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Effects of Concussion: Subtle Yet Prolonged For Those With Multiple Concussion History


Recent studies have found that healthy high school athletes with a history of multiple concussions perform more poorly on neurocognitive tests and have more symptoms compared to their peers who have no concussions in their histories.

In 2005, my colleagues and I published a study in the journal Neurosurgery1 that looked at healthy athletes at an academically competitive secondary boarding school.  We reported on the lingering effects of multiple concussions.  Our findings showed that:

  • recently concussed athletes have significantly impaired performance on tests of attention, processing speed, and mental flexibility compared with youth athletes with no history of concussion or history of only one previous concussion;
  • youth athletes who had sustained two or more previous concussions but who do not report or demonstrate any physical, medical, or cognitive difficulties related to a history of concussion appear indistinguishable on testing from youth athletes who have just experienced a concussion in the past week.  This suggested that the effects of concussion on sustained attention and cognitive flexibility linger for a long period of time after the injury.  We viewed such finding as providing "further support for the vulnerability of the youth brain." Remember note on clothes pin
  • Increased exposure to participation in contact sports (e.g. 2 years) may place the athlete at greater risk for more chronic traumatic brain injury;
  • The cumulative effects of concussion may extend to general academic performance. Academic GPA was significantly lower for youth athletes with a history of multiple concussions (as it was for recently concussed athletes);
  • The extent to which parents and athletes exhibited surprise and a lack of knowledge during interviews was considered "striking."  Many athletes described concussive events without ever having realized that concussions had been sustained.  Parents frequently seemed embarrassed and alarmed listening to their children describe, for the first time, a mild hit that resulted in confusion, disorientation, "seeing stars," and headache. 

New study confirms long-term effect of multiple concussions

The long-term effects of concussion among high school athletes was again confirmed in a recent 2011 study, also to be published by my colleagues and I in the journal Neurosurgery. With my colleague, Philip Schatz, PhD, the lead author and Director of Research for the Sports Concussion Center of New Jersey and Professor of Psychology at St. Joseph's University in Philadelphia, we found that high school athletes with a history of concussions consistently report more concussion-related symptoms such as headache, balance problems, and dizziness than peers with no concussion history.  

The implications of the new study might extend beyond management of youth athletes with a history of concussion and have broader policy implications: "Coaches, parents, athletic trainers, school physicians, and all individuals involved in the organization, implementation, and supervision of high school and youth athletes may need to consider policy and practice revisions to insure [their] long-term safety," we wrote. 

Our findings should not only "serve as a caution for parents, coaches, and sports medicine personnel supervising high school and other youth athletes with a history of concussion" but as providing support for "the recent surge in advocacy on state and federal governmental levels to establish youth concussion management programs and to better regulate the rules of youth sports."

1. Moser RS, Schatz P, Jordan BD. Prolonged Effects of Concussion in High School Athletes. Neurosurgery 2005; 57(2):300-306.

2. Schatz P, Moser RS, Covassin T, Karpf R.  Early Indicators of Enduring Symptoms in High School Athletes with Multiple Previous Concussions.  Neurosurgery 2011;68:1562-1567.

Posted July 15, 2011