Rosemarie Scolaro Moser

Prolonged effects of concussion in high school athletes.

OBJECTIVE:To identify enduring prolonged neuropsychological effects of cerebral concussion in high school youth athletes. METHODS:High school athletes (n = 223) underwent baseline neuropsychological evaluation between 1999 and 2000, assigned to independent groups on the basis of concussion history: athletes with no concussion history or present medical and/or neuropsychological complaints (n = 82), symptom-free athletes who experienced one (n = 56) or two or more (n = 45) concussions (not in the prior 6 mo), and those who experienced a concussion 1 week before testing (n = 40). Main outcome measures included a structured clinical interview, demographic form, symptom checklist, the Repeatable Battery for the Assessment of Neuropsychological Status, and the Trail Making Tests A and B. Analyses of variance were used to determine between-group differences. RESULTS:Athletes with recent concussions performed significantly worse on measures of attention and concentration than youth athletes with no concussion history. Symptom-free athletes with a history of two or more concussions performed similar on testing to youth athletes who had just experienced a recent concussion. Similarly, cumulative academic grade point averages were significantly lower not only for youth athletes with two or more previous concussion groups, but for youth athletes who experienced recent concussions, suggesting that athletes with lower grade point averages may be more prone to concussion. CONCLUSION:There seem to be subtle yet significant prolonged neuropsychological effects in youth athletes with a history of two or more previous concussions.

Efficacy of Immediate and Delayed Cognitive and Physical Rest for Treatment of Sports-Related Concussion

OBJECTIVES To evaluate the efficacy of cognitive and physical rest for the treatment of concussion. STUDY DESIGN High school and collegiate athletes (N = 49) underwent post-concussion evaluations between April 2010 and September 2011 and were prescribed at least 1 week of cognitive and physical rest. Participants were assigned to groups on the basis of the time elapsed between sustaining a concussion and the onset of rest (1-7 days, 8-30 days, 31+ days). Main outcome measures included Concussion Symptom Scale ratings and scores on the 4 composite indices of the Immediate Post-Concussion Assessment and Cognitive Testing measure, both before and following rest. Mixed-factorial design ANOVA were used to compare changes on the dependent measures within and between groups. RESULTS Participants showed significantly improved performance on Immediate Post-Concussion Assessment and Cognitive Testing and decreased symptom reporting following prescribed cognitive and physical rest (P < .001), regardless of the time between concussion and onset of rest (P = .44). CONCLUSION These preliminary data suggest that a period of cognitive and physical rest may be a useful means of treating concussion-related symptoms, whether applied soon after a concussion or weeks to months later.

Enduring effects of concussion in youth athletes

The purpose of this study was to explore the mild, enduring effects of concussion in otherwise healthy youth athletes. Reported history of concussion and cognitive functioning was examined in an initial sample of 35 youth athletes, 21 of whom were considered healthy volunteers (No Recent Concussion within the past 6 months) with no identified medical or neuropsychological difficulties related to concussion. The remaining 14 volunteers had each sustained a concussion within 1 week of testing (Recent Concussion). Significant differences in performances on a general cognitive measure, and specifically in the area of attention, were found as a function of number of concussions reported by the No Recent Concussion athletes. Furthermore, on some of the measures, No Recent Concussion athletes with a history of two or more concussions appeared to resemble Recent Concussion athletes more so than No Recent Concussion athletes with a history of one or no concussion. The importance of assessment of youth concussion and the use of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for this purpose are discussed.

Group versus individual administration affects baseline neurocognitive test performance.

Background: Computer-based tests are widely used for the purpose of documenting baseline neurocognitive function, and athletes are often tested in groups. At present, there is limited research on the effects of administering these tests in a group versus individual setting. Hypothesis: Athletes assessed with neurocognitive tests in groups would show decreased performance compared with those assessed individually. Study Design: Cohort study; Level of evidence, 3. Methods: High school athletes completed preseason baseline neurocognitive tests either in groups in their school or individually in a private neuropsychological clinic (with no significant between-group differences in sex, history of concussion, and attention deficit disorder/learning disability). All athletes completed the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) test battery on 1 occasion, which yielded scores in the area of verbal memory, visual memory, motor processing speed, reaction time, and symptom scores. Results: Athletes in the group setting scored significantly lower on verbal memory (mean 83.4 vs 86.5; P = .003), visual memory (mean 71.6 vs 76.7; P = .0001), motor processing speed (mean 35.6 vs 38.4; P = .0001), and reaction time (mean 0.61 vs 0.57; P = .001), but not symptom scores (mean 6.1 vs 4.4; P = .11), and exhibited a greater rate of invalid baselines. Similar results were obtained after excluding athletes with attention deficit disorder/learning disability and/or a history of concussion. Conclusion: Administering baseline neurocognitive testing to athletes in a group setting may introduce extraneous error, negatively affecting test performance.

Prevalence of Invalid Computerized Baseline Neurocognitive Test Results in High School and Collegiate Athletes

CONTEXT Limited data are available regarding the prevalence and nature of invalid computerized baseline neurocognitive test data. OBJECTIVE To identify the prevalence of invalid baselines on the desktop and online versions of ImPACT and to document the utility of correcting for left-right (L-R) confusion on the desktop version of ImPACT. DESIGN Cross-sectional study of independent samples of high school (HS) and collegiate athletes who completed the desktop or online versions of ImPACT. Participants or Other Participants: A total of 3769 HS (desktop = 1617, online = 2152) and 2130 collegiate (desktop = 742, online = 1388) athletes completed preseason baseline assessments. MAIN OUTCOME MEASURE(S) Prevalence of = ImPACT validity indicators, with correction for L-R confusion (reversing left and right mouse-click responses) on the desktop version, by test version and group. Chi-square analyses were conducted for sex and attentional or learning disorders. RESULTS At least 1 invalid indicator was present on 11.9% (desktop) versus 6.3% (online) of the HS baselines and 10.2% (desktop) versus 4.1% (online) of collegiate baselines; correcting for L-R confusion (desktop) decreased this overall prevalence to 8.4% (HS) and 7.5% (collegiate). Online Impulse Control scores alone yielded 0.4% (HS) and 0.9% (collegiate) invalid baselines, compared with 9.0% (HS) and 5.4% (collegiate) on the desktop version; correcting for L-R confusion (desktop) decreased the prevalence of invalid Impulse Control scores to 5.4% (HS) and 2.6% (collegiate). Male athletes and HS athletes with attention deficit or learning disorders who took the online version were more likely to have at least 1 invalid indicator. Utility of additional invalidity indicators is reported. CONCLUSIONS The online ImPACT version appeared to yield fewer invalid baseline results than did the desktop version. Identification of L-R confusion reduces the prevalence of invalid baselines (desktop only) and the potency of Impulse Control as a validity indicator. We advise test administrators to be vigilant in identifying invalid baseline results as part of routine concussion management and prevention programs.

Current Issues in Pediatric Sports Concussion

This article reviews current issues in the following areas of pediatric sports-related concussion: incidence of concussion, potential long-term effects, return to play, and the emergence of legislation regarding concussion education and management programs. Incidence of concussion is presented in context of emergency room visits, as well as under-reporting of concussions. The literature on history of concussion is reviewed, for high school, collegiate, and professional athletes, with respect to potential long-term effects of cerebral concussion. Specific discussions of effects include: decreased cognition and increased symptom reporting following multiple concussions, and recent diagnoses of chronic traumatic encephalopathy in non-professional and youth athletes. Recent legislative and advocacy efforts are reviewed, including mandated programs in specific states.

What is the difference in concussion management in children as compared with adults? A systematic review

Aim To evaluate the evidence regarding the management of sport-related concussion (SRC) in children and adolescents. The eight subquestions included the effects of age on symptoms and outcome, normal and prolonged duration, the role of computerised neuropsychological tests (CNTs), the role of rest, and strategies for return to school and return to sport (RTSp). Design Systematic review. Data sources MEDLINE (OVID), Embase (OVID) and PsycInfo (OVID). Eligibility criteria for selecting studies Studies were included if they were original research on SRC in children aged 5 years to 18 years, and excluded if they were review articles, or did not focus on childhood SRC. Results A total of 5853 articles were identified, and 134 articles met the inclusion criteria. Some articles were common to multiple subquestions. Very few studies examined SRC in young children, aged 5–12 years. Summary/conclusions This systematic review recommends that in children: child and adolescent age-specific paradigms should be applied; child-validated symptom rating scales should be used; the widespread routine use of baseline CNT is not recommended; the expected duration of symptoms associated with SRC is less than 4 weeks; prolonged recovery be defined as symptomatic for greater than 4 weeks; a brief period of cognitive and physical rest should be followed with gradual symptom-limited physical and cognitive activity; all schools be encouraged to have a concussion policy and should offer appropriate academic accommodations and support to students recovering from SRC; and children and adolescents should not RTSp until they have successfully returned to school, however early introduction of symptom-limited physical activity is appropriate. Systematic review registration PROSPERO 2016:CRD42016039184

Age and Test Setting Affect the Prevalence of Invalid Baseline Scores on Neurocognitive Tests

Background: Prevalence rates of invalid baseline scores on computerized neurocognitive assessments for high school, collegiate, and professional athletes have been published in the literature. At present, there is limited research on the prevalence of invalid baseline scores in pre–high school athletes. Hypothesis: Pre–high school athletes assessed with baseline neurocognitive tests would show higher prevalence rates of invalidity than older youth athletes, and those athletes, regardless of age, who were tested in a large group setting would show a higher prevalence rate of invalidity than athletes tested in a small group setting. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 502 athletes between the ages of 10 and 18 years completed preseason baseline neurocognitive tests in “large” or “small” groups. All athletes completed the online version of ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). Baseline test results that were “flagged” by the computer software as being of suspect validity and labeled with a “++” symbol were identified for analysis. Participants were retrospectively assigned to 2 independent groups: large group or small group. Test administration of the large group occurred off-site in groups of approximately 10 athletes, and test administration of the small group took place at a private-practice neuropsychology center with only 1 to 3 athletes present. Results: Chi-square analyses identified a significantly greater proportion of participants obtaining invalid baseline results on the basis of age; younger athletes produced significantly more invalid baseline scores (7.0%, 17/244) than older athletes (2.7%, 7/258) (χ2 (1) = 4.99; P = .021). Log-linear analysis revealed a significant age (10-12 years, 13-18 years) × size (small, large) interaction effect (χ2 (4) = 66.1; P < .001) on the prevalence of invalidity, whereby younger athletes tested in larger groups were significantly more likely to provide invalid results (11.9%) than younger athletes tested in smaller groups (5.4%), older athletes tested in larger groups (2.7%), and older athletes tested in smaller groups (2.7%). Conclusion: Younger athletes tend to exhibit a greater prevalence of invalid baseline results on neurocognitive computerized tests than older youth athletes; the prevalence increases when testing is conducted in a large group and nonclinical setting.

Alzheimer's Disease Clinical and Research Update for Health Care Practitioners

Of the approximately 6.8 million Americans who have been diagnosed with dementia, over 5 million have been diagnosed with Alzheimers Disease (AD). Due to the rise in the aging population, these figures are expected to double by 2050. The following paper provides an up-to-date review of clinical issues and relevant research. Research related to the methods of the earliest possible detection of AD is ongoing. Health care professionals should play a critical role in differentially diagnosing AD patients, as well as supporting their families. Novel interventions, including medications, natural supplements, and behavioral techniques, are constantly appearing in the literature. It is necessary for the health practitioner to remain current, regarding AD, as such information will facilitate better care for patients and their families.

Examining prescribed rest as treatment for adolescents who are slow to recover from concussion

Abstract Objective: Rest is a widely recommended treatment for concussion, but its utility is unclear following the acute stage of recovery. This study examined the effects of 1-week of prescribed rest in concussed adolescent athletes. Method: Participants were 13 adolescent athletes with persistent symptoms following a concussion. More than three-quarters (77%) had self-reported ADHD, learning disability or two prior concussions. All completed ImPACT® at another facility, but none completed a period of comprehensive rest prior to examination at a specialty practice. Three time points of test data were compared, to control for possible spontaneous recovery: Test 1 (external facility), Test 2 (before prescribed rest) and Test 3 (following prescribed rest). Results: Repeated measures ANOVAs revealed a significant effect of prescribed rest on all ImPACT® composite scores and the total symptom score. Post-hoc analyses revealed no significant differences between Time 1 and Time 2, whereas significant differences were present after prescribed rest. Following prescribed rest, having two or more reliably improved cognitive test scores or having improved symptoms was present in eight of the 13 patients (61.5%). Conclusions: A substantial percentage of adolescents with persistent symptoms following concussion showed improvement in symptoms and cognitive functioning following education, reassurance and 1-week of prescribed rest.