Return-to-play decisions should commonly follow post-exertion neurocognitive testing, researchers find

January 31, 2013, University of Pittsburgh Medical Center

(Medical Xpress)—Too many athletes may be going back onto the field, court or rink too soon after a concussion, according to a new study that recommends athletes undergo post-exertion neurocognitive testing before being cleared to return to play.

Three UPMC and researchers were co-authors of a study published in the January edition of showing that cognitive concussion issues may linger undetected in athletes at rest. That's what the Boston-based study, by lead investigator Neal McGrath, Ph.D., and Wayne Dinn, Ph.D., of Sports Concussion New England, found in more than one in four high-school age athletes. They reported being symptom-free and returned to baseline neurocognitive-test levels, meaning most clinicians and would allow them to return to their sports. Yet, in spite of feeling ready to return, 27.7 percent of these athletes displayed at least one area of after moderate physical exertion.

Those players were then kept from , allowed more time to heal and ultimately passed post-exertion cognitive testing before being cleared to return to play. Thus, the researchers concluded that computerized neurocognitive testing following moderate exertion should be part of the standard procedure when making return-to-play decisions for athletes for whom activity or exercise shows that they remain cognitively impaired.

"For years now, it has been widely understood that no contact-sports athlete should return to play until all signs point to a full recovery," McGrath said. "We have also known that computerized neurocognitive testing can show lingering cognitive deficits even when recovering athletes feel symptom-free. It has been standard practice to progress symptom-free athletes back through increasing over a few days while checking for a of symptoms. These findings suggest that post-exertion neurocognitive testing may be an important way to help verify that recovering athletes are ready to sustain hits again in football, hockey, soccer and other contact sports."

"We feel the issue is less related to heart rate and more related to the vestibular system, which is responsible for helping us to navigate our environment—space, motion, movement, balance," said Michael "Micky" Collins, Ph.D., executive and clinical director of the UPMC Sports Medicine Concussion Program and a participating investigator in the study. "The role and importance of exertion in recovery from concussion is ubiquitous; that's why we have a full-time exertional physical therapists in our program. This study looked at . But I think in future studies we need to look at return-to-school and cognitive function back in the classroom as well."

From a pool of more than 800 concussion cases reviewed over a two-year period, 54 contact-sports athletes from 15 high schools and a junior-hockey team met the criteria for the study, which used their scores from the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and clinical examinations by an attending sports-medicine professional. McGrath, a clinical neuropsychologist, also independently confirmed the findings of a concussion in each athlete. When the players exhibited no more symptoms and their neurocognitive scores returned to baseline levels—determinants used by most clinicians and state laws in permitting athletes to return to play—participants were put through moderate exercise for approximately 15 to 25 minutes on a treadmill, elliptical or stationary bicycle. After a brief rest period, they completed neurocognitive testing again.

Fifteen of those athletes (the aforementioned 27.7 percent) displayed cognitive deficiencies that would categorize them as still injured with a concussion and therefore unfit to return to play. In particular, these scored significantly lower in the verbal and visual memory portions of the neurocognitive testing. However, processing speed and reaction scores did not worsen following exertion.

"This suggests that tests focusing primarily on reaction time or processing speed may not be as effective at detecting post-exertion impairment," said Anthony Kontos, Ph.D., assistant research director of the UPMC Sports Medicine Program. "As such, a comprehensive test that includes verbal and visual memory in addition to these other tests should be used by clinicians."

"Moving forward, we plan additional research involving a larger sample that includes more girls," Kontos added, citing this study's small number of female participants (11 of the 54). "We also plan to examine the effects of different levels of exertion on cognitive performance."

Explore further: Does baseline concussion testing really reduce risks to athletes?

More information: … 02699052.2012.729282

Related Stories

Does baseline concussion testing really reduce risks to athletes?

June 1, 2011
Baseline concussion tests given to hundreds of thousands of athletes might, paradoxically, increase risks in some cases, according to a Loyola University Health System researcher.

Effects of a concussion may last longer than symptoms, study shows

February 29, 2012
A study recently published by the University of Kentucky's Scott Livingston shows that physiological problems stemming from a concussion may continue to present in the patient even after standard symptoms subside.

Does gender affect acute concussive injury in soccer players? 'No' according to this study

October 2, 2012
Many studies suggest gender-related differences in athletes' responses to sports-related concussion. Nevertheless, findings have not been unanimous, and no guidelines regarding gender-specific strategies for prevention or ...

Study flags over-reliance on computer tests in return-to-plan decisions after concussion

February 2, 2012
A new study by researchers at Indiana University-Purdue University Columbus and Pace University is critical of the widespread use of computerized neuropsychological tests (CNT) in decisions regarding when athletes can return ...

Risk factors identified for prolonged sports concussion symptoms

January 16, 2013
Researchers have found clear, identifiable factors that signal whether an athlete will experience concussive symptoms beyond one week. The researchers sought to identify risk factors for prolonged concussion symptoms by examining ...

Recommended for you

Placental accumulation of flame retardant chemical alters serotonin production in rats

January 22, 2018
A North Carolina State University-led research team has shown a connection between exposure to a widely used flame retardant chemical mixture and disruption of normal placental function in rats, leading to altered production ...

Marijuana use does not lower chances of getting pregnant

January 22, 2018
Marijuana use—by either men or women—does not appear to lower a couple's chances of getting pregnant, according to a new study led by Boston University School of Public Health (BUSPH) researchers.

Women run faster after taking newly developed supplement, study finds

January 19, 2018
A new study found that women who took a specially prepared blend of minerals and nutrients for a month saw their 3-mile run times drop by almost a minute.

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.