Advertisement

Sports Medicine

, Volume 38, Issue 1, pp 53–67 | Cite as

The Effect of Sport Concussion on Neurocognitive Function, Self-Report Symptoms and Postural Control

A Meta-Analysis
  • Steven P. Broglio
  • Timothy W. Puetz
Review Article

Abstract

Sport concussion is commonly assessed using a battery of tests that evaluate neurocognitive functioning, postural control and self-report symptoms. The degree to which concussion affects each of these measures is unclear. Thus, the purpose of this meta-analysis is to systematically review and quantify the effect of sport concussion on each assessment measure when administered immediately post-injury and in the 2 weeks following injury. PubMed and PsychINFO databases were searched from January 1970 to June 2006, from which 39 were included for review. Studies were selected for review if they included concussed athletes who were evaluated using one of the three assessment measures. One post-morbid assessment must have been completed within 14 days of injury and compared with a baseline measure or control group. Study design, type of neurocognitive assessment, timing of assessment following injury and number of post-concussion assessments were extracted as potential moderators. Sport-related concussion had a large negative effect (mean Δ 95% confidence interval) on neurocognitive functioning (−0.81; −1.01, −0.60), self-report symptoms (−3.31; −6.35, −0.27) and postural control (−2.56; −6.44, 1.32) in the initial assessment following injury. A reduced, but large effect, was also seen in the 14 days following the initial assessment for neurocognitive functioning (−0.26; −0.46, −0.06), self-report symptoms (−1.09; −2.07, −0.11) and postural control (−1.16; −2.59, 0.27). Our findings demonstrated large effects for each aspect of the assessment battery. These findings support the use of the multifaceted concussion evaluation.

Keywords

Postural Control Paper Test Neurocognitive Function Assessment Battery Neurocognitive Functioning 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 2006; 21 (5): 375–8PubMedCrossRefGoogle Scholar
  2. 2.
    Gerberich SG, Priest JD, Boen JR, et al. Concussion incidences and severity in secondary school varsity football players. Am J Public Health 1983; 73 (12): 1370–5PubMedCrossRefGoogle Scholar
  3. 3.
    Thurman DJ, Alverson C, Browne D. Traumatic brain injury in the United States: a report to Congress. Atlanta (GA): Centers for Disease Control and Prevention, 1999Google Scholar
  4. 4.
    Powell JW, Barber-Foss KD. Traumatic brain injury in high school athletes. JAMA 1999 Sep 8; 282 (10): 958–63PubMedCrossRefGoogle Scholar
  5. 5.
    Guskiewicz KM, Weaver NL, Padua DA, et al. Epidemiology of concussion in collegiate and high school football players. Am J Sports Med 2000 Sep; 28 (5): 643–50PubMedGoogle Scholar
  6. 6.
    National Collegiate Athletic Association. Injury Surveillance System: football 2002-2003. National Collegiate Athletic Association 2003 [online]. Available from URL: (http://www.ncaa/org/membership/outreach/healthsafety/iss/index.html) [Accessed 2006 Jun 12]Google Scholar
  7. 7.
    Pellman EJ, Powell JW, Viano DC, et al. Concussion in profes sional football: epidemiological features of game injuries and review of the literature -part 3. Neurosurgery 2004 Jan; 54 (1): 81–94PubMedCrossRefGoogle Scholar
  8. 8.
    Guskiewicz KM, Bruce SL, Cantu RC, et al. National Athletic Trainers’ Association position statement: management of sport-related concussion. J Athl Train 2004; 29 (3): 280–97Google Scholar
  9. 9.
    McCrory P, Johnston K, Meeuwisse W, et al. Summary and agreement statement of the second International Conference on Concussion in Sport, Prague 2004. Br J Sports Med 2005 Apr; 39 (4): 196–204PubMedGoogle Scholar
  10. 10.
    Notebaert AJ, Guskiewicz KM. Current trends in athletic training practice for concussion assessment and management. J Athl Train 2005; 40 (4): 320–5PubMedGoogle Scholar
  11. 11.
    Grindel SH, Lovell MR, Collins MW. The assessment of sport related concussion: the evidence behind neuropsychological testing and management. Clin J Sport Med 2001; 11 (3): 134–43PubMedCrossRefGoogle Scholar
  12. 12.
    Collie A, Darby D, Maruff P. Computerised cognitive assessment of athletes with sports related head injury. Br J Sports Med 2001 Oct 1; 35 (5): 297–302PubMedCrossRefGoogle Scholar
  13. 13.
    Peterson CL, Ferrara MS, Mrazik M, et al. Evaluation of neuropsychological domain scores and postural stability following cerebral concussion in sports. Clin J Sport Med 2003; 13 (4): 230–7PubMedCrossRefGoogle Scholar
  14. 14.
    Guskiewicz KM, Riemann BL, Perrin DH, et al. Alternative approaches to the assessment of mild head injury in athletes. Med Sci Sports Exerc 1997; 29 (7 Suppl.): S213–21PubMedGoogle Scholar
  15. 15.
    Collins MW, Grindel SH, Lovell MR, et al. Relationship between concussion and neuropsychological performance in col lege football players. JAMA 1999; 282 (10): 964–70PubMedCrossRefGoogle Scholar
  16. 16.
    Schatz P, Pardini JE, Lovell MR, et al. Sensitivity and specificity of the ImPACT Test Battery for concussion in athletes. Arch Clin Neuropsychol 2006; 21 (1): 91–9PubMedCrossRefGoogle Scholar
  17. 17.
    Erlanger DM, Saliba E, Barth JT, et al. Monitoring resolution of postconcussion symptoms in athletes: preliminary results of a web-based neuropsychological test protocol. J Athl Train 2001; 36 (3): 280–7PubMedGoogle Scholar
  18. 18.
    Collie A, Makdissi M, Maruff P, et al. Cognition in the days following concussion: comparison of symptomatic versus asymptomatic athletes. J Neurol Neurosurg Psychiatry 2006; 77 (2): 241–5PubMedCrossRefGoogle Scholar
  19. 19.
    McCrea M, Barr WB, Guskiewicz KM, et al. Standard regression-based methods for measuring recovery after sport-relatedconcussion. J Int Neuropsychol Soc 2005; 11: 58–69PubMedCrossRefGoogle Scholar
  20. 20.
    Piland SG, Motl RW, Guskiewicz KM, et al. Structural validity of a self-report concussion-related symptom scale. Med Sci Sports Exerc 2006; 38 (1): 27–32PubMedCrossRefGoogle Scholar
  21. 21.
    Lovell MR, Collins MW. Neuropsychological assessment of the college football player. J Head Trauma Rehabil 1998; 13 (2): 9–26PubMedCrossRefGoogle Scholar
  22. 22.
    Ferguson RJ, Mittenberg W, Barone DF, et al. Postconcussion syndrome following sports-related head injury: expectation as etiology. Neuropsychology 1999; 13 (4): 582–9PubMedCrossRefGoogle Scholar
  23. 23.
    Piland SG, Motl RW, Ferrara MS, et al. Evidence for the factorial and construct validity of a self-report concussion symptoms scale. J Athl Train 2003; 38 (2): 104–12PubMedGoogle Scholar
  24. 24.
    Van Kampen DA, Lovell MR, Pardini JE, et al. The ‘value added’ of neurocognitive testing after sports-related concussion. Am J Sport Med 2006; 30: 1–6Google Scholar
  25. 25.
    McCrea M, Hammeke T, Olsen G, et al. Unreported concussion in high school football players: implications for prevention. Clin J Sport Med 2004 Jan; 14 (1): 13–7PubMedCrossRefGoogle Scholar
  26. 26.
    McCrea M, Guskiewicz KM, Marshall SW, et al. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA 2003 Nov 19; 290 (19): 2556–63PubMedCrossRefGoogle Scholar
  27. 27.
    Guskiewicz KM, Ross SE, Marshall SW. Postural stability and neuropsychological deficits after concussion in collegiate athletes. J Athl Train 2001; 36 (3): 263–73PubMedGoogle Scholar
  28. 28.
    Belanger HG, Vanderploeg RD. The neuropsychological impact of sports-related concussion: a meta-analysis. J Int Neuropsychol Soc 2005; 11: 345–57PubMedCrossRefGoogle Scholar
  29. 29.
    Giza CC, Hovda DA. The neurometabolic cascade of concussion. J Athl Train 2001; 36 (3): 228–35PubMedGoogle Scholar
  30. 30.
    Grindel SH. Epidemiology and pathophysiology of minor traumatic brain injury. Curr Sports Med Rep 2003; 2: 18–23PubMedGoogle Scholar
  31. 31.
    Aubry M, Cantu R, Dvorak J, et al. Summary and agreement statement of the first International Conference on Concussion in Sport, Vienna 2001. Br J Sports Med 2002 Feb 1; 36 (1): 6–7PubMedCrossRefGoogle Scholar
  32. 32.
    Hedges LV, Oklin I. Statistical methods for meta-analysis. New York: Academic Press, 1985Google Scholar
  33. 33.
    Gleser LJ, Oklin I. Stochastically dependent effect sizes. In: Cooper H, Hedges LV, editors. The handbook of research synthesis. New York: Sage, 1994: 339–55Google Scholar
  34. 34.
    Rosenthal R. Meta-analytic procedures for social research. Newbury Park (CA): Sage, 1991Google Scholar
  35. 35.
    Iverson GL, Gaetz M, Lovell MR, et al. Cumulative effects of concussion in amateur athletes. Brain Inj 2004; 18 (5): 433–43PubMedCrossRefGoogle Scholar
  36. 36.
    Maddocks DL, Dicker GD, Saling MM. The assessment of orientation following concussion in athletes. Clin J Sport Med 1995; 5 (1): 32–5PubMedCrossRefGoogle Scholar
  37. 37.
    Cremona-Meteyard SL, Geffen GM. Persistent visuospatial attention deficits following mild head injury in Australian rule football players. Neuropsychologia 1994; 32: 649–62PubMedCrossRefGoogle Scholar
  38. 38.
    Guskiewicz KM, Perrin DH, Gansneder BM. Effects of mild head injury on postural stability in athletes. J Athl Train 1996; 31 (4): 300–6PubMedGoogle Scholar
  39. 39.
    Guskiewicz KM, McCrea M, Marshall SW, et al. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA concussion study. JAMA 2003; 290 (19): 2549–55PubMedCrossRefGoogle Scholar
  40. 40.
    Hinton-Bayre AD, Geffen GM, Geffen LB, et al. Concussion in contact sports: reliable change indices of impairment and recovery. J Clin Exp Neuropsychol 1999; 21 (1): 70–86CrossRefGoogle Scholar
  41. 41.
    Riemann BL, Guskiewicz KM. Effects of mild head injury on postural stability as measured through clinical balance testing. J Athl Train 2000; 35 (1): 19–25PubMedGoogle Scholar
  42. 42.
    Hedges LV, Pigott TD. The power of statistical tests for moderators in meta-analysis. Psychol Med 2004; 9: 426–45Google Scholar
  43. 43.
    Hedges LV, Pigott TD. The power of statistical tests in metaanalysis. Psychol Methods 2001; 6: 203–17PubMedCrossRefGoogle Scholar
  44. 44.
    Detsky AS, Naylor CD, O’Rourke K, et al. Incorporating variations in the quality of individual randomized trials into metaanalysis. J Clin Epidemiol 1992; 45: 255–65PubMedCrossRefGoogle Scholar
  45. 45.
    Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979; 86 (2): 420–8PubMedCrossRefGoogle Scholar
  46. 46.
    Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; I (8476): 307–10CrossRefGoogle Scholar
  47. 47.
    Altman DG, Bland JM. Measurement in medicine: the analysis of method comparison studies. Statistician 1983; 32: 307–17CrossRefGoogle Scholar
  48. 48.
    Juni P, Witschi A, Bloch R, et al. The hazards of scoring the quality of clinical trials for meta-analysis. JAMA 1999; 282: 1054–60PubMedCrossRefGoogle Scholar
  49. 49.
    Barr WB, McCrea M. Sensitivity and specificity of standardized neurocognitive testing immediately following sports concussion. J Int Neuropsychol Soc 2001; 7 (6): 693–702PubMedCrossRefGoogle Scholar
  50. 50.
    Bruce JM, Echemendia RJ. Delayed-onset deficits in verbal encoding strategies among patients with mild traumatic brain injury. Neuropsychology 2003; 17 (4): 622–9PubMedCrossRefGoogle Scholar
  51. 51.
    Collins MW, Lovell MR, Iverson GL, et al. Examining concussion rates and return to play in high school football players wearing newer helmet technology: a three-year prospective cohort study. Neurosurgery 2006; 58 (2): 275–86PubMedCrossRefGoogle Scholar
  52. 52.
    Collins MW, Iverson GL, Lovell MR, et al. On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Clin J Sport Med 2003; 13 (4): 222–9PubMedCrossRefGoogle Scholar
  53. 53.
    Echemendia RJ, Putukian M, Mackin RS, et al. Neuropsycho-logical test performance prior to and following sports-related mild traumatic brain injury. Clin J Sport Med 2001 Jan; 11 (1): 23–31PubMedCrossRefGoogle Scholar
  54. 54.
    Field M, Collins MW, Lovell MR, et al. Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. J Pediatr 2003; 142 (5): 546–53PubMedCrossRefGoogle Scholar
  55. 55.
    Hinton-Bayre AD, Geffen G, McFarland K. Mild head injury and speed of information processing: a prospective study of professional rugby league players. Clin Exp Neuropsych 1997; 19 (2): 275–89CrossRefGoogle Scholar
  56. 56.
    Iverson GL, Lovell MR, Collins MW. Interpreting change on ImPACT following sport concussion. Clin Neuropsychol 2003; 17 (4): 460–70PubMedCrossRefGoogle Scholar
  57. 57.
    Iverson GL, Brooks BL, Collins MW, et al. Tracking neuropsychological recovery following concussion in sport. Brain Inj 2006; 20 (3): 245–52PubMedCrossRefGoogle Scholar
  58. 58.
    Lovell MR, Collins MW, Iverson GL, et al. Recovery from mild concussion in high school athletes. J Neurosurg 2003; 98 (2): 296–301PubMedCrossRefGoogle Scholar
  59. 59.
    Lovell MR, Collins MW, Iverson GL, et al. Grade 1 or ‘Ding’ concussions in high school athletes. Am J Sport Med 2004 Jan 1; 32 (1): 47–54CrossRefGoogle Scholar
  60. 60.
    Macciocchi SN, Barth JT, Alves W, et al. Neuropsychological functioning and recovery after mild head injury in collegiate athletes. Neurosurgery 1996 Sep; 39 (3): 510–4PubMedGoogle Scholar
  61. 61.
    Maddocks D, Saling M. Neuropsychological deficits following concussion. Brain Inj 1996; 10 (2): 99–103PubMedCrossRefGoogle Scholar
  62. 62.
    McClincy MP, Lovell MR, Pardini JE, et al. Recovery from sports concussion in high school and collegiate athletes. Brain Inj 2006; 20 (1): 33–9PubMedCrossRefGoogle Scholar
  63. 63.
    McCrea M, Kelly JP, Kluge J, et al. Standardized assessment of concussion in football players. Neurology 1997 Mar; 48 (3): 586–8PubMedCrossRefGoogle Scholar
  64. 64.
    McCrea M, Kelly JP, Randolph C, et al. Standardized Assessment of Concussion (SAC): on-site mental status evaluation of the athlete. J Head Trauma Rehabil 1998 Apr; 13 (2): 27–35CrossRefGoogle Scholar
  65. 65.
    McCrea M. Standardized mental status assessment of sports concussion. Clin J Sport Med 2001; 11 (3): 176–81CrossRefGoogle Scholar
  66. 66.
    McCrea M, Kelly J, Randolph C, et al. Immediate neurocognitive effects of concussion. Neurosurgery 2002; 50 (5): 1032–40PubMedGoogle Scholar
  67. 67.
    Moser RS, Schatz P. Enduring effects of concussion in youth athletes. Arch Clin Neuropsychol 2002; 17 (1): 91–100PubMedGoogle Scholar
  68. 68.
    Moser RS, Schatz P, Jordan BD. Prolonged effects of concus sion in high school athletes. Neurosurgery 2005; 57 (2): 300–6PubMedCrossRefGoogle Scholar
  69. 69.
    Pellman EJ, Lovell MR, Viano DC, et al. Concussion in professional football: neuropsychological testing -part 6. Neurosurgery 2004 Dec; 55 (6): 1290–303CrossRefGoogle Scholar
  70. 70.
    Pellman EJ, Lovell MR, Viano DC, et al. Concussion in professional football: recovery of NFL and high school athletes assessed by computerized neuropsychological testing-part 12. Neurosurgery 2006; 58 (2): 263–74CrossRefGoogle Scholar
  71. 71.
    Warden DL, Bleiberg J, Cameron KL, et al. Persistent prolongation of simple reaction time in sports concussion. Neurology 2001; 57 (35): 524–6CrossRefGoogle Scholar
  72. 72.
    Egger M, Davey-Smith B, Schneider M, et al. Bias in metaanalysis detected by a simple, graphical test. BMJ 1997; 315: 629–34PubMedCrossRefGoogle Scholar
  73. 73.
    Duval S. The ‘Trim and Fill’ method. In: Rothstein H, Sutton A, Borenstein M, editors. Publication bias in meta-analysis: prevention, assessment and adjustments. Indianapolis (IN): Wiley, 2005: 127–44Google Scholar
  74. 74.
    Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56 (2): 455–63PubMedCrossRefGoogle Scholar
  75. 75.
    Lipsey MW, Wilson DB. Practical meta-analysis. Newbury Park (CA): Sage Publications, 2001Google Scholar
  76. 76.
    Erlanger DM, Feldman D, Kutner KC, et al. Development and validation of a web-based neuropsychological test protocol for sports-related return-to-play decision-making. Arch Clin Neuropsychol 2003; 18 (3): 293–316PubMedGoogle Scholar
  77. 77.
    Bleiberg J, Cernich AN, Cameron K, et al. Duration of cognitive impairment after sports concussion. Neurosurgery 2004; 54 (5): 1073–80CrossRefGoogle Scholar
  78. 78.
    Guskiewicz KM. Postural stability assessment following concussion: one piece of the puzzle. Clin J Sport Med 2001 Jul; 11 (3): 182–9PubMedCrossRefGoogle Scholar
  79. 79.
    Broshek DK, Kaushik T, Freeman JR, et al. Sex differences in outcome following sports-related concussion. J Neurosurg 2005; 102 (5): 856–63PubMedCrossRefGoogle Scholar
  80. 80.
    Randolph C, McCrea M, Barr WB. Is neuropsychological testing useful in the management of sport-related concussion? J Athl Train 2005; 40 (3): 139–54PubMedGoogle Scholar
  81. 81.
    Valovich-Mcleod TC, Perrin DH, Guskiewicz KM, et al. Serial administration of clinical concussion assessments and learning effects in healthy young athletes. Clin J Sport Med 2005; 14 (5): 287–95CrossRefGoogle Scholar
  82. 82.
    Kissick J, Johnston KM. Return to play after concussion: principles and practice. Clin J Sport Med 2005; 15 (6): 426–31CrossRefGoogle Scholar

Copyright information

© Adis Data Information BV. 2008

Authors and Affiliations

  1. 1.Department of Kinesiology and Community HealthUniversity of Illinois at Urbana-ChampaignUrbanaUSA
  2. 2.Department of KinesiologyUniversity of GeorgiaAthensUSA

Personalised recommendations