Standard pencil and paper neuropsychological tests (see box) 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.
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Common Neuropsychological Tests Used in Sport Concussion Assessment2 |
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Neuropsychological Test |
Cognitive Domain |
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Controlled Oral Word Association |
Verbal Fluency |
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Hopkins Verbal Learning Test |
Verbal learning, immediate and delayed memory |
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Trail Making: Parts A and B |
Visual scanning, attention, information processing speed, psychomotor speed |
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Wechsler Letter Number Sequencing Test |
Verbal working memory |
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Wechsler Digit Span: Digits Forward and Digits Backward |
Attention, concentration |
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Symbol Digit Modalities Test |
Psychomotor speed, attention, concentration |
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Paced Auditory Serial Addition Test |
Attention, concentration |
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Stroop Color Word Test |
Attention, information processing speed |
Because most states require advance training and licensing to purchase and use NP tests, and they are copyright protected, the National Athletic Training Association's 2004 Position Statement2 recommends that a licensed psychologist, preferably board-certified in clinical neuropsychology or with clinical experience in evaluating sport-related concussions, oversee and supervise the testing. The Zurich consensus statement echoes that position ("Neuropsychologists are in the best position to interpret NP tests by virtue of their background and training.").
1. Concussion Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008, P. McCrory et. al, Br. J. Sports Med. 2009; 43; i76-i84.