Evaluation of Concussion: Signs and Symptoms

Chapter

Clinically observable signs and symptoms of concussion are the result of the pathophysiological processes that ensue immediately after the introduction of traumatic external forces. Although, additional information is necessary to further clarify the most common signs and self-reported sequelae of concussion: post-concussive symptoms, amnesia, and LOC. Proper concussion management begins as soon as an injury is suspected, often on the playing field, court, or sidelines. Once more serious injury is ruled out (e.g., open head injury, airways obstructed, etc.) and concussion is the working diagnosis, a thorough assessment of signs and symptoms should be completed. Often this assessment is performed by the team physician, athletic trainer, or emergency medical personnel. These professionals are often faced with the decision of whether the injured athlete should be sent to the emergency room for further evaluation, including a brain imaging examination. A proper assessment of concussion should include a thorough assessment of signs and symptoms, with documentation of the presence and duration of each.

Apart from self-reported symptoms, cognitive impairments are less observable by medical staff, teammates, or coaches, less transient than other signs of concussion (e.g., LOC, vomiting, etc.), and less susceptible to dissimulation and underreporting from an athlete who is motivated to return to play. Additionally, in the absence of signs and symptoms, lingering cognitive deficits which may be undetectable to the athlete may be apparent on neuropsychological tests, thus serving as a valuable indicator of concussion severity.

Keywords

Practice Effect Mild Traumatic Brain Injury National Football League Symbol Digit Modality Test Collegiate Athlete 
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.
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References

  1. Gronwall, D., & Wrightson, P. (1974). Delayed recovery of intellectual function after minor head injury. Lancet, 2(7881), 605-609.CrossRefPubMedGoogle Scholar
  2. Bohnen, N., Twijnstra, A, & Jolles, J. (1992). Post-traumatic and emotional symptoms in different subgroups of patients with mild head injury. Brain Injury, 6(6), 481-487.CrossRefPubMedGoogle Scholar
  3. Echemendia, R. J., Putukian, M., Mackin, R.S., Julian, L.J., & Shoss, N. (2001). Neuropsychological test performance prior to and following sports-related mild traumatic brain injury. Clinical Journal of Sports Medicine, 11, 23-31.CrossRefGoogle Scholar
  4. Lovell, M. R., Collins, M. W., Iverson, G. L., Field, M., Maroon, J. C., Cantu, R., Podell, K., Powell, J. W., Belza, M., & Fu, F. H. (2003). Recovery from mild concussion in high school athletes. Neurosurgery, 98(2), 296-301.Google Scholar
  5. 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. The Journal of Pediatrics, 142(5), 546-553.CrossRefPubMedGoogle Scholar
  6. Bruce, J. M., & Echemendia, R. J. (2004). Delayed-onset deficits in verbal encoding strategies among patients with mild traumatic brain injury, Neuropsychology, 17(4), 622-629.Google Scholar
  7. Barth, J. T., Alves, W. M., Ryan, T. V., Macciocchi, S. N., Rimel, R. W., Jane, J. A., Nelson, W. E. (1989). Mild head injury in sports: Neuropsychological sequelae and recovery of function. In H. S. Levin, H. M. Eisenberg, & A. L. Benton (Eds.), Mild head injury (pp. 257-275). New York: Oxford University Press.Google Scholar
  8. 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(3), 510-514.CrossRefPubMedGoogle Scholar
  9. Barth, J. T., Macciocchi, S. N., Giordani, B., Rimel, R., Jane, J. A., & Boll, T. J. (1983). Neuropsychological sequelae of minor head injury. Neurosurgery, 13(5), 529-533.PubMedCrossRefGoogle Scholar
  10. Voller, B., Benke, T., Benedetto, K., Schnider, P., Auff, E., & Aichner, F. (1999). Neuropsychological, MRI, and EEG findings after very mild traumatic brain injury. Brain Injury, 13(10), 821-827.PubMedGoogle Scholar
  11. McCrea, M., Guskiewicz, K. M., Marshall, S. W., Barr, W., Randolph, C., Cantu, R. C., Onate, J. A., Yang, J., & 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(19), 2556-2563.CrossRefPubMedGoogle Scholar
  12. Guskiewicz, K. M., Ross, S. E., & Marshall, S. W. (2001). Postural stability and Postural stability and neuropsychological deficits after concussion in collegiate athletes. Journal of Athletic Training, 36(3), 263-273.PubMedGoogle Scholar
  13. Slobounov, S. M., & Sebastianelli, W. (2006). Foundation of Sport-Related Brain Injuries (pp. 445-477). New York: Springer.Google Scholar
  14. Gasquoine, P. G. (1998). Historical perspectives on postconcussion symptoms. Clinical Neuropsychologist, 12(3), 315-324.Google Scholar
  15. Guskiewicz, K. M., Weaver, N. L., Padua, D. A., & Garrett, W. E. (2000). Epidemiology of concussion in college and high school football players. American Journal of Sports Medicine, 28, 643-650.PubMedGoogle Scholar
  16. Guskiewicz, K. M., McCrea, M., Marshall, S. W., Cantu, R. C., Randolph, C., Barr, W., Onate, J. A., & 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(19), 2549-2549.CrossRefPubMedGoogle Scholar
  17. Pellman, E. J., Viano, D. C., Casson, I. R., Arfken, C., & Powell, J. (2004). Concussion in professional football: Injuries involving 7 or more days out—Part 5. Neurosurgery, 55 (5), 1100-1119.CrossRefPubMedGoogle Scholar
  18. Erlanger, D., Feldman, D., Kutner, K., Kaushik, T., Kroger, H., Festa, J., Barth, J., Freeman, J., & Broshek, D. (2003). Development and validation of a web-based neuropsychological test protocol for sports-related return-to-play decision-making. Archives of Clinical Neuropsychology, 18(3), 293-316.PubMedGoogle Scholar
  19. Kelly, J. P., & Rosenberg, J. H. (1997). Diagnosis and management of concussion in sports. Neurology, 48(3), 575-580.PubMedGoogle Scholar
  20. Alves, W., Macciocchi, S. N., & Barth, J. T. (1993). Postconcussive symptoms after uncomplicated mild head injury. Journal of Head Trauma Rehabilitation, 8(3), 48-59.CrossRefGoogle Scholar
  21. Cantu, R. C. (2001). Posttraumatic retrograde and anterograde amnesia: Pathophysiology and implications in grading and safe return to play. Journal of Athletic Training, 36(3), 244-248.PubMedGoogle Scholar
  22. Echemendia, R. J., & Julian, L. J. (2001). Mild traumatic brain injury in sports: Neuropsychology’s contribution to a developing field. Neuropsychology Review, 11(2), 69-86.CrossRefPubMedGoogle Scholar
  23. Lovell, M. R., Collins, M. W., Iverson, G. L., Johnston, K. M., & Bradley, J. P. (2004). Grade 1 or “ding” concussions in high school athletes. American Journal of Sports Medicine, 32(1), 47-54.PubMedGoogle Scholar
  24. Giza, C. C., & Hovda, D. A. (2001). Neurometabolic cascade of concussion. Journal of Athletic Training, 36(3), 228-235.PubMedGoogle Scholar
  25. Symonds, S. C. (1962). Concussion and its sequelae. The Lancet, 1(1), 1-5.CrossRefGoogle Scholar
  26. 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 Sports Medicine, 13(4), 222-229.CrossRefGoogle Scholar
  27. Mergner, T., Maurer, C., Peterka,R. (2003). A multisensory posture control model of human upright stance. In: Progress of Brain Research, vol 142. C. Prablanc, D. Pelisson and Y. Rosetti (eds), Elsevier Science, pp.189-201.Google Scholar
  28. Lishman, W. A. (1988). Physiogenesis and psychogenesis in the post-concussional syndrome. Biological Journal of Psychiatry, 153, 460-469.CrossRefGoogle Scholar
  29. Ingelsoll, C. D., & Armstrong, C. W. (1992). The effect of closed-head injury on postural sway. Medicine in Science, Sports & Exercise, 24, 739-743.Google Scholar
  30. Wober, C., Oder, W., Kollegger, H., Prayer, L., Baumgartner, C., & Wober-Bingol, C. (1993). Posturagraphic measurement of body sway in survivors of severe closed-head injury. Archive of Physical Medical Rehabilitation, 74, 1151-1156.Google Scholar
  31. Geurts, A., Knoop, J., & van Limbeek, J. (1999). Is postural control associated with mental functioning is the persistent postconcussion syndrome? Archive Physical Rehabilitation, 80, 144-149.CrossRefGoogle Scholar
  32. Rieman, B. & Guskiewicz, K. (2002). Effect of mild head injury on postural stability as measured through clinical balance testing. Journal of Athletic Training, 35, 19-25.Google Scholar
  33. Valovich, T., Periin, D., Gansneder, B. (2003). Repeat administration elicits a practice effect with the balance error scoring system but not with the standardized assessment of concussion in high school athletes. Journal of Athletic Training, 38(10), 51-56.PubMedGoogle Scholar
  34. Peterson, C., Ferrara, M., Mrazik, M., Piland, S., Elliott, R. (2003). Evaluation of neuropsychological domain scores and postural stability following cerebral concussion in sport. Clinical Journal of Sport Medicine, 13(4), 230-237.CrossRefPubMedGoogle Scholar
  35. Cavanaugh, J., Guskiewicz, K., Stergiou, N. (2005a). A nonlinear dynamic approach for evaluating postural control: new directions for the management of sport-related cerebral concussion. Sport Medicine, 35(11), 935-950.CrossRefGoogle Scholar
  36. Cavanaugh, J., Guskiewicz, K., Giuliani, C., Marshall, S., Mercer, V., Stergiou, N. (2005b). Detecting altered postural control after cerebral concussion in athletes with normal postural stability. British Journal of Sports Medicine, 39(11), 805-811.CrossRefPubMedGoogle Scholar
  37. Cavanaugh, J.T., Guskiewicz, K.M., Giuliani, C., Marshall, S., Merser, V.S., Stergion, N. (2006). Recovery of postural control after cerebral concussion: new insights using approximate entropy. Journal of Athletic Training, 41(3), 305-313.PubMedGoogle Scholar
  38. Kushner, D. (1998). Mild traumatic brain injury: Toward understanding manifestations and treatment. Archive of Internal Medicine, 158, 10-24.CrossRefGoogle Scholar
  39. Povlishock, J. T., Erb, D. E. , & Astruc, J. (1992). Axonal response to traumatic brain injury: reactive axonal change, deafferentation and neuroplasticity, Journal of Neurotrauma, 9 (suppl.1), 189-200.Google Scholar
  40. Heitger, M.H., Jones, R.D., Dalrymple-Alford, J.C., et al. (2006). Motor deficits and recovery during the first year following mild closed head injury. Brain Injury, 20(8), 807-824.CrossRefPubMedGoogle Scholar
  41. Geets, W., & Louette, N (1985). Early EEG in 300 cerebral concussions. EEG and Clinical Neurophysiology, 14(4), 333-338.Google Scholar
  42. McClelland, R. J., Fenton, G. W. , Rutherford, W. (1994). The postconcussional syndrome revisited. Journal of the Royal Society of Medicine, 87, 508-510.PubMedGoogle Scholar
  43. Tebano, T. M., Cameroni, M., Gallozzi, G., Loizzo, A., Palazzino, G., Pessizi, G., & Ricci, G. F. (1988). EEG spectral analysis after minor head injury in man. EEG and Clinical Neurophysiology, 70, 185-189.CrossRefGoogle Scholar
  44. Montgomery, A., Fenton, G. W., McCLelland, R. J., MacFlyn, G., & Rutherford, W. H. (1991). The psychobiology of minor head injury. Psychological Medicine, 21, 375-384.CrossRefPubMedGoogle Scholar
  45. Pratar-Chand, R., Sinniah, M., & Salem, F. A. (1988). Cognitive evoked potential (P300): a metric for cerebral concussion. Acta Neurologia Scandinavia, 78, 185-189.CrossRefGoogle Scholar
  46. Watson, W. R., Fenton, R. J., McClelland, J., Lumbsden, J., Headley, M., & Rutherford, W. H. (1995). The post-concussional state: Neurophysiological aspects. British Journal of Psychiatry, 167, 514-521.CrossRefPubMedGoogle Scholar
  47. Thatcher, R. W., Walker, R. A., Gerson, I., & Geisler, F. H. (1989). EEG discriminant analyses of mild head injury. EEG and Clinical Neurophysiology, 73, 94-106.CrossRefGoogle Scholar
  48. Thornton, K. E. (1999). Exploratory investigation into mild brain injury and discriminant analysis with high frequency bands (32-64 Hz). Brain Injury, 13(7), 477-488.CrossRefPubMedGoogle Scholar
  49. Slobounov, S., Sebastianelli, W., Simon, R. (2002). Neurophysiological and behavioral Concomitants of Mild Brain Injury in College Athletes. Clinical Neurophysiology, 113, 185-193.CrossRefPubMedGoogle Scholar
  50. Thompson, J., Sebastianelli, W., Slobounov, S. (2005). EEG and postural correlates of mild traumatic brain injury in athletes. Neuroscience Letters, 377, 158-163.CrossRefPubMedGoogle Scholar
  51. Slobounov, S., Sebastianelli, W., Moss, R. (2005). Alteration of posture-related cortical potentials in mild traumatic brain injury. Neuroscience Letters, 383, 251-255.CrossRefPubMedGoogle Scholar
  52. McClincy, M. P., Lovell, M. R., Pardini, J., Collins, M. W., & Spore, M. W. (2006). Recovery from sports concussion in high school and collegiate athletes. Brain Injury, 20 (1), 33-39.CrossRefPubMedGoogle Scholar
  53. Guskiewicz, K. M., Riemann, B. L., Perrin, D. H., & Nashner, L. M. (1997). Alternative approaches to the assessment of mild head injury in athletes. Medical Science and Sports Exercise, 29(Suppl. 7), 5213-5221.Google Scholar
  54. Lovell, M. R., & Collins, M. W. (1998). Neuropsychological assessment of the college football player. Journal of Head Trauma Rehabilitation, 13(2), 9-26.CrossRefPubMedGoogle Scholar
  55. Alves, W., Macciocchi, S. N., & Barth, J. T. (1993). Postconcussive symptoms after uncomplicated mild head injury. Journal of Head Trauma Rehabilitation, 8(3), 48-59.CrossRefGoogle Scholar
  56. Chelune, G. J., Naugle, R.I., Luders, H., Sedlak, J., and Awad, I.A. (1993). Individual change after epilepsy surgery: Practice effects and base-rate information. Neuropsychology, 7 (1), 41-52.CrossRefGoogle Scholar
  57. Iverson, G. L. and Gaetz, M. (2004). Practical Considerations for Interpreting Change Following Brain Injury. In M. R. Lovell, Collins, M.W., Echemendia, R.J., and Barth, J.T. (Ed.), Traumatic Brain Injury in Sports (Vol. 1, pp. 323-356). New York: Taylor and Francis.Google Scholar
  58. Mackin, R. S., Sabsevitz, D.S., Julian, L., Junco, R., Dwyer, M. and Echemendia, R.J. (1997). Stability Coefficients and Practice Effects of Neuropsychological Tests in College Athletes: Preliminary Findings. Paper presented at the Sports Related and Nervous System Injuries Orlando, Florida.Google Scholar
  59. Barth, J. T., Alves, W.M., Ryan, T.V., Macciocchi, S.N., Rimel, R.W., Jane, J.A., and Nelson, W.E. (1989). Mild head injury in sports: Neuropsychological sequelae and recovery of function. In H. E. H. Levin, and A. Benton (Ed.), Mild Head Injury (pp. 257-275). New York, NY: Oxford University Press.Google Scholar
  60. McCrea, M., Barr, W.B., Guskiewicz, K., Randolph, C.R., Marshall, S.W., Cantu, R., Onate J.A., and Kelly, J.P. (2005). Standard regression-based methods for measuring recovery after sport-related concussion. Journal of the International Neuropsychological Society, 11, 58-69.CrossRefPubMedGoogle Scholar
  61. Echemendia, R. J., and Cantu, R.C. (2004). Return to Play Following Cerebral Brain Injury. In M. R. Lovell, Collins, M.W., Echemendia, R.J., and Barth, J.T. (Ed.), Traumatic Brain Injury in Sports (Vol. 1, pp. 479-498). New York: Taylor and Francis.Google Scholar
  62. Dikmen, S. S., Heaton, R.K., Grant, I., and Temkin, N.R. (1999). Test-retest reliability and practice effects of Expanded Halstead-Reitan Neuropsychological Test Battery. Journal of the International Neuropsychological Society, 5(4), 346-356.PubMedGoogle Scholar
  63. Jacobson, N. S., and Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12-19.CrossRefPubMedGoogle Scholar
  64. Barr, W. B., and McCrea, M. (2001). Sensitivity and specificity of standardized neurocognitive testing immediately following sports concussion. Journal of the International Neuropsychological Society, 7(6), 693-702.CrossRefPubMedGoogle Scholar
  65. Hinton-Bayre, A. D., Geffen, G.M., Geffen, L.B., McFarland, K.A., and Friis, P. (1999). Concussion in contact sports: Reliable change indices of impairment and recovery. Journal of Clinical and Experimental Neuropsychology, 21(1), 70-86.CrossRefPubMedGoogle Scholar
  66. Iverson, G. L., Lovell, M.R., and Collins, M.W. (2003). Interpreting Change on ImPACT Following Sport Concussion. Clinical Neuropsychologist, 17(4), 460-467.PubMedGoogle Scholar
  67. Brandt, J., and Benedict, R.H.B. (2001). Hopkins Verbal Learning Test-Revised professional manual Odessa, FL: Psychological Assessment Resources.Google Scholar
  68. Trennery, M. R., Crosson, B., DeBoe, J., and Leber, W.R. (1989). Stroop Neuropsychological Screening Test Manual. Odessa FL: Psychological Assessment Resources.Google Scholar
  69. Reitan, R. M. (1958). Validity of the Trail-Making Test. Perceptual and Motor Skills, 8, 271-276.CrossRefGoogle Scholar
  70. Smith, A. (1982). Symbol Digit Modalities Test Manual (Revised). Los Angeles: Western Psychological Services.Google Scholar
  71. Echemendia, R. J. (1997). Neuropsychological assessment of the college athlete: The Penn State concussion program. Neuropsychology, 10(2), 189-193.Google Scholar
  72. Basso, M. R., Bornstein, R.A., and Lang, J.M. (1999). Practice effects on commonly used measures of executive function across twelve months. Clinical Neuropsychologist, 13(3), 283-292.PubMedGoogle Scholar
  73. Bornstein, R. A., Baker, G.B., and Douglass, A.B. (1987). Short-term retest reliability of the Halstead-Reitan Battery in a normal sample. The Journal of Nervous and Mental Disease, 175(4), 229-232.CrossRefPubMedGoogle Scholar
  74. desRosiers, G. a. K., D. (1987). Cognitive assessment in closed head injury: Stability, validity, and parallel forms for two neuropsychological measures of recovery. The International Journal of Clinical Neuropsychology, 9(4), 162-173.Google Scholar
  75. Matarazzo, J. D., Wiens, A.N., Matarazzo, R.G., and Goldstein, S.G. (1974). Psychometric and clinical test-retest reliability of the Halstead Impairment Index in a sample of healthy, young, normal men. The Journal of Nervous and Mental Disease, 158(1), 37-49.CrossRefPubMedGoogle Scholar
  76. Craddick, R.A., and Stern, M.R. (1963). Practice effects on the trail making test. Perceptual and Motor Skills, 17, 651-653.PubMedGoogle Scholar
  77. Mitrushina, M., and Satz, P. (1991). Effects of repeated administration of a neuropsychological battery in the elderly. Journal of Clinical Psychology, 47(6), 790-801.CrossRefPubMedGoogle Scholar
  78. Dikmen, S. S., Reitan, R. M., and Temkin, N. R. (1983). Neuropsychological recovery in head injury. Archives of Neurology, 40(6), 333-338.PubMedGoogle Scholar
  79. Dye, O. A. (1979). Effects of practice on trail making test performance. Perceptual and Motor Skills, 48, 296.Google Scholar
  80. Macciocchi, S. N., Barth, J. T., Littlefield, L., and Cantu, R.C. (2001). Multiple concussions and neuropsychological functioning in collegiate football players. Journal of Athletic Training, 36(3), 303-306.PubMedGoogle Scholar
  81. Macciocchi, S. N., Barth, J. T., Alves, W., Rimel, W. R., and Jane, J. A. (1996). Neuropsychological functioning and recovery after mild head injury in collegiate athletes. Neurosurgery, 39, 510-514.CrossRefPubMedGoogle Scholar
  82. Guskiewicz, K. M., Ross, S. E., and Marshall, S. W. (2001). Postural stability and neuropsychological deficits after concussion in collegiate athletes. Journal of Athletic Training, 36, 263-273.PubMedGoogle Scholar
  83. Davidson, D. J., Zacks, R. T., and Williams, C. C. (2003). Stroop interference, practice, and aging. Aging Neuropsychology and Cognition, 10(2), 85-98.Google Scholar
  84. Houx, P. J., Shepherd, J., Blauw, G-J., Murphy, M. B., Ford, I., Bollen, E. L., Buckley, B., Stott, D. J., Jukema, W., Hyland, M., Gaw, A., Norrie, J., Kamper, A. M., Perry, I. J., MacFarlane, P. W., Edo Meinders, A., Sweeney, B. J., Packard, C. J., Twomey, C., Cobbe, S. M., and Westendorp, R. G. (2002). Testing cognitive function in elderly populations: The PROSPER study. Journal of Neurology, Neurosurgery, and Psychiatry, 73(4), 385-389.CrossRefPubMedGoogle Scholar
  85. Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18, 643-662.CrossRefGoogle Scholar
  86. Golden, C. G. (1978). A manual for clinical and experimental users Stroop color and word test. Stoelting: Wood Dale IL.Google Scholar
  87. Connor, A., Franzen, M., and Sharp, B. (1988). Effects of practice and differential instructions on Stroop performance. The International Journal of Clinical Neuropsychology, 10(1), 4.Google Scholar
  88. Hinton-Bayre, A. D., and Geffen, G. (2004). Australian rules football and rugby league. In M. R. Lovell, Collins, M. W., Echemendia, R. J., and Barth, J. T. (Ed.), Traumatic Brain Injury in Sports. New York: Taylor and Francis.Google Scholar
  89. Franzen, M. D., Tishelman, A.C., Sharp, B.H., and Friedman, A.G. (1987). Test-retest reliability of the Stroop Word Color Test across two intervals. Archives of Clinical Neuropsychology, 2, 265-272.PubMedGoogle Scholar
  90. Uchiyama, C. L., D’Elia, L. F., Dellinger, A. M., Selnes, O. A., Becker, J. T., Wesch, J. E., Chen, B.B., Satz, P., van Gorp, W., and Miller, E. N. (1994). Longitudinal comparison of alternate versions of the Symbol Digit Modalities Test: Issues of form comparability and moderating demographic variables. Clinical Neuropsychologist, 8(2), 209-218.CrossRefGoogle Scholar
  91. Bohnen, N., Twijnstra, A, and Jolles, J. (1992). Post-traumatic and emotional symptoms in different subgroups of patients with mild head injury. Brain Injury, 6(6), 481-487.CrossRefPubMedGoogle Scholar
  92. Erlanger, D., Feldman, D., Kutner, K., Kaushik, T., Kroger, H., Festa, J., Barth, J., Freeman, J., and Broshek, D. (2003). Development and validation of a web-based neuropsychological test protocol for sports-related return to play decision-making. Archives of Clinical Neuropsychology, 18, 293-316.PubMedGoogle Scholar
  93. Reitan, R., Davison, L. A. (1974). Clinical neuropsychology: Current status and applications. Washington DC: VH Winston.Google Scholar
  94. Gronwall, D., & Wrightson, P. (1975). Cumulative effect of concussion. Lancet, 2(7943), 995-997.CrossRefPubMedGoogle Scholar
  95. Smith, A. (1973). Symbol Digit Modalities Test. Manual. Los Angeles: Western Psychological Services.Google Scholar
  96. 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(3), 510-514.CrossRefPubMedGoogle Scholar
  97. Hinton-Bayre, A. D., Geffen, G. M., & McFarland, K. A. (1999). Sensitivity of neuropsychological tests to the acute effects of concussion in contact sport. In D. T. B. Murdoch, E. Ward (Ed.), Brain Impairment and Rehabilitation: A National Perspective (pp. 75-81). Brisbane: Academic Press.Google Scholar
  98. Pellman, E. J., Lovell, M. R., Viano, D. C., Casson, I. R., & Tucker, A. M.. (2004). Concussion in professional football:Neuropsychological testing—Part6. Neurosurgery, 55, 1290-1305.CrossRefPubMedGoogle Scholar
  99. Maroon, J. C., Lovell, M. R., Norwig, J., Podell, K., Powell, J. W., & Hartl, R. (2000). Cerebral concussion in athletes: evaluation and neuropsychological testing. Neurosurgery, 47(3), 659-669; discussion 669-672.Google Scholar
  100. Podell, K. (2004). Computerized assessment of sports-related brain injury. In R. J. E. M. R. Lovell, J. T. Barth, M. W. Collins (Ed.), Traumatic Brain Injury in Sports (pp. 375-393). Lisse, The Netherlands: Swets & Zeitlinger.Google Scholar
  101. Bailes, J. E., & Cantu, R. C. (2001). Head injury in athletes. Neurosurgery, 48(1), 26-45; discussion 45-26.Google Scholar
  102. Powell, J. W., & Barber-Foss, K. D. (1999). Traumatic brain injury in high school athletes. JAMA, 282(10), 958-963.CrossRefPubMedGoogle Scholar
  103. Iverson, G. L., Lovell, M.R., Collins, M. W. (2005). Validity of ImPACT for measuring processing speed following sports-related concussion. Journal of Clinical & Experimental Neuropsychology, 27(6), 683-689.CrossRefGoogle Scholar
  104. McCrea, M., Kelly, J. P., Randolph, C., et al. (1998). Standardized assessment of concussion (SAC): On-site mental status evaluation of the athlete. J Head Trauma Rehab, 13, 27-35.CrossRefGoogle Scholar
  105. Aubrey M. C. R, Dvorak J, Graf-Bauman T, Johnston KM, Kelly J, Lovell MR, McCrory P, Meeuwisse WH, Schamasch P. (2002). Summary and agreement statement of the 1st international symposium on concussion in sport, Vienna 2001. Clinical Journal of Sport Medicine, 12, 6-11.CrossRefGoogle Scholar

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