Melvin Field

Recovery from mild concussion in high school athletes

OBJECT A computerized neuropsychological test battery was conducted to evaluate memory dysfunction and self-reporting of symptoms in a group of high school athletes who had suffered concussion. METHODS Neuropsychological performance prior to and following concussion was compared with the test performance of an age-matched control group. Potentially important diagnostic markers of concussion severity are discussed and linked to recovery within the 1st week of injury. CONCLUSIONS High school athletes who had suffered mild concussion demonstrated significant declines in memory processes relative to a noninjured control group. Statistically significant differences between preseason and postinjury memory test results were still evident in the concussion group at 4 and 7 days postinjury. Self-reported neurological symptoms such as headache, dizziness, and nausea resolved by Day 4. Duration of on-field mental status changes such as retrograde amnesia and posttraumatic confusion was related to the presence of memory impairment at 36 hours and 4 and 7 days postinjury and was also related to slower resolution of self-reported symptoms. The results of this study suggest that caution should be exercised in returning high school athletes to the playing field following concussion. On-field mental status changes appear to have prognostic utility and should be taken into account when making return-to-play decisions following concussion. Athletes who exhibit on-field mental status changes for more than 5 minutes have longer-lasting postconcussion symptoms and memory decline.

Cumulative effects of concussion in high school athletes.

OBJECTIVE A common assumption in sports medicine is that a history of concussion is predictive of a lower threshold for, as well as a worse outcome after, subsequent concussive injury. The current study was conducted to investigate the relationship between concussion history in high school athletes and the on-field presentation of symptoms after subsequent concussion. METHODS One hundred seventy-three athletes who experienced sports-related concussion composed the initial study group. Binary groups were subsequently created on the basis of concussion history. Sixty athletes with no concussion history were compared with 28 athletes with a history of three or more concussions. The groups were compared in terms of the on-field presentation of symptoms after an in-study concussion. Dependent variables included the postinjury presence of loss of consciousness, anterograde amnesia, retrograde amnesia, and confusion. RESULTS Athletes with three or more prior concussions were more likely to experience on-field positive loss of consciousness (&khgr;2 = 8.0, P = 0.005), anterograde amnesia (&khgr;2 = 5.5, P = 0.019), and confusion (&khgr;2 = 5.1, P = 0.024) after a subsequent cerebral concussion. An odds ratio revealed that athletes with a history of three concussions were 9.3 times more likely than athletes with no history of concussion to demonstrate three to four abnormal on-field markers of concussion severity. CONCLUSION This study is the first to suggest a cumulative effect of concussion in high school athletes. A more severe on-field presentation of concussion markers is evidenced in high school athletes with a pronounced history of concussion. This study’s findings highlight the need for more long-term outcome studies in high school athletes who sustain sports-related concussions.

Relationship Between Postconcussion Headache and Neuropsychological Test Performance in High School Athletes

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: Prospective 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 anterograde 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.

Return to golf after spine surgery.

OBJECT no published evidence indicates when patients can resume golfing after spine surgery. The objective of this study is to provide data from surveys sent to spine surgeons. METHODS a survey of North American Spine Society members was undertaken querying the suggested timing of return to golf. Of 1000 spine surgeons surveyed, 523 responded (52.3%). The timing of recommended return to golf and the reasons were questioned for college/professional athletes and avid and recreational golfers of both sexes. Responses were tallied for lumbar laminectomy, lumbar microdiscectomy, lumbar fusion, and anterior cervical discectomy with fusion. RESULTS the most common recommended time for return to golf was 4-8 weeks after lumbar laminectomy and lumbar microdiscectomy, 2-3 months after anterior cervical fusion, and 6 months after lumbar fusion. The results showed a statistically significant increase in the recommended time to resume golf after lumbar fusion than after cervical fusion in all patients (p < 0.01). The same holds true for the return to play after cervical fusion compared with either lumbar laminectomy or lumbar microdiscectomy for all golfer types (p < 0.01). There was a statistically significant shorter recommended time for professional and college golfers compared with noncompetitive golfers after lumbar fusion (p < 0.01), anterior cervical discectomy and fusion (p < 0.01), and lumbar microdiscectomy (p < 0.01). CONCLUSIONS the return to golf after spine surgery depends on many variables, including the general well-being of patients in terms of pain control and comfort when golfing. This survey serves as a guide that can assist medical practitioners in telling patients the average times recommended by surgeons across North America regarding return to golf after spine surgery.