106. Slobounov, S., Cao, C., & Sebastianelli, W. (2009). Differential effect of first versus second concussive episodes on wavelet information quality of EEG. Clinical Neurophysiology, 120, 862–867. doi:10.1016/j.clinph.2009.03.009.PubMedCrossRefPubMedCentralGoogle Scholar
  107. Snoek, J. W., Minderhoud, J. M., & Wilmink, J. T. (1984). Delayed deterioration following mild head injury in children. Brain, 107, 15–36.PubMedCrossRefGoogle Scholar
  108. Swanik, C. B., Covassin, T., Stearne, D. J., & Schatz, P. (2007). The relationship between neurocognitive function and noncontact anterior cruciate ligament injuries. American Journal of Sports Medicine, 35, 943–948. doi:10.1177/0363546507299532.PubMedCrossRefGoogle Scholar
  109. Taylor, A. M. (2012). Neuropsychological evaluation and management of sport-related concussion. Current Opinion in Pediatrics, 24, 717–723. doi:10.1097/MOP.0b013e32835a279b.PubMedCrossRefGoogle Scholar
  110. Taylor, H. G., Dietrich, A., Nuss, K., Wright, M., Rusin, J., Bangert, B., . . . Yeates, K. O. (2010). Post-concussive symptoms in children with mild traumatic brain injury. Neuropsychology, 24, 148–159. doi:10.1037/a0018112.
  111. Tierney, R. T., Sitler, M. R., Swanik, C. B., Swanik, K. A., Higgins, M., & Torg, J. (2005). Gender differences in head-neck segment dynamic stabilization during head acceleration. Medicine and Science in Sports and Exercise, 37, 272–279.PubMedCrossRefGoogle Scholar
  112. Tierney, R. T., Higgins, M., Caswell, S. V., Brady, J., McHardy, K., Driban, J. B., & Darvish, K. (2008). Sex differences in head acceleration during heading while wearing soccer headgear. Journal of Athletic Training, 43, 578–584. doi:10.4085/1062-6050-43.6.578.PubMedCrossRefPubMedCentralGoogle Scholar
  113. Vagnozzi, R., Signoretti, S., Tavazzi, B., Floris, R., Ludovici, A., Marziali, S., . . . Lazzarino, G. (2008). Temporal window of metabolic brain vulnerability to concussion: a pilot 1H-magnetic resonance spectroscopic study in concussed athletes—part III. Neurosurgery, 62, 1286–1295. doi:10.1227/01.neu.0000333300.34189.74.
  114. Valovich McLeod, T. C., Bay, R. C., Heil, J., & McVeigh, S. D. (2008). Identification of sport and recreational activity concussion history through the preparticipation screening and a symptom survey in young athletes. Clinical Journal of Sport Medicine, 18, 235–240. doi:10.1097/JSM.0b013e3181705756.PubMedCrossRefGoogle Scholar
  115. Zuckerman, S. L., Lee, Y. M., Odom, M. J., Solomon, G. S., Forbes, J. A., & Sills, A. K. (2012a). Recovery from sports-related concussion: days to return to neurocognitive baseline in adolescents versus young adults. Surgical Neurology International, 3, 130. doi:10.4103/2152-7806.102945.PubMedCrossRefPubMedCentralGoogle Scholar
  116. Zuckerman, S. L., Solomon, G. S., Forbes, J. A., Haase, R. F., Sills, A. K., & Lovell, M. R. (2012b). Response to acute concussive injury in soccer players: is gender a modifying factor? Journal of Neurosurgery: Pediatrics, 10, 504–510. doi:10.3171/2012.8.PEDS12139.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Lindsay D. Nelson
    • 1
  • Julie K. Janecek
    • 2
  • Michael A. McCrea
    • 1
    • 3
  1. 1.Department of Neurology, Division of NeuropsychologyMedical College of WisconsinMilwaukeeUSA
  2. 2.Department of PsychiatryUniversity of Illinois at ChicagoChicagoUSA
  3. 3.Department of NeurosurgeryMedical College of WisconsinMilwaukeeUSA

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