Assessment and Management of Concussion: A Neuropsychological Perspective

Abstract

The concussion in athletics is the most puzzling neurological and functional abnormality facing sport medicine today. Neuropsychology has focused on the assessment and management of Mild Traumatic Brain Injury (MTBI) for many years but only recently have neuropsychological measures and techniques been used with sports-related concussion. The nature of the pathology underlying MTBI makes it difficult to visualize the injury using modern neuroimaging techniques. In contrast, functional techniques like those used in neuropsychological assessment provide sensitive, validated and cost-effective approaches to assessing sports concussions. A rich literature has now developed that demonstrates the effectiveness of both traditional and computerized neuropsychological batteries. Data have revealed that these techniques can reliably distinguish between athletes with concussion and those without concussion within 2 hours of injury. These studies have also shown that recovery following concussion is dynamic with neurocognitive symptom patterns changing over time. Children appear to be more vulnerable to concussion than adults and have more protracted symptoms than adults. Although very useful, neuropsychological techniques provide only one component in the complex interplay of variables that comprise the return to play decision. Much attention has been paid to the diagnosis of sports-related concussion but little has been paid to the rehabilitation of these injuries. Although the vast majority of players with concussions achieve symptom resolution and neurocognitive baseline status within 7–10 days of injury, some do not. Rehabilitation efforts are discussed. It was noted that those approaches aimed at education and amelioration of the psychological factors associated with concussion have proven to be the most useful.