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Standard regression-based methods for measuring recovery after sport-related concussion

Published online by Cambridge University Press:  28 January 2005

MICHAEL McCREA ,
WILLIAM B. BARR ,
KEVIN GUSKIEWICZ ,
CHRISTOPHER RANDOLPH ,
STEPHEN W. MARSHALL ,
ROBERT CANTU ,
JAMES A. ONATE  and
JAMES P. KELLY
MICHAEL McCREA
Affiliation:
Neuroscience Center, Waukesha Memorial Hospital, Waukesha Department of Neurology, Medical College of Wisconsin, Milwaukee
WILLIAM B. BARR
Affiliation:
Departments of Neurology and Psychiatry, New York University School of Medicine, New York
KEVIN GUSKIEWICZ
Affiliation:
Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill Department of Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill
CHRISTOPHER RANDOLPH
Affiliation:
Department of Neurology, Loyola University Medical School, Maywood
STEPHEN W. MARSHALL
Affiliation:
Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill
ROBERT CANTU
Affiliation:
Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill Neurosurgery Service, Emerson Hospital, Concord
JAMES A. ONATE
Affiliation:
Department of Rehabilitation Sciences, Athletic Training Program, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston
JAMES P. KELLY
Affiliation:
Department of Neurosurgery, University of Colorado Health Sciences Center, Denver
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Abstract

Clinical decision making about an athlete's return to competition after concussion is hampered by a lack of systematic methods to measure recovery. We applied standard regression-based methods to statistically measure individual rates of impairment at several time points after concussion in college football players. Postconcussive symptoms, cognitive functioning, and balance were assessed in 94 players with concussion (based on American Academy of Neurology Criteria) and 56 noninjured controls during preseason baseline testing, and immediately, 3 hr, and 1, 2, 3, 5, and 7 days postinjury. Ninety-five percent of injured players exhibited acute concussion symptoms and impairment on cognitive or balance testing immediately after injury, which diminished to 4% who reported elevated symptoms on postinjury day 7. In addition, a small but clinically significant percentage of players who reported being symptom free by day 2 continued to be classified as impaired on the basis of objective balance and cognitive testing. These data suggest that neuropsychological testing may be of incremental utility to subjective symptom checklists in identifying the residual effects of sport-related concussion. The implementation of neuropsychological testing to detect subtle cognitive impairment is most useful once postconcussive symptoms have resolved. This management model is also supported by practical and other methodological considerations. (JINS, 2005, 11, 58–69.)

Keywords

Brain injuryBrain concussionAthletic injuries
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 11 , Issue 1 , January 2005 , pp. 58 - 69
Copyright
© 2005 The International Neuropsychological Society

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