Neuropsychological Assessment of Sports-Related Concussion: Pediatric Challenges

Abstract

The fourth International Consensus Statement on Concussion in Sport reports that 80–90 of concussions recover in 7–10 days. Impairments in postural control are a cardinal symptom following a sports-related concussion; however, many studies suggest that these impairments resolve within 3–5 days post-injury. Multiple recent studies, utilizing diverse and sophisticated research paradigms, are suggesting that this may be premature and that prolonged recovery could be normal. Therefore, the overarching purpose of the studies reported herein is to investigate impairments in postural control following a concussion and to identify recovery. We investigated the effi cacy of non-novel tasks including gait initiation, gait variability, gait termination, and static stance and track the individuals performance across time to identify residual impairments compared to performance on the standard clinical assessment battery. In the acute aftermath of a concussion, the subjects demonstrated substantial impairments in postural control across all tasks which are consistent with a multiple previous investigations. However, the novel fi ndings were the identifi cation of persistentand lingering impairments in postural control which were present despite apparent full recovery on all clinical measures. Specifi cally, the impairments were more apparent when evaluating central control mechanisms(e.g., movement strategies and anticipatory postural adjustments) as standard kinematic variables returned to premorbid values in a timelier manner. These results suggest that individuals may be returning to sports participation prior to complete concussion recovery and could be a mechanism for the high recurrent concussion rate as well as recent speculation associating concussions and other sports-related injuries. © Springer Science+Business Media New York 2014.