Attention-Deficit Hyperactivity Disorder Status and Baseline Neurocognitive Performance in High School Athletes.

Approximately 136,000 concussions occur annually in American high school sports. Neuropsychological data indicate that children with preexisting cognitive difficulties, such as attention-deficit hyperactivity disorder (ADHD), may have protracted recovery from concussion. ADHD, with an estimated prevalence of 11% in youth, may increase an athlete's vulnerability to sustaining sports-related traumatic brain injury (TBI). The preponderance of evidence focusing on TBI and ADHD has derived from motor vehicle accidents rather than sports-related incidents. Thus, it is paramount to explore how ADHD may relate to injury in the sports concussion context, as well as to assess how ADHD may affect baseline neurocognitive testing. Adolescent athletes with ADHD (n = 256) demonstrated significantly reduced Verbal Memory, Visual Motor, and Impulse Control index scores compared with their peers without ADHD (n = 256). Athletes with ADHD were nearly twice as likely to have sustained a prior concussion (ADHD, 14.1%; non-ADHD, 7.8%). Knowledge regarding the unique neurocognitive profile of athletes with ADHD may enhance clinical management decisions.

History of neuropsychological study of sport-related concussion.

Although the medical literature has a long history of description and comment on concussion, the occurrence of concussion within the context of sports other than boxing was not judged to be problematic until the 1980s. Neuropsychological assessment played a critical and integral role in identifying the cognitive sequelae of concussion and mapping out the short- and long-term vagaries in recovery. This paper captures that history and expands upon current applications of neuropsychological assessment in the diagnosis and management of sport-related concussion.

Vibrotactile pattern perception as a method for the assessment of brain dysfunction.

An immediate need exists for a portable diagnostic device for the assessment of cortical function, and diagnosis of mTBI. This paper presents initial results using a vibrotactile acuity test for the objective and quantitative diagnosis of acute mTBI suspects. mTBI is hypothesized to involve derangement or damage to the underlying cortical network. In particular, fundamental building blocks of the cortex are changed in such a way as to limit the functional connectivity within and between cortical columns. Our approach is based on sensory illusions that are configured as a test of neural connectivity. Pilot clinical test data showed differences between a small healthy normal group and a concussion group using a sports concussion model.

Neuropsychological evaluation in the diagnosis and management of sports-related concussion.

A mild traumatic brain injury in sports is typically referred to as a concussion. This is a common injury in amateur and professional athletics, particularly in contact sports. This injury can be very distressing for the athlete, his or her family, coaches, and school personnel. Fortunately, most athletes recover quickly and fully from this injury. However, some athletes have a slow recovery, and there are reasons to be particularly concerned about re-injury during the acute recovery period. Moreover, some athletes who have experienced multiple concussions are at risk for long-term adverse effects. Neuropsychologists are uniquely qualified to assess the neurocognitive and psychological effects of concussion. The National Academy of Neuropsychology recommends neuropsychological evaluation for the diagnosis, treatment, and management of sports-related concussion at all levels of play.

In-home monitoring of persons with dementia: ethical guidelines for technology research and development.

Innovative technologies are rapidly emerging that offer caregivers the support and means to assist older adults with cognitive impairment to continue living "at home." Technology research and development efforts applied to older adults with dementia invoke special grant review and institutional review board concerns, to ensure not only safe but also ethically appropriate interventions. Evidence is emerging, however, that tensions are growing between innovators and reviewers. Reviewers with antitechnology biases are in a position to stifle needed innovation. Technology developers who fail to understand the clinical and caregiving aspects of dementia may design applications that are not in alignment with users' capabilities. To bridge this divide, we offer an analysis of the ethical issues surrounding home monitoring, a model framework, and ethical guidelines for technology research and development for persons with Alzheimer's disease and their caregivers.

Designing for older adult users of handheld technology.

There are few interface design guidelines for handheld devices used by adults sixty years and older. Yet, this growing user group would benefit from the portability offered by such technology in promoting health management and social interaction. In this paper, we describe a usability framework for conducting studies on the use of a PocketPC by older adult caregivers. The usability framework provides a basis for conducting studies taking into account the user profile of an older adult, environment factors, usability quality factors, and technology objectives.

Soccer heading frequency predicts neuropsychological deficits.

This study investigated the presence of neuropsychological deficits associated with hitting the ball with one's head (heading) during soccer play. A neuro-cognitive test battery was administered to 60 male soccer players, high school, amateur and professional level, and 12 nonplaying control participants. The effects of currently reported heading behavior as well as that of estimated lifetime heading experience on neuropsychological test performance were examined. Players with the highest lifetime estimates of heading had poorer scores on scales measuring attention, concentration, cognitive flexibility and general intellectual functioning. Players' current level of heading was less predictive of neuro-cognitive level. Comparison of individual scores to age-appropriate norms revealed higher probabilities of clinical levels of impairment in players who reported greater lifetime frequencies of heading. Because of the worldwide popularity of the game, continued research is needed to assess the interaction between heading and soccer experience in the development of neuropsychological deficits associated with soccer play.

Short-term and long-term outcome of athletic closed head injuries.

The continued development of the sport environment as a laboratory for clinical investigation of mild head injury has greatly advanced the use of neuropsychological assessment in evaluating brain-injured athletes, and tracking their symptoms and recovery in an objective manner. The use of neurocognitive baseline measures has become critical in determining whether a brain-injured athlete has recovered function sufficiently to return to play. The rapid growth of computerized and web-based neurocognitive assessment measures provides an efficient, valid technology to put such testing within the reach of most institutions and organizations that field sport teams. Moreover, the knowledge of the recovery curve following mild head injury in the sport environment can be generalized to the management of MTBI in general clinical environments where baseline measures are unlikely. What we know today is that sideline assessments of severity are not predictive of which athletes will show the most typical 5- to 10-day recovery period and which will report persistent PCS complaints and exhibit impaired neurocognitive performance for an extended time. The research on mechanisms of brain injury in MTBI suggests that unpredictable, diffuse white-matter damage may control much of the variability in functional impairments and recovery duration.

Recency and frequency of soccer heading interact to decrease neurocognitive performance.

This study investigated the role of heading recency interacting with heading frequency in determining neuropsychological deficits associated with heading the ball during soccer play. Sixty-four high-ability male soccer players ages 16 to 34 completed the California Verbal Learning Test (CVLT), the Trailmaking Test, the Paced Auditory Serial Addition Test (PASAT), the Facial Recognition Test, the Rey-Osterrieth Complex Figure, and the Shipley Scales. Heading recency interacted with heading frequency, such that players with the highest self-reported estimates of heading who also experienced heading within the previous 7 days scored significantly lower on CVLT, Shipley, Trailmaking, and PASAT than other combinations of heading and recency. Although strict ball-to-head contacts could not be isolated as sufficient to cause this interaction, these results increase the weight of evidence that heading behavior is problematic for causing at least transient cognitive impairment.

Symptom-based assessment of the severity of a concussion.

OBJECT: Current grading systems of concussion and return-to-play guidelines have little empirical support. The authors therefore examined the relationships of the characteristics and symptoms of concussion and the history of concussion to three indicators of concussion severity-number of immediate symptoms, number of symptoms at the initial follow-up examination, and duration of symptoms--to establish an empirical basis for grading concussions. METHODS: Forty-seven athletes who sustained concussions were administered alternate forms of an Internet-based neurocognitive test until their performances were within normal limits relative to baseline levels. Assessments of observer-reported and self-reported symptoms at the sideline of the playing field on the day of injury, and at follow-up examinations were also obtained as part of a comprehensive concussion management protocol. Although loss of consciousness (LOC) was a useful indicator of the initial severity of the injury, it did not correlate with other indices of concussion severity, including duration of symptoms. Athletes reporting memory problems at follow-up examinations had significantly more symptoms in general, longer durations of those symptoms, and significant decreases in scores on neurocognitive tests administered approximately 48 hours postinjury. This decline of scores on neurocognitive testing was significantly associated with an increased duration of symptoms. A history of concussion was unrelated to the number and duration of symptoms. CONCLUSIONS: This paper represents the first documentation of empirically derived indicators of the clinical course of postconcussion symptom resolution. Self-reported memory problems apparent 24 hours postconcussion were robust indicators of the severity of sports-related concussion and should be a primary consideration in determining an athlete's readiness to return to competition. A decline on neurocognitive testing was the only objective measure significantly related to the duration of symptoms. Neither a brief LOC nor a history of concussion was a useful predictor of the duration of postconcussion symptoms.