Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-23T15:47:02.464Z Has data issue: false hasContentIssue false

19 - Contribution of Objective Tests to the Diagnosis of Sport-Related Concussion

from Part III - Diagnosis and Management of Concussion

Published online by Cambridge University Press:  22 February 2019

By
Elizabeth Teel  and
Kevin Guskiewicz
Edited by
Jeff Victoroff  and
Erin D. Bigler
Jeff Victoroff
Affiliation:
University of Southern California, Torrance
Erin D. Bigler
Affiliation:
Brigham Young University, Utah
Get access

Summary

Kevin Guskiewicz, currently Dean of the College of Arts & Sciences at the University of North Dakota at Chapel Hill, will be remembered as one of the principal architects of the 21st-century revolution in concussion science. An authority in sports medicine, in 2003 he and his colleagues published the seminal National Collegiate Athletic Association (NCAA) Concussion Study -- the most compelling demonstration to that date that repetition of typical sport-related CBIs dramatically increases the risk of lasting neurological dysfunction. In the present chapter, Drs. Guskiewicz and Teel narrow their focus to a practical matter: what might responsible adults do, whether at the scene of a sport-related CBI or thereafter, to estimate the gravity of the brain injury? Their review spans the spectrum from checklists to virtual reality-based testing. Since almost no young athletes, especially in developing nations, will ever undergo sophisticated biomarker surveillance, these more portable and less elaborate approaches will probably play an incomparably greater role than chemistry or imaging in the global effort to mitigate the risk of permanent brain damage from sports.
Type
Chapter
Information
Concussion and Traumatic Encephalopathy
Causes, Diagnosis and Management
 , pp. 672 - 682
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Guskiewicz, KM, McCrea, M, Marshall, SW, et al. Cumulative effects associated with recurrent concussion in collegiate football players: The NCAA Concussion Study. JAMA 2003;290(19):2549–2555.CrossRefGoogle Scholar
Delaney, JS, Lacroix, VJ, Leclerc, S, Johnston, KM. Concussions among university football and soccer players. Clin J Sport Med 2002;12(6):331–338.Google Scholar
Patel, AV, Mihalik, JP, Notebaert, AJ, Guskiewicz, KM, Prentice, WE. Neuropsychological performance, postural stability, and symptoms after dehydration. J Athl Train 2007;42(1):66.Google Scholar
McCrory, P, Meeuwisse, WH, Aubry, M, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. J Am Coll Surg 2013;216(5):11.CrossRefGoogle ScholarPubMed
McCrea, M, Guskiewicz, KM, Marshall, SW, et al. Acute effects and recovery time following concussion in collegiate football players: The NCAA Concussion Study. JAMA 2003;290(19):2556–2563.Google Scholar
McCrea, M, Barr, WB, Guskiewicz, K, et al. Standard regression-based methods for measuring recovery after sport-related concussion. J Int Neuropsychol Soc 2005;11(01):58–69.Google Scholar
Piland, SG, Motl, RW, Ferrara, MS, Peterson, CL. Evidence for the factorial and construct validity of a self-report concussion symptoms scale. J Athl Train 2003;38(2):104.Google Scholar
Collins, MW, Iverson, GL, Lovell, MR, McKeag, DB, Norwig, J, Maroon, J. On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Clin J Sport Med 2003;13(4):222–229.Google Scholar
Lovell, MR, Collins, MW, Iverson, GL, et al. Recovery from mild concussion in high school athletes. J Neurosurg 2003;98(2):296–301.CrossRefGoogle ScholarPubMed
Giza, CC, Kutcher, JS, Ashwal, S, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports. Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013; 80(24):2250–2257.Google Scholar
Mansell, JL, Tierney, RT, Higgins, M, McDevitt, J, Toone, N, Glutting, J. Concussive signs and symptoms following head impacts in collegiate athletes. Brain Inj 2010;24(9):1070–1074.Google Scholar
Van Kampen, DA, Lovell, MR, Pardini, JE, Collins, MW, Fu, FH. The “value added” of neurocognitive testing after sports-related concussion. Am J Sports Med 2006;34(10):1630–1635.Google Scholar
McCrea, M. Standardized mental status testing on the sideline after sport-related concussion. J Athl Train 2001;36(3):274–279.Google ScholarPubMed
McCrea, M, Kelly, JP, Randolph, C, et al. Standardized assessment of concussion (SAC): On-site mental status evaluation of the athlete. J Head Trauma Rehabil 1998;13(2):27–35.Google Scholar
Barr, WB, McCrea, M. Sensitivity and specificity of standardized neurocognitive testing immediately following sports concussion. J Int Neuropsychol Soc 2001;7(6):693–702.Google Scholar
French, L, McCrea, M, Baggett, M. The Military Acute Concussion Evaluation (MACE). J Special Ops Med 2008;8(1):68–77.Google Scholar
McCrea, M, Jaffee, M, Helmick, K, Guskiewicz, K, Doncevic, S. Validation of the Military Acute Concussion Evaluation (MACE) for in-theater evaluation of combat-related traumatic brain injury. DTIC document; 2009. Defense Technical Information Center document. Available at www.dtic.mil/dtic/tr/fulltext/u2/a515492.pdf.Google Scholar
Coldren, RL, Kelly, MP, Parish, RV, Dretsch, M, Russell, ML. Evaluation of the Military Acute Concussion Evaluation for use in combat operations more than 12 hours after injury. Milit Med 2010;175(7):477–481.Google Scholar
Riemann, BL, Guskiewicz, KM, Shields, EW. Relationship between clinical and forceplate measures of postural stability. J Sport Rehabil 1999;8:71–82.Google Scholar
Balance Error Scoring System (BESS) manual. Developed by researchers and clinicians at the University of North Carolina’s Sports Medicine Research Laboratory. Available at www.carolinashealthcare.org/documents/carolinasrehab/bess_manual_.pdf.Google Scholar
Riemann, BL, Guskiewicz, KM. Effects of mild head injury on postural stability as measured through clinical balance testing. J Athl Train 2000;35(1):19–25.Google Scholar
McCrea, M, Guskiewicz, K, Randolph, C, et al. Incidence, clinical course, and predictors of prolonged recovery time following sport-related concussion in high school and college athletes. J Int Neuropsychol Soc 2013;19(1):22–33.CrossRefGoogle ScholarPubMed
Guskiewicz, KM. Postural stability assessment following concussion: One piece of the puzzle. Clin J Sport Med 2001;11(3): 182–189.CrossRefGoogle ScholarPubMed
Valovich McLeod, TC, Perrin, DH, Guskiewicz, KM, Shultz, SJ, Diamond, R, Gansneder, BM. Serial administration of clinical concussion assessments and learning effects in healthy young athletes. Clin J Sport Med 2004;14(5):287–295.CrossRefGoogle ScholarPubMed
Susco, TM, McLeod, TCV, Gansneder, BM, Shultz, SJ. Balance recovers within 20 minutes after exertion as measured by the Balance Error Scoring System. J Athl Train 2004;39(3):241.Google ScholarPubMed
Fox, ZG, Mihalik, JP, Blackburn, JT, Battaglini, CL, Guskiewicz, KM. Return of postural control to baseline after anaerobic and aerobic exercise protocols. J Athl Train 2008;43(5):456–463.Google Scholar
Sport Concussion Assessment Tool, 3rd edition. Available at: http://bjsm.bmj.com/content/47/5/259.full.pdf.Google Scholar
Guskiewicz, KM, Register-Mihalik, J, McCrory, P, et al. Evidence-based approach to revising the SCAT2: Introducing the SCAT3. Br J Sports Med 2013;47(5):289–293.Google Scholar
Putukian, M, Echemendia, R, Dettwiler-Danspeckgruber, A, Duliba T, Bruce J, Furtado JL, et al. Prospective clinical assessment using Sideline Concussion Assessment Tool-2 testing in the evaluation of sport-related concussion in college athletes. Clin J Sport Med 2015;25:36–42.CrossRefGoogle ScholarPubMed
Iverson, GL, Lovell, MR, Collins, MW. Interpreting change on ImPACT following sport concussion. Clin Neuropsychol 2003;17(4):460–467.Google Scholar
Schatz, P, Pardini, JE, Lovell, MR, Collins, MW, Podell, K. Sensitivity and specificity of the ImPACT test battery for concussion in athletes. Arch Clin Neuropsychol 2006;21:91–99.Google Scholar
Gualtieri, CT, Johnson, LG, Reliability and validity of a computerized neurocognitive test battery, CNS Vital Signs. Arch Clin Neuropsychol 2006;21:623–643.Google Scholar
Levinson, D, Reeves, D. Monitoring recovery from traumatic brain injury using Automated Neuropsychological Assessment Metrics (ANAM V1.0). Arch Clin Neuropsychol 1997;12(2):155–166.CrossRefGoogle ScholarPubMed
Erlanger, D, Saliba, E, Barth, J, Almquist, J. Monitoring resolution of postconcussion symptoms in athletes: Preliminary results of a web-based neuropsychological test protocol. J Athl Train 2001;36:280–287.Google ScholarPubMed
Louey, AG, Cromer, JA, Schembri, A., Darby, DG, Maruff, P, Makdissi, M, McCrory, P. Detecting cognitive impairment after concussion: Sensitivity of change from baseline and normative data methods using the CogSport/Axon cognitive test battery. Arch Clin Neuropsychol 2014;29(5):432–441.Google Scholar
Erlanger, D, Feldman, D, Kutner, K, et al. Development and validation of a web-based neuropsychological test protocol for sports-related return-to-play decision-making. Arch Clin Neuropsychol 2003;18(3):293–316.Google Scholar
Erlanger, D, Kaushik, T, Cantu, R, et al. Symptom-based assessment of the severity of a concussion. J Neurosurg 2003;98(3):477–484.Google Scholar
Collie, A, Makdissi, M, Maruff, P, Bennell, K, McCrory, P. Cognition in the days following concussion: Comparison of symptomatic versus asymptomatic athletes. J Neurol Neurosurg Psychiatry 2006;77(2):241–245.Google Scholar
Broglio, SP, Macciocchi, SN, Ferrara, MS. Sensitivity of the concussion assessment battery. Neurosurgery 2007;60(6):1050–1057.Google Scholar
McClincy, MP, Lovell, MR, Pardini, J, Collins, MW, Spore, MK. Recovery from sports concussion in high school and collegiate athletes. Brain Inj 2006;20(1):33–39.Google Scholar
Macciocchi, SN, Barth, JT, Alves, W, Rimel, RW, Jane, JA. Neuropsychological functioning and recovery after mild head injury in collegiate athletes. Neurosurg 1996;39(3):510–514.Google Scholar
Randolph, C, McCrea, M, Barr, WB. Is neuropsychological testing useful in the management of sport-related concussion? J Athl Train 2005;40(3):139–152.Google ScholarPubMed
Collins, MW, Grindel, SH, Lovell, MR, et al. Relationship between concussion and neuropsychological performance in college football players. JAMA 1999;282(10):964–970.Google Scholar
Broglio, SP, Ferrara, MS, Sopiarz, K, Kelly, MS. Reliable change of the sensory organization test. Clin J Sport Med 2008;18(2):148–154.Google Scholar
Peterson, CL, Ferrara, MS, Mrazik, M, Piland, S, Elliott, R. Evaluation of neuropsychological domain scores and postural stability following cerebral concussion in sports. Clin J Sport Med 2003;13(4):230–237.Google Scholar
Slobounov, S, Slobounov, E, Newell, K. Application of virtual reality graphics in assessment of concussion. Cyberpsychol Behav 2006;9(2):188–191.Google Scholar
Slobounov, S, Tutwiler, R, Sebastianelli, W, Slobounov, E. Alteration of postural responses to visual field motion in mild traumatic brain injury. Neurosurg 2006;59(1):134–139.Google Scholar
Teel, EF, Ray, WJ, Geronimo, AM, Slobounov, SM. Residual alterations of brain electrical activity in clinically asymptomatic concussed individuals: An EEG study. Clin Neurophysiol 2014;125(4):703–707.CrossRefGoogle ScholarPubMed
Slobounov, S, Wu, T, Hallett, M, Shibasaki, H, Slobounov, E, Newell, K. Neural underpinning of postural responses to visual field motion. Biol Psychol 2006;72(2):188–197.Google Scholar
Slobounov, SM, Zhang, K, Pennell, D, Ray, W, Johnson, B, Sebastianelli, W. Functional abnormalities in normally appearing athletes following mild traumatic brain injury: A functional MRI study. Exp Brain Res 2010;202(2):341–354.CrossRefGoogle ScholarPubMed
Jaiswal, N, Ray, W, Slobounov, S. Encoding of visual-spatial information in working memory requires more cerebral efforts than retrieval: Evidence from an EEG and virtual reality study. Brain Res 2010;6:80–89.Google Scholar
Rose, FD, Brooks, BM, Rizzo, AA. Virtual reality in brain damage rehabilitation: Review. CyberPsychol Behav 2005;8(3):241–262.Google Scholar
Parker, TM, Osternig, LR, Lee, H-J, Donkelaar, Pv, Chou, L-S. The effect of divided attention on gait stability following concussion. Clin Biomech 2005;20(4):389–395.Google Scholar
Catena, RD, van Donkelaar, P, Chou, L-S. Cognitive task effects on gait stability following concussion. Exp Brain Res 2007; 176(1):23–31.Google Scholar
Parker, TM, Osternig, LR, van Donkelaar, P, Chou, L-S. Balance control during gait in athletes and non-athletes following concussion. Med Engineer Physics 2008;30(8):959–967.CrossRefGoogle ScholarPubMed
Parker, TM, Osternig, LR, P VAND, Chou, LS. Gait stability following concussion. Med Sci Sports Exerc 2006;38(6):1032–1040.Google Scholar
Guskiewicz, K, Bruce, S, Cantu, R, Ferrara MS, Kelly JP, McCrea M, et al. Research based recommendations on management of sport related concussion: Summary of the National Athletic Trainers’ Association position statement. Br J Sports Med 2006;40(1):6–10.Google Scholar
Gaetz, M, Bernstein, DM. The current status of electrophysiologic procedures for the assessment of mild traumatic brain injury. J Head Trauma Rehabil 2001;16(4):386–405.Google Scholar
Leon-Carrion, J, Martin-Rodriguez, JF, Damas-Lopez, J, Martin, JMB, Dominguez-Morales, MDR. A QEEG index of level of functional dependence for people sustaining acquired brain injury: The Seville Independence Index (SINDI). Brain Inj 2008;22(1):61–74.Google Scholar
Arciniegas, DB. Clinical electrophysiologic assessments and mild traumatic brain injury: State-of-the-science and implications for clinical practice. Int J Psychophysiol 2011;82(1):41–52.Google Scholar
Thatcher, RW, Walker, R, Gerson, I, Geisler, F. EEG discriminant analyses of mild head trauma. Electroencephalogr Clin Neurophysiol 1989;73(2):94–106.Google Scholar
Duncan, CC, Barry, RJ, Connolly, JF, et al. Event-related potentials in clinical research: Guidelines for eliciting, recording, and quantifying mismatch negativity, P300, and N400. Clin Neurophysiol 2009;120(11):1883–1908.Google Scholar
Broglio, SP, Pontifex, MB, O’Connor, P, Hillman, CH. The persistent effects of concussion on neuroelectric indices of attention. J Neurotrauma 2009;26(9):1463–1470.Google Scholar
Bazarian, JJ, Zhong, J, Blyth, B, Zhu, T, Kavcic, V, Peterson, D. Diffusion tensor imaging detects clinically important axonal damage after mild traumatic brain injury: A pilot study. J Neurotrauma 2007;24(9):1447–1459.Google Scholar
Miller, L. Neuropsychology and pathophysiology of mild head injury and the postconcussion syndrome: Clinical and forensic considerations. J Cogn Rehabil 1996;15:8–23.Google Scholar
Mittl, R, Grossman, R, Hiehle, J, et al. Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal head CT findings. Am J Neuroradiol 1994;15(8):1583–1589.Google Scholar
Povlishock, JT, Coburn, TH. Morphopathological change associated with mild head injury. Mild Head Inj 1989;37–53.Google Scholar
Shenton, M, Hamoda, H, Schneiderman, J, et al. A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury. Brain Imaging Behav 2012;6(2):137–192.Google Scholar
Bazarian, JJ, Zhu, T, Blyth, B, Borrino, A, Zhong, J. Subject-specific changes in brain white matter on diffusion tensor imaging after sports-related concussion. Magnet Res Imag 2012;30(2):171–180.Google Scholar
Hammeke, TA, McCrea, M, Coats, SM, et al. Acute and subacute changes in neural activation during the recovery from sport-related concussion. J Int Neuropsychol Soc 2013;19(8):863–872.Google Scholar
Ogawa, S, Lee, T, Kay, A, Tank, D. Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc Natl Acad Sci 1990;87(24):9868–9872.Google Scholar
Ogawa, S, Menon, R, Tank, D, et al. Functional brain mapping by blood oxygenation level-dependent contrast magnetic resonance imaging. A comparison of signal characteristics with a biophysical model. Biophys J 1993;64(3):803–812.Google Scholar
Jueptner, M, Weiller, C. Review: Does measurement of regional cerebral blood flow reflect synaptic activity? Implications for PET and fMRI. NeuroImage 1995;2(2PA):148–156.Google Scholar
Hillary, FG, Steffener, J, Biswal, BB, Lange, G, DeLuca, J, Ashburner, J. Functional magnetic resonance imaging technology and traumatic brain injury rehabilitation: Guidelines for methodological and conceptual pitfalls. J Head Trauma Rehabil 2002;17(5):411–430.Google Scholar
Heeger, DJ, Ress, D. What does fMRI tell us about neuronal activity? Nature Rev Neurosci 2002;3(2):142–151.Google Scholar
Slobounov, S, Gay, M, Johnson, B, Zhang, K. Concussion in athletics: Ongoing clinical and brain imaging research controversies. Brain Imaging Behav 2012;6(2):224–243.Google Scholar
Maruta, J, Lee, SW, Jacobs, EF, Ghajar, J. A unified science of concussion. Ann NY Acad Sci 2010;1208(1):58–66.Google Scholar
Chu, Z, Wilde, E, Hunter, J, et al. Voxel-based analysis of diffusion tensor imaging in mild traumatic brain injury in adolescents. Am J Neuroradiol 2010;31(2):340–346.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×