1 | 2 | 3 | 4

Determining Extent Of Injury To Brain Is Difficult
Factors Complicating Concussion Recognition And Management
Concussion Work-Up
Importance Of Prior Concussions
Computerized Neuropsychological Assessment: Replacing Pen And Paper Tests
The Balance Error Scoring System: A Useful Test
When A CT Or MRI Is Recommended
Concussion Management And Return To Play Guidelines
Final Recommendations

Standard pencil and paper neuropsychological tests have proven useful for identifying cognitive deficits resulting from concussions, and have been available to sports medicine clinicians for several years. These tests are designed to assess various domains of cognitive functioning such as short-term memory, working memory, attention, concentration, visual spatial capacity, information processing speed, and reaction time. The tests assist clinicians in quantifying the severity of the injury and eliminating some of the guesswork. The key to a successful testing program is having results from pre-season baseline testing for comparison to post-injury results.

IMPORTANT MESSAGE You are on the Old MomsTeam.com website. This article has been updated and moved to the new website. Click here to be redirected to the new site or copy and paste into your browser: http://www.momsteam.com

More recently, computer generated neuropsychological test programs have been developed and are currently being validated in the sports setting. They include the:

1. Automated Neuropsychological Assessment Metrics (ANAM) system: a PC Windows-based test protocol developed by the National Rehabilitation Hospital Assistive Technology and Neuroscience Center in Washington, DC;

2. CogState developed by CogState Ltd of Victoria, Australia; and

3. Concussion Resolution Index (CRI) developed by HeadMinder, Inc. of New York, NY; and

4. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) developed at the University of Pittsburgh Medical Center.

Computerized tests have three significant advantages over more traditional pen and paper neuropsychological tests:

• They take less time (more traditional pen and paper neuropsychological tests usually take an hour or more to administer)

• They are easier to administer, as they do not need to be administered by a neuropsychologist.

• They allow for infinite variety in the test questions that alleviate the practice or learning effects seen with more traditional neuropsychological test batteries.

It is therefore very likely that in the future there will be increasing use of such computer-generated tests.

Back to Top

Balance has traditionally been assessed using a standard Rhomberg Test and heel to toe walking as part of the neuropsychological examination. Researchers at the University of North Carolina (UNC) have studied and validated the use of force plate systems for assessing balance (postural stability) after concussion. In an attempt to provide a more cost-effective, yet quantifiable method of assessing balance in athletes, UNC researchers developed the Balance Error Scoring System (BESS). This system utilizes six testing conditions under varying stances and surface conditions, but does not require the use of an expensive force plate system. While not currently a mainstream of concussion work-up, such testing can be a useful adjunct.

Back to Top

Conventional CT or MRI scans of the brain are:

• Usually normal with a concussion (although not needed in mild cases when symptoms are brief)

• Recommended when there is:

  • Loss of consciousness for more than a few seconds

  • Prolonged impairment of the conscious state, especially any suggestion of deteriorating level of consciousness

• Dramatic worsening of a headache

• Focal neurologic deficit

• Seizure activity, or

• Persistent or worsening PCSS.

Back to Top

1 | 2 | 3 | 4

Article Updated August 15, 2006

	Reprint Policy Return to Head Injury Home Page

Related Articles

 Concussions: Advice For Parents Of Youth Athletes
 Concussion Grading Systems And Return-To-Play Guidelines: A Comparison