title: The “Value Added” of Neurocognitive Testing after Sports-Related Concussion Recovery of postural control after cerebral concussion: new insights using approximate entropy. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. Sensitivity and specificity of the ImPACT Test Battery for concussion in athletes. The Nature and Duration of Acute Concussive Symptoms in Australian Football Is there a relationship between whiplash-associated disorders and concussion in hockey? A preliminary study Examining Concussion Rates and Return to Play in High School Football Players Wearing Newer Helmet Technology: A Three-Year Prospective Cohort Study Evaluation of Neuropsychological Domain Scores and Postural Stability Following Cerebral Concussion in Sports SEX DIFFERENCES IN NEUROPSYCHOLOGICAL FUNCTION AND POST‐CONCUSSION SYMPTOMS OF CONCUSSED COLLEGIATE ATHLETES FUNCTIONAL BRAIN ABNORMALITIES ARE RELATED TO CLINICAL RECOVERY AND TIME TO RETURN‐TO‐PLAY IN ATHLETES Relation between subjective fogginess and neuropsychological testing following concussion. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Grade 1 or “Ding” Concussions in High School Athletes Relationship between Postconcussion Headache and Neuropsychological Test Performance in High School Athletes Mild head injury in sports. Predicting Slow Recovery From Sport-Related Concussion: The New Simple-Complex Distinction Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. MEASUREMENT OF HEAD IMPACTS IN COLLEGIATE FOOTBALL PLAYERS: RELATIONSHIP BETWEEN HEAD IMPACT BIOMECHANICS AND ACUTE CLINICAL OUTCOME AFTER CONCUSSION Neuropsychological functioning and recovery after mild head injury in collegiate athletes. CogSport: Reliability and Correlation with Conventional Cognitive Tests Used in Postconcussion Medical Evaluations The assessment of orientation following concussion in athletes. Effect of Mild Brain Injury on an Instrumented Agility Task
abstract: Background Neurocognitive testing has been endorsed as a “ cornerstone ’ of concussion management by recent Vienna and Prague meetings of the Concussion in Sport Group . Neurocognitive testing is important given the potential unreliability of athlete self-report after injury . Relying only on athletes'ormalities after injury . Study Design Case control study ; Level of evidence , 3 . Methods High school and college athletes with a diagnosed concussion were tested 2 days after injury . Postinjury neurocognitive performance ( Immediate Postconcussion Assessment and Cognitive Testing ) and symptom ( postconcussion symptom ) scores were compared with preinjury ( baseline ) scores and with those of an agex and education-matched noninjured athlete control group . “ Abnormal ” test performance was determined statistically with Reliable Change Index scores . Results Sixty-four percent of concussed athletes reported a significant increase in symptoms , as judged by postconcussion symptom scores , compared with preinjury baseline at 2 days after injury . Eighty-three percent of the concussed sample demonstrated significantly poorer neurocognitive test results relative to their own baseline performance . The addition of neurocognitive testing result ed in a net increase in sensitivity of 19 % . Ninety-three percent of the sample had either abnormal neurocognitive test results or a significant increase in symptoms , relative to their own baseline ; 30 % of a control group demonstrated either abnormalities in neurocognitive testing or elevated symptoms , as judged by postconcussion symptom scores . For the concussed group , use of symptom and neurocognitive test results result ed in an increased yield of 29 % overreliance on symptoms alone . In contrast , 0 % of the control group had both symptoms and abnormal neurocognitive testing . Conclusion Reliance on patients ’ self-reported symptoms after concussion is likely to result in underdiagnosis of concussion and may result in premature return to play . Neurocognitive testing increases diagnostic accuracy when used in conjunction with self-reported symptoms CONTEXT The return-to-play decision after sport-related cerebral concussion depends in part on knowing when an athlete has fully recovered postural control after injury . OBJECTIVE To describe the postconcussion recovery of postural control using approximate entropy ( ApEn ) , a regularity statistic from nonlinear dynamics . DESIGN Retrospective case series analysis . SETTING Sports medicine research laboratory . PATIENTS OR OTHER PARTICIPANTS Collegiate athletes from whom center-of-pressure and symptom data were collected at preseason , less than 48 hours after injury , and 48 to 96 hours after injury . MAIN OUTCOME MEASURE(S ) Approximate entropy values reflecting the amount of r and omness contained in center-of-pressure oscillations were calculated for anterior-posterior ( AP ) and medial-lateral ( ML ) time series . Equilibrium scores reflecting the amplitude of center-of-pressure AP oscillations were used to indicate postural stability . The number and severity of symptoms were described . RESULTS Compared with the healthy preseason state , ApEn values for the AP and ML time series generally declined immediately after injury in both steady and unsteady injured athletes . At 48 to 96 hours after injury , ApEn values for the ML time series remained significantly depressed ( mean difference compared with preseason = -0.268 , st and ard error = 0.072 ) , even among athletes whose initial postural instability had resolved . We found few significant relationships between changes in ApEn values and changes in symptoms before and after injury . CONCLUSIONS The effects of cerebral concussion on postural control appear to persist for longer than 3 to 4 days , even among athletes with no signs of unsteadiness . Our results may reflect changes in neurophysiologic or mechanical constraints on postural control . Approximate entropy provides a theoretically distinct , valuable measurement alternative that may prove useful for reducing uncertainty in the return-to-play decision CONTEXT Approximately 300 000 sport-related concussions occur annually in the United States , and the likelihood of serious sequelae may increase with repeated head injury . OBJECTIVE To estimate the incidence of concussion and time to recovery after concussion in collegiate football players . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 2905 football players from 25 US colleges were tested at preseason baseline in 1999 , 2000 , and 2001 on a variety of measures and followed up prospect ively to ascertain concussion occurrence . Players injured with a concussion were monitored until their concussion symptoms resolved and were followed up for repeat concussions until completion of their collegiate football career or until the end of the 2001 football season . MAIN OUTCOME MEASURES Incidence of concussion and repeat concussion ; type and duration of symptoms and course of recovery among players who were injured with a concussion during the seasons . RESULTS During follow-up of 4251 player-seasons , 184 players ( 6.3 % ) had a concussion , and 12 ( 6.5 % ) of these players had a repeat concussion within the same season . There was an association between reported number of previous concussions and likelihood of incident concussion .  Players reporting a history of 3 or more previous concussions were 3.0 ( 95 % confidence interval , 1.6 - 5.6 ) times more likely to have an incident concussion than players with no concussion history . Headache was the most commonly reported symptom at the time of injury ( 85.2 % ) , and mean overall symptom duration was 82 hours . Slowed recovery was associated with a history of multiple previous concussions ( 30.0 % of those with > or =3 previous concussions had symptoms lasting > 1 week compared with 14.6 % of those with 1 previous concussion ) . Of the 12 incident within-season repeat concussions , 11 ( 91.7 % ) occurred within 10 days of the first injury , and 9 ( 75.0 % ) occurred within 7 days of the first injury . CONCLUSIONS Our study suggests that players with a history of previous concussions are more likely to have future concussive injuries than those with no history ; 1 in 15 players with a concussion may have additional concussions in the same playing season ; and previous concussions may be associated with slower recovery of neurological function This study explored the diagnostic utility of the composite scores of Immediate Post-Concussion Assessment and Cognitive Testing ( ImPACT ) and Post Concussion Symptom Scale scores ( PCSS ) . Recently concussed high school athletes ( N=72 ) were tested within 72 h of sustaining a concussion , and data were compared to non-concussed high school athletes with no history of concussion ( N=66 ) . Between-groups MANOVA revealed a significant multivariate effect of concussion on test performance ( p<.001 ) ; univariate ANOVAS revealed all six measures contributed to the between-groups differences . A discriminant function analyses was conducted to measure the ability of the five ImPACT composite scores , as well as the PCSS to classify concussion status . One discriminant function was identified that consisted of the Visual Memory , Processing Speed , and Impulse Control composite scores PCSS , which correctly classified 85.5 % of the cases . Approximately 82 % of participants in the concussion group and 89 % of participants in the control group were correctly classified . Using these data , the sensitivity of ImPACT was 81.9 % , and the specificity was 89.4 % . As part of a formal concussion management program , ImPACT is a useful tool for the assessment of the neurocognitive and neurobehavioral sequelae of concussion , and can also provide post-injury cognitive and symptom data that can assist a practitioner in making safer return to play decisions Objective The purpose of this pilot study was to document the nature and temporal profile of the clinical symptoms of acute sport-related concussion . Design Prospect i ve cohort study Patient Population A total of 303 elite Australian football players participating in a national competition during a single season . Outcome Measures Number and duration of symptoms , digit symbol substitution test ( DSST ) scores , time of return to play post injury . Results A total of 23 concussions were recorded over the course of the 20-week football season . No catastrophic head injuries occurred . Headache was the most common symptom and the most persistent , with 40 % of players reporting headache symptoms lasting more than 15 minutes . Ten of the players ( 43 % ) returned to sport on the day of the injury with the remainder resuming play within 2 weeks . A low likelihood of return to play on the day of injury was found where 3 or more symptoms were present or where the symptoms lasted more than 15 minutes . These findings were significantly correlated with poor DSST performance . Conclusions This pilot study suggests that both the number of postconcussive symptoms and their duration may be used as a measure of injury severity and a guide for return to play Primary objective : To examine the relationship between the occurrence of  whiplash-associated disorders and concussion symptoms in hockey players . Research design : Prospect i ve cohort observational study to examine the relationship between whiplash associated disorders and concussion in actual hockey play . Methods and procedures : Twenty hockey teams were followed prospect ively for one season . Team therapists completed acute and 7–10 day follow-up evaluation question naires for all of the players who received either a whiplash mechanism or a concussion . Main outcomes and results : 183 players were registered for this study ; 13 received either a whiplash mechanistic injury or a concussion injury . Initial injuries ranged from WAD I to WAD III and all subjects reported concussion symptoms . Only three subjects reported full resolution of bothWAD and concussion symptoms at the 7–10 day follow-up evaluation . Conclusions : There is a strong association between whiplash induced neck injuries and the symptoms of concussion in hockey injuries . Both should be evaluated when dealing with athletes/ patients suffering from either injury OBJECTIVE : The purpose of this study was to compare concussion rates and recovery times for athletes wearing newer helmet technology compared to traditional helmet design . METHODS : This was a three-year , prospect i ve , naturalistic , cohort study . Participants were 2,141 high school athletes from Western Pennsylvania . Approximately half of the sample wore the Revolution helmet manufactured by Riddell , Inc.  ( n = 1,173 ) and the remainder of the sample used  st and ard helmets ( n = 968 ) . Athletes underwent computerized neurocognitive testing through the use of ImPACT at the beginning of the study . Following a concussion , players were reevaluated at various time intervals until recovery was complete . RESULTS : In the total sample , the concussion rate in athletes wearing the Revolution was 5.3 % and in athletes wearing st and ard helmets was 7.6 % [ & khgr;2 ( 1 , 2 , 141 ) = 4.96 , P < 0.027 ] . The relative risk estimate was 0.69 ( 95 % confidence interval = 0.499– 0.958 ) . Wearing the Revolution helmet was associated with approximately a 31 % decreased relative risk and 2.3 % decreased absolute risk for sustaining a concussion in this cohort study . The athletes wearing the Revolution did not differ from athletes wearing st and ard helmets on the mechanism of injury ( e.g. , head-to-head strike ) , on-field concussion markers ( e.g. , amnesia or loss of consciousness ) , or on-field presentation of symptoms ( e.g. , headaches , dizziness , or balance problems ) . CONCLUSION : Recent sophisticated laboratory research has better eluci date d injury biomechanics associated with concussion in professional football players . This data has led to changes in helmet design and new helmet technology , which appears to have beneficial effects in reducing the incidence of cerebral concussion in high school football players Context With increasing knowledge and research about concussion , there have been few objective studies that have used neuropsychological domain scores and postural stability to assess concussion . Objective To evaluate the recovery curve of athletes who incur sport-related concussion from repeated serial testing of neuropsychological and posturography testing . Design A prospect i ve epidemiological model was used for the course of the study . Setting Division I intercollegiate athletics . Participants Athletes participating in football , soccer , basketball , softball , and cheerleading . Main Outcome Measures  Neuropsychological scores and posturography measures  were obtained preseason and serially at day 1 , day 2 , day 3 , and day 10 postconcussion .  Control participants  were tested at the same intervals .  Neuropsychological scores were converted to st and ards score and then into domains of attention , learning , speed of information processing , concentration , memory , and verbal fluency . Analysis of covariance with the baseline test as the covariate was used to analyze the data with univariate post hoc tests performed . Results Significant group differences were found for self reported symptoms ( P = 0.001 ) , speed of information processing ( P = 0.005 ) , mean stability ( P = 0.002 ) , and vestibular function ( P = 0.003 ) between injured and control participants . A group , by day , planned comparison found that speed of information processing and composite balance measures demonstrated significant differences through day 10 postinjury , while symptoms and the vestibular ratio remained significant only through day 3 . Conclusions The concussion recovery curve demonstrated short-term neuropsychological and posturography deficits following injury . A comprehensive approach to concussion management should be used to assess the injury and make return-to-play decisions OBJECTIVE Our purpose was to determine whether sex differences exist with respect to post-concussion symptoms and neurocognitive function in concussed collegiate athletes . METHODS A prospect i ve dependent- sample cohort design was used to compare baseline and post-concussion neuropsychological test scores and endorsed symptoms as functions of serial post-concussion assessment with respect to time and sex . The Immediate Post-concussion Assessment and Cognitive Testing ( ImPACT ) battery was administered to a multicenter analysis group of 79 concussed athletes . This computerized neuropsychological test was given to the athletes during the preseason and , on average , 2 and 8 days postinjury . RESULTS Multivariate analyses revealed no significant between-group differences on baseline test performance with respect to sex on any of the ImPACT composite scores or on the total symptom score . Multivariate analyses of post-concussion data revealed a significant main effect of time on ImPACT scores , but no main effect of sex was identified , and no time-by-sex interaction existed . Post hoc analysis revealed that concussed female athletes performed significantly worse than concussed male athletes on visual memory tasks ( P = 0.001 ) , and analysis of endorsed post-concussion symptoms revealed that concussed men were significantly more likely than concussed women to report post-concussion symptoms of vomiting ( P = 0.001 ) and sadness ( P = 0.017 ) . Athletes ' scores were examined individually using the reliable-change methodology . At 2 days post-injury , 58 % of concussed athletes had one or more reliable incidents of performance decline or increases in symptom reporting . At 8 days post-concussion , 30 % of concussed athletes were still showing one or more reliable change from preseason values . CONCLUSIONS College athletes exhibit differences on visual memory composite scores and symptoms post-concussion as a function of sex . These data support the importance of evaluating neuropsychological status and post-concussion symptoms in concussed athletes . In addition , these data illustrate the importance of analyzing an individual athlete 's recovery pattern , because individual differences in recovery trajectories may be overshadowed by global norm-group comparisons OBJECTIVE The relationship between athlete reports of symptoms , neurophysiological activation , and neuropsychological functioning is investigated in a sample of high school athletes . METHODS All athletes were evaluated using functional magnetic resonance imaging ( fMRI ) , a computer-based battery of neurocognitive tests , and a subjective symptom scale . Athletes were evaluated within approximately 1 week of injury and again after clinical recovery using all assessment modalities . RESULTS This study found that abnormal fMRI results during the first week of recovery predicted clinical recovery . As a group , athletes who demonstrated hyperactivation on fMRI scans at the time of their first fMRI scan demonstrated a more prolonged clinical recovery than athletes who did not demonstrate hyperactivation at the time of their first fMRI scan . CONCLUSION These results demonstrate the relationship between neurophysiological , neuropsychological , and subjective symptom data in a relatively large sample composed primarily of concussed high school athletes .  fMRI represents an important evolving technology for the underst and ing of brain recovery after concussion and may help shape return-to-play guidelines in the future The purpose of this study was to examine the relation between the subjective report of feeling foggy at one-week post concussion and acute neuropsychological outcome . The outcome variables were derived from a computerized neuropsychological screening battery , Immediate Post-Concussion Assessment and Cognitive Testing ( ImPACT ) . Participants were 110 high school students who sustained a sports-related concussion and were evaluated 5 - 10 days post injury ( M = 6.8 days ) . Athletes were divided into two groups on the basis of self-reported fogginess . The first group reported no fogginess ( n = 91 ) , whereas the second group reported experiencing some degree of fogginess ( n = 19 ) on a 6-point scale . The athletes with persistent fogginess experienced a large number of other post-concussion symptoms , compared to the athletes with no reported fogginess . In addition , the athletes with persistent fogginess had significantly slower reaction times , reduced memory performance , and slower processing speed . Thus , athletes with any degree of self-reported fogginess at one-week post injury are likely to have adverse effects from their concussions in multiple domains OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Background Recent concussion management guidelines have suggested that athletes with mild ( grade 1 ) concussions may be returned to play if asymptomatic for 15 minutes . The purpose of this study was to assess the utility of a current concussion management guideline in classifying and managing mild concussion . Hypothesis High school athletes diagnosed with a grade 1 concussion will demonstrate measurable decline in neuropsychological functioning that persists during the 1st week of recovery . Study Design Prospect i ve study design ed to evaluate neuropsychological functioning both prior to and following concussion . Methods Forty-three high school athletes completed  neuropsychological test performance  and  symptom ratings  prior to the season and at two times during the 1st week following  mild concussion . Results Thirty-six hours after injury , mildly concussed high school athletes demonstrated a decline in memory ( P < 0.003 ) and a dramatic increase in self-reported symptoms ( P < 0.00001 ) compared to baseline performance . Conclusions Athletes with grade 1 concussion demonstrated memory deficits and symptoms that persisted beyond the context in which they were injured . These data suggest that current grade 1 return-to-play recommendations that allow for immediate return to play may be too liberal . Clinical Relevance A reconsideration of current concussion grading systems appears to be warranted Background : The relevance of headache to outcome after sports-related concussion is poorly understood . Hypotheses : High school athletes reporting headache approximately 1 week after injury will have significantly more other concussion symptoms and will perform more poorly on neuropsychological tests than athletes not experiencing headache . Study Design : Prospect i ve cohort study . Methods : Study participants included 109 high school athletes who had sustained concussion and who were divided into two groups : those reporting headache 7 days after injury and those reporting no headaches . The two groups were compared regarding on-field markers of concussion severity at the time of injury and symptoms and neurocognitive test results collected via ImPACT , a computerized neuropsychological test battery and postconcussion symptom scale , at a mean of 6.8 days after injury . Results : Athletes reporting posttraumatic headache demonstrated significantly worse performance on reaction time and memory ImPACT neurocognitive composite scores . These athletes also reported significantly more symptoms other than headache and were more likely to have demonstrated on-field antero grade amnesia . Conclusions : Findings suggest that any degree of postconcussion headache in high school athletes 7 days after injury is likely associated with an incomplete recovery after concussion Mild head injury has been recognized as producing numerous " postconcussive " symptoms that temporarily reduce an individual 's ability to function . Controversy exists over the short- and long-term effects of mild head injuries , and the effects of repeated concussive blows to the head have not been sufficiently studied . Amateur and professional athletes provide an excellent population for the examination of many aspects of postconcussive syndrome . The nature , incidence , and cognitive and emotional symptoms of mild head injury , are review ed within , the framework of professional and amateur sports . Particular attention is paid to the few available prospect i ve studies of amateur boxers and collegiate football players Objective : Following the Second International Conference on Concussion in Sport in 2005 , a summary agreement statement was published that introduced new terminology for sport-related concussions . This new classification system is binary ( ie , “ simple ” versus “ complex ” concussions ) . Athletes who are slow to recover ( ie , > 10 days ) are classified as having complex concussions . The purpose of this study was to determine if high school football players , retrospectively classified as having a simple or a complex concussion , could be differentiated in the first 48 after injury on the basis of symptom reporting or neuropsychological testing . Design : Case-control study . Setting : Pennsylvania high school football programs . Participants : The total sample consisted of 114 concussed high school football players who were identified through a 3 year prospect i ve cohort study . Interventions : All completed a computerized neuropsychological screening evaluation within 72 hours of injury . They were followed clinical ly until they recovered and were cleared to return to play . They were classified retrospectively as having a simple ( n = 55 ) or complex ( n = 59 ) concussion based on their recovery times . Main Outcome Measurements : Neurocognitive test performance and symptom ratings . Results : Within 72 hours after injury , athletes with complex concussions performed more poorly on neuropsychological testing and reported more symptoms than those with simple concussions . Athletes with complex concussions who were slow to recover were 18 times more likely to have 3 unusually low neuropsychological test scores than those with simple concussions ( 95 % CI = 2.3 - 144.9 ) . Athletes with previous concussions did not recover more slowly . Conclusions : This study provides evidence that supports and refutes the clinical usefulness of the new simple-complex concussion classification system CONTEXT Lack of empirical data on recovery time following sport-related concussion hampers clinical decision making about return to play after injury . OBJECTIVE To prospect ively measure immediate effects and natural recovery course relating to symptoms , cognitive functioning , and postural stability following sport-related concussion . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 1631 football players from 15 US colleges . All players underwent preseason baseline testing on concussion assessment measures in 1999 , 2000 , and 2001 . Ninety-four players with concussion ( based on American Academy of Neurology criteria ) and 56 noninjured controls underwent assessment of symptoms  , cognitive functioning  , and postural stability immediately , 3 hours , and 1 , 2 , 3 , 5 , 7 , and 90 days after injury . MAIN OUTCOME MEASURES Scores on the Grade d Symptom Checklist ( GSC ) , St and ardized Assessment of Concussion ( SAC ) , Balance Error Scoring System ( BESS ) , and a neuropsychological test battery . RESULTS No player with concussion was excluded from participation ; 79 players with concussion ( 84 % ) completed the protocol through day 90 . Players with concussion exhibited more severe symptoms ( mean GSC score 20.93 [ 95 % confidence interval [ CI ] , 15.65 - 26.21 ] points higher than that of controls ) , cognitive impairment ( mean SAC score 2.94 [ 95 % CI , 1.50 - 4.38 ] points lower than that of controls ) , and balance problems ( mean BESS score 5.81 [ 95 % CI , -0.67 to 12.30 ] points higher than that of controls ) immediately after concussion . On average , symptoms gradually resolved by day 7 ( GSC mean difference , 0.33 ; 95 % CI , -1.41 to 2.06 ) , cognitive functioning improved to baseline levels within 5 to 7 days ( day 7 SAC mean difference , -0.03 ; 95 % CI , -1.33 to 1.26 ) , and balance deficits dissipated within 3 to 5 days after injury ( day 5 BESS mean difference , -0.31 ; 95 % CI , -3.02 to 2.40 ) . Mild impairments in cognitive processing and verbal memory evident on neuropsychological testing 2 days after concussion resolved by day 7 . There were no significant differences in symptoms or functional impairments in the concussion and control groups 90 days after concussion . CONCLUSIONS Collegiate football players may require several days for recovery of symptoms , cognitive dysfunction , and postural instability after concussion . Further research is required to determine factors that predict variability in recovery time after concussion . St and ardized measurement of postconcussive symptoms , cognitive functioning , and postural stability may enhance clinical management of athletes recovering from concussion OBJECTIVE To determine the relationship between recorded head accelerations and impact locations and acute clinical outcome of symptomatology , neuropsychological , and postural stability tests after cerebral concussion in Division I collegiate football players . METHODS A prospect i ve field study was used in which accelerometers were embedded in the football helmets of 88 collegiate football players .  Linear and rotational accelerations of all head impacts sustained over the course of 2004 to 2006 National Collegiate Athletic Association football seasons were collected in real-time . Change scores were calculated on clinical measures from the players ' preseason baseline to postinjury ( within 48 h ) and regressed against the recorded linear and rotational accelerations of the head at the time of the concussion . RESULTS Thirteen concussions were recorded ranging in impact magnitudes of 60.51 to 168.71 g. Linear regression showed no significant relationships between impact magnitude ( linear or rotational acceleration ) or impact location and change scores for symptom severity , postural stability , or neurocognitive function ( P > 0.05 ) . CONCLUSION Our findings suggest that football players are concussed by impacts to the head that occur at a wide range of magnitudes and that clinical measures of acute symptom severity , postural stability , and neuropsychological function all appear to be largely independent of impact magnitude and location . Because of the varying magnitudes and locations of impacts result ing in concussion as well as other factors such as the frequency of subconcussive impacts and number of previous concussions , it may be difficult to establish a threshold for concussive injury that can be applied to all football players OBJECTIVE This study prospect ively examined neuropsychological functioning in 2300 collegiate football players from 10 National Collegiate Athletic Association Division A universities . The study was design ed to determine the presence and duration of neuropsychological symptoms after mild head injury . METHODS A nonequivalent repeated measures control group design was used to compare the neuropsychological test scores and symptoms of injured players ( n = 183 ) with those of gender , age , and education matched controls . A number of neuropsychological tests , including the Paced Auditory Serial Addition Test , the Digit Symbol Test , and the Trail Making Test , as well as a symptom checklist  were used . TECHNIQUE Players and controls were assessed before engaging in game activity and 24 hours , 5 days , and 10 days after injury , using the st and ardized test battery and symptom checklist . RESULTS Players with head injuries displayed impaired performance and increased symptoms in comparison to controls , but this impairment resolved within 5 days in most players . Players with head injuries showed significant improvement between 24 hours and 5 days , as well as between 5 and 10 days . CONCLUSION Although single , uncomplicated mild head injuries do cause limited neuropsychological impairment , injured players generally experience rapid resolution of symptoms with minimal prolonged sequelae Objective To determine the repeatability of a computerized cognitive test design ed to monitor recovery from concussion and assist team physicians make return to play decisions ( CogSport ™ ) . To determine the correlation between CogSport and two conventional neuropsychological tests . Design Prospect i ve , serial investigation of cognitive function . Setting Professional and semi-professional Australian Football clubs and a university affiliated research institute in Melbourne , Australia . Participants Three-hundred healthy young adults , including 240 elite athletes . Main Outcome Measures Intra-class correlation ( ICC ) coefficients for CogSport performance measures administered serially . ICC between CogSport performance measures and conventional neuropsychological tests . Normative data for CogSport performance measures . Results Measures of psychomotor function , decision making , working memory and learning were highly reliable . Some measures also displayed high correlations with conventional neuropsychological tests of information processing and attention . Preliminary normative data is described . Conclusions CogSport is a highly reliable cognitive function test when administered to healthy young adults and elite athletes . CogSport measures similar cognitive functions as conventional tests used commonly in concussion research The purpose of this study was to investigate the sensitivity of  orientation and recent memory questions  in the diagnosis of concussion . In a prospect i ve study over 7 consecutive years ( 1985 - 1991 ) , all players at a professional Australian Rules Football club who sustained a concussive injury ( n = 28 ) were administered a set of questions evaluating orientation and recent memory .  Concussion was diagnosed independently on the basis of loss or disturbance of consciousness and clinical symptoms . A control group of age-matched nonconcussed players was administered the same set of questions . The results showed that items evaluating recently acquired information were more sensitive in the assessment of concussion than st and ard orientation items . The relative sensitivity of orientation questions must be considered when they are used in the clinical diagnosis of concussion in sport Objective To identify an objective evaluation technique to guide return-to-play decisions following mild brain injury ( MBI ) using an agility task that incorporates cognitive and motor performance . Design Prospect i ve , controlled , repeated measures study . Setting Collegiate athletic training facility . Participants 84 athletes ( 25 male rugby players , 34 female rugby players , 25 male ice hockey players ) from 3 intercollegiate club teams participated . 9 athletes who suffered MBI during their competitive seasons and 9 matched controls completed the entire study protocol . Main Outcome Measures Time to complete an agility task on the Cybex Reactor and a postconcussive symptoms scale score were assessed in all subjects during the preseason . Injured subjects and matched controls were also assessed 1 , 3 , 5 , and 10 days postinjury . Results Repeated measures analyses of variance revealed significant differences between injured subjects and controls in postconcussion symptoms , but not agility performance . Post hoc testing revealed that injured subjects reported significantly more postconcussion symptoms on Day 1 after injury . Conclusion The methods of agility assessment used in this study appear to not be sensitive enough to detect functional impairment following MBI
target: Six core scales were identified with a broad range of symptom items but with limited information on their psychometric properties .
background: OBJECTIVE To identify  self-reported sport concussion symptom scales  and to describe the psychometric properties of these identified scales .