Does baseline concussion testing aid in identifying future concussion risk?

The purpose was to determine differences in pre-season baseline performance between student-athletes who suffered a future sport-related concussion (fSRC) and those who did not. Collegiate student-athletes (82 fSRC, 82 matched control, age = 18.4 ± 0.8years, height = 172.7 ± 10.3 cm, mass = 80.1 ± 20.9 kg) completed baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Balance Error Scoring System (BESS), and Standardized Assessment of Concussion (SAC). Results of the independent t-tests suggested there were no differences between the fSRC and the control groups for ImPACT composite scores (95% confidence intervals, Visual Memory: fSRC 70.4-75.9, Control 73.4-78.5, p = 0.134; Verbal Memory: fSRC 83.8-87.7, Control 85.7-89.9, p = 0.155; Reaction Time: fSRC 0.562-0.591, Control 0.580-0.614, p = 0.071; Visual Motor Speed: fSRC 38.5-41.1, Control 38.2-40.9, p = 0.757), BESS total errors (fSRC 11.3-13.7, Control 11.8-14.4, p = 0.483), or SAC (fSRC 26.6-27.4, Control 26.9-27.6, p = 0.394). Receiver operating characteristic (ROC) areas-under-the-curve were 0.417-0.515. Our findings suggest that baseline concussion assessments cannot be used to predict individuals who may sustain a fSRC.

Does Anxiety Affect Neuropsychological Assessment in College Athletes?

Clinical Scenario: Anxiety is a mental disorder that affects a large portion of the population and may be problematic when evaluating brain injuries such as concussion. The reliance of cognitive testing in concussion protocols call for the examination of potential cognitive alterations commonly seen in athletes with anxiety. Focused Clinical Question: Does anxiety affect neuropsychological assessments in healthy college athletes? Summary of Key Findings: Three studies were included: 1 cross-sectional study and 2 prospective cohort studies. One study examined the effect of a range of psychological issues on concussion baseline testing in college athletes. Another study examined the effect of anxiety on reaction time both before and after sport competition in college-aged athletes. The final study examined the effects of psychosocial issues on reaction time during demanding tasks in college athletes. The first study reported slower simple and complex reaction times in athletes with anxiety. The second study found that athletes with high trait anxiety have slower reaction times both before and after competition. The third study reported that demanding tasks led to increased state anxiety which slowed reaction time. Overall, all 3 studies support the adverse effect anxiety can have on cognitive testing in athletes. Clinical Bottom Line: College athletes who present with anxiety at baseline may be susceptible to decreased performance on neuropsychological assessments. Strength of Recommendation: There is level B evidence that anxiety in healthy college athletes can impact neuropsychological assessments, and level C evidence that anxiety at baseline concussion assessment impacts neuropsychological testing in college athletes.

The effect of acute pain on executive function.

BACKGROUND AND AIM: Executive functions are high-level cognitive processes that allow a person to success-fully engage in an independent and self-fulfilling life. Previous literature indicates that chronic pain can affect executive function, but there are limited studies that investigate the effect of acute pain on executive function. The purpose of this study was to determine if acute pain affects executive function in recreationally active indi-viduals who sustained a musculoskeletal injury. METHODS: Twenty-four recreationally active participants who presented with acute pain following a muscu-loskeletal injury underwent a neuropsychological battery within 72 hours of injury. Follow up testing occurred within two weeks from the initial testing session when participants were pain free. Pain intensity was measured using the Visual Analog Scale (VAS). The neuropsychological battery consisted of the following tests: Digit Span (DS), Rey Auditory Verbal Learning Test (RAVLT), and Trail Making Test B (TMT-B). The DS was bro-ken into two separate scores, the RAVLT four scores, and TMT-B one score. Seven paired samples t-tests were conducted using an adjusted alpha level of 0.007. RESULTS: Participants had significantly improved scores when pain free in DS forwards (p < 0.007) and TMT-B (p < 0.007). No significant difference was observed for the DS backward (p = 0.023), RAVLT A1 (p = 0.563), RAVLT sum A1 to A5 (p = 0.953), RAVLT A6 (p = 1.0), RAVLT recognition list A (p = 0.009). These results suggest that immediate recall and complex attention may be diminished in individ-uals who experience acute pain due to a musculoskeletal injury. CONCLUSIONS: Results from this study suggest acute pain from musculoskeletal injuries may disrupt executive function. RELEVANCE FOR PATIENTS: Patients should be aware that there may be cognitive changes after a musculoskeletal injury. Knowing which cognitive domains may be impaired during acute pain could impact clinical practice and further benefit patients suffering from pain and its associated symptoms.

Comparison of Psychological Response between Concussion and Musculoskeletal Injury in Collegiate Athletes.

The psychological response to musculoskeletal injuries has been well documented, however, research on the psychological response to concussion is limited. The Profile of Mood States (POMS) and the State-Trait Anxiety Inventory (STAI) have recently been used to assess the psychological recovery of concussions. Although some studies indicate that psychological response is different for musculoskeletal injuries and concussion, there is currently not enough information to indicate this difference occurs at specific clinical milestones. The purpose of this study was to compare the psychological responses of student-athletes who have been diagnosed with a concussion to those of athletes diagnosed with musculoskeletal injuries with similar recovery duration. Fifteen collegiate athletes who sustained a musculoskeletal injury were recruited and matched with 15 previously collected concussion participants. The main outcome measures were the scores of POMS constructs: tension-anxiety, anger-hostility, fatigue-inertia, depression-dejection, vigor-activity, confusion-bewilderment, and total mood disturbance and STAI (state anxiety only). Two-way MANOVAs was run to determine the effects of group and time on POMS and STAI constructs. There were no significant interactions identified, but follow-up ANOVAs identified a main effect for time for most POMS subscales, with POMS scores improving over time in both groups. Analyses also revealed that tension-anxiety, vigor-activity and the STAI were not affected by time or group. The findings of this study, that both groups' psychological response to injury improves over time and at similar clinical milestones suggests reduction in sports and team related activities may play a substantial role in the psychological response to either concussion or musculoskeletal injury.