Effect of concussion on clinically measured reaction time in 9 NCAA division I collegiate athletes: a preliminary study. Clinical versus Functional Reaction Time: Implications for Postconcussion Management Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. Relation between subjective fogginess and neuropsychological testing following concussion. SEX DIFFERENCES IN NEUROPSYCHOLOGICAL FUNCTION AND POST‐CONCUSSION SYMPTOMS OF CONCUSSED COLLEGIATE ATHLETES Exploring differences in computerized neurocognitive concussion testing between African American and White athletes. Is neuropsychological testing useful in the management of sport-related concussion? A double-blinded randomised controlled trial exploring the effect of anodal transcranial direct current stimulation and uni-lateral robot therapy for the impaired upper limb in sub-acute and chronic stroke. Influence of parotid-sparing radiotherapy on xerostomia in head and neck cancer patients. Effects of concussion on attention and executive function in adolescents. Predictors of delayed recovery following pediatric sports-related concussion: a case-control study. Identifying neurocognitive deficits in adolescents following concussion. Evaluation of Neuropsychological Domain Scores and Postural Stability Following Cerebral Concussion in Sports Cognition in the days following concussion: comparison of symptomatic versus asymptomatic athletes. Prevalence of neurocognitive and balance deficits in collegiate aged football players without clinically diagnosed concussion. Immediate Neurocognitive Effects of Concussion Depression and neurocognitive performance after concussion among male and female high school and collegiate athletes.
OBJECTIVES To evaluate the effect of concussion on clinical ly measured reaction time ( RT(clin ) ) and in comparison to a computerized reaction time measure ( RT(comp ) ) . DESIGN Prospect i ve , repeated measures observational study . SETTING Athletic training clinic at a National Collegiate Athletic Association ( NCAA ) Division I university . PARTICIPANTS Data are reported for 9 collegiate athletes with acute concussion who were part of a larger cohort of 209 athletes recruited from the university 's football , women 's soccer , and wrestling teams before the start of their respective athletic seasons . METHODS  Baseline RT(clin ) and RT(comp )  were measured during preparticipation physical examinations . RT(clin ) measured the time required to catch a suspended vertical shaft by h and closure after its release by the examiner . RT(comp ) was derived from the simple RT component of the CogState-Sport computerized neurocognitive test battery . Athletes who subsequently sustained a physician-diagnosed concussion underwent repeated RT(clin ) and RT(comp ) testing within 72 hours of injury . A Wilcoxon signed rank test was used to compare baseline and after-injury RTs . MAIN OUTCOME MEASUREMENTS After-injury changes in RT(clin ) and RT(comp ) were calculated with respect to each athlete 's own preseason baseline value . RESULTS After-injury RT(clin ) was prolonged in 8 of the 9 athletes with concussions , whereas RT(comp ) was prolonged in 5 of the 9 athletes with concussions . The mean ( st and ard deviation ) RT(clin ) increased from 193 ± 21 ms to 219 ± 31 ms ( P = .050 ) , and mean RT(comp ) increased from 247 ± 75 to 462 ± 120 ms ( P = .214 ) . CONCLUSIONS We concluded that RT(clin ) appears to be sensitive to the known prolongation of RT after concussion and compares favorably with an accepted computerized RT measure . This study supports the potential utility of RT(clin ) as part of a multifaceted concussion assessment battery ABSTRACT Purpose This study aim ed to examine the association between clinical and functional reaction time ( RT ) assessment s with and without simultaneous cognitive tasks among healthy individuals . Methods Participants ( n = 41 , 49 % female ; 22.5 ± 2.1 yr ; 172.5 ± 11.9 cm ; 71.0 ± 13.7 kg ) completed clinical ( drop stick , Stroop ) and functional ( gait , jump l and ing , single-leg hop , anticipated cut , unanticipated cut ) RT assessment s in r and om order . All RT assessment s , except Stroop and unanticipated cut , were completed under single- ( movement only ) and dual-task conditions ( movement and subtracting by 6s or 7s ) . Drop stick involved catching a r and omly dropped rod embedded in a weighted disk . Stroop assessed RT via  computerized neurocognitive testing . An instrumented walkway measured gait RT when center-of-pressure moved after r and om stimulus . All other functional RT assessment s involved participants jumping forward and performing a vertical jump ( jump l and ing ) , balancing on one leg ( single-leg hop ) , or a 45 ° cut in a known ( anticipated cut ) or unknown ( unanticipated cut ) direction . RT was determined when the sacrum moved following r and om visual stimulus . Pearson correlation coefficients and a 5 × 2 repeated- measures ANOVA compared RT assessment s and cognitive conditions . Results Stroop RT outcomes did not significantly correlate with functional RT assessment s ( r range = −0.10 to 0.24 ) . A significant assessment by cognitive task interaction ( F4,160 = 14.01 ; P < 0.001 ) revealed faster single-task RT among all assessment s compared with dual-task ( mean differences , −0.11 to −0.09 s ; P < 0.001 ) , except drop stick ( P = 0.195 ) . Single-leg hop ( 0.58 ± 0.11 s ) was significantly slower compared with jump l and ing ( 0.53 ± 0.10 s ) , anticipated cut ( 0.49 ± 0.09 s ) , gait ( 0.29 ± 0.07 s ) , and drop stick ( 0.21 ± 0.03 s ; P values ≤ 0.001 ) . Dual-task assessment s were significantly slower than single-task assessment s ( mean difference , 0.08 s ; P < 0.001 ) . Conclusions Clinical and functional RT assessment s were not correlated with each other , suggesting that sport-like RT is not being assessed after concussion . Functional and dual-task RT assessment s may add clinical value and warrant further exploration after concussion CONTEXT Lack of empirical data on recovery time following sport-related concussion hampers clinical decision making about return to play after injury . OBJECTIVE To prospect ively measure immediate effects and natural recovery course relating to symptoms , cognitive functioning , and postural stability following sport-related concussion . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 1631 football players from 15 US colleges . All players underwent preseason baseline testing on concussion assessment measures in 1999 , 2000 , and 2001 . Ninety-four players with concussion ( based on American Academy of Neurology criteria ) and 56 noninjured controls underwent assessment of symptoms  , cognitive functioning  , and postural stability immediately , 3 hours , and 1 , 2 , 3 , 5 , 7 , and 90 days after injury . MAIN OUTCOME MEASURES Scores on the Grade d Symptom Checklist ( GSC ) , St and ardized Assessment of Concussion ( SAC ) , Balance Error Scoring System ( BESS ) , and a neuropsychological test battery . RESULTS No player with concussion was excluded from participation ; 79 players with concussion ( 84 % ) completed the protocol through day 90 . Players with concussion exhibited more severe symptoms ( mean GSC score 20.93 [ 95 % confidence interval [ CI ] , 15.65 - 26.21 ] points higher than that of controls ) , cognitive impairment ( mean SAC score 2.94 [ 95 % CI , 1.50 - 4.38 ] points lower than that of controls ) , and balance problems ( mean BESS score 5.81 [ 95 % CI , -0.67 to 12.30 ] points higher than that of controls ) immediately after concussion . On average , symptoms gradually resolved by day 7 ( GSC mean difference , 0.33 ; 95 % CI , -1.41 to 2.06 ) , cognitive functioning improved to baseline levels within 5 to 7 days ( day 7 SAC mean difference , -0.03 ; 95 % CI , -1.33 to 1.26 ) , and balance deficits dissipated within 3 to 5 days after injury ( day 5 BESS mean difference , -0.31 ; 95 % CI , -3.02 to 2.40 ) . Mild impairments in cognitive processing and verbal memory evident on neuropsychological testing 2 days after concussion resolved by day 7 . There were no significant differences in symptoms or functional impairments in the concussion and control groups 90 days after concussion . CONCLUSIONS Collegiate football players may require several days for recovery of symptoms , cognitive dysfunction , and postural instability after concussion . Further research is required to determine factors that predict variability in recovery time after concussion . St and ardized measurement of postconcussive symptoms , cognitive functioning , and postural stability may enhance clinical management of athletes recovering from concussion The purpose of this study was to examine the relation between the subjective report of feeling foggy at one-week post concussion and acute neuropsychological outcome . The outcome variables were derived from a computerized neuropsychological screening battery , Immediate Post-Concussion Assessment and Cognitive Testing ( ImPACT ) . Participants were 110 high school students who sustained a sports-related concussion and were evaluated 5 - 10 days post injury ( M = 6.8 days ) . Athletes were divided into two groups on the basis of self-reported fogginess . The first group reported no fogginess ( n = 91 ) , whereas the second group reported experiencing some degree of fogginess ( n = 19 ) on a 6-point scale . The athletes with persistent fogginess experienced a large number of other post-concussion symptoms , compared to the athletes with no reported fogginess . In addition , the athletes with persistent fogginess had significantly slower reaction times , reduced memory performance , and slower processing speed . Thus , athletes with any degree of self-reported fogginess at one-week post injury are likely to have adverse effects from their concussions in multiple domains OBJECTIVE Our purpose was to determine whether sex differences exist with respect to post-concussion symptoms and neurocognitive function in concussed collegiate athletes . METHODS A prospect i ve dependent- sample cohort design was used to compare baseline and post-concussion neuropsychological test scores and endorsed symptoms as functions of serial post-concussion assessment with respect to time and sex . The Immediate Post-concussion Assessment and Cognitive Testing ( ImPACT ) battery was administered to a multicenter analysis group of 79 concussed athletes . This computerized neuropsychological test was given to the athletes during the preseason and , on average , 2 and 8 days postinjury . RESULTS Multivariate analyses revealed no significant between-group differences on baseline test performance with respect to sex on any of the ImPACT composite scores or on the total symptom score . Multivariate analyses of post-concussion data revealed a significant main effect of time on ImPACT scores , but no main effect of sex was identified , and no time-by-sex interaction existed . Post hoc analysis revealed that concussed female athletes performed significantly worse than concussed male athletes on visual memory tasks ( P = 0.001 ) , and analysis of endorsed post-concussion symptoms revealed that concussed men were significantly more likely than concussed women to report post-concussion symptoms of vomiting ( P = 0.001 ) and sadness ( P = 0.017 ) . Athletes ' scores were examined individually using the reliable-change methodology . At 2 days post-injury , 58 % of concussed athletes had one or more reliable incidents of performance decline or increases in symptom reporting . At 8 days post-concussion , 30 % of concussed athletes were still showing one or more reliable change from preseason values . CONCLUSIONS College athletes exhibit differences on visual memory composite scores and symptoms post-concussion as a function of sex . These data support the importance of evaluating neuropsychological status and post-concussion symptoms in concussed athletes . In addition , these data illustrate the importance of analyzing an individual athlete 's recovery pattern , because individual differences in recovery trajectories may be overshadowed by global norm-group comparisons The purpose of the current study was to explore potential differences in pre- and post-concussion performance on a computerized neurocognitive concussion test between African American and White high-school and collegiate student-athletes . A prospect i ve case-control design was used to compare baseline and 2- and 7-day post-concussion computerized neurocognitive performance and symptoms between 48 White and 48 African American athletes matched for age , gender , and concussion history . The Immediate Post-Concussion Assessment Cognitive Test ( ImPACT ) version 2.0 ( NeuroHealth System , LLC , Pittsburgh , PA , USA ) computer software program was used to assess neurocognitive function ( i.e. , verbal and visual memory , motor processing speed , and reaction time ) and concussion symptoms . Regardless of race/ethnicity , there were significant decrements in computerized neurocognitive performance and increased symptoms following a concussion for the entire sample . African Americans and Whites did not differ significantly on baseline or post-concussion verbal memory , visual memory , reaction time , and total reported symptoms . However , African American participants were 2.4 × more likely to have at least one clinical ly significant cognitive decline on ImPACT at 7 days post-concussion and scored lower at 7 days post-concussion compared with baseline on processing speed than White participants . The authors concluded that the baseline ImPACT test was culturally equivalent and construct valid for use with these two racial/ethnic groups . However , in contrast , the findings support deleterious performance for the African American athletes compared with the White athletes on the ImPACT post-concussion evaluation that is of critical clinical relevance and warrants further research OBJECTIVE Neuropsychological ( NP ) testing has been used for several years as a way of detecting the effects of sport-related concussion in order to aid in return-to-play determinations . In addition to st and ard pencil- and -paper tests , computerized NP tests are being commercially marketed for this purpose to professional , collegiate , high school , and elementary school programs . However , a number of important questions regarding the clinical validity and utility of these tests remain unanswered , and these questions present serious challenges to the applicability of NP testing for the management of sport-related concussion . Our purpose is to outline the criteria that should be met in order to establish the utility of NP instruments as a tool in the management of sport-related concussion and to review the degree to which existing tests have met these criteria . DATA SOURCES A comprehensive literature review of MEDLINE and PsychLit from 1990 to 2004 , including all prospect i ve , controlled studies of NP testing in sport-related concussion . DATA SYNTHESIS The effects of concussion on NP test performance are so subtle even during the acute phase of injury ( 1 - 3 days postinjury ) that they often fail to reach statistical significance in group studies . Thus , this method may lack utility in individual decision making because of a lack of sensitivity . In addition , most of these tests fail to meet other psychometric criteria ( eg , adequate reliability ) necessary for this purpose . Finally , it is unclear that NP testing can detect impairment in players once concussion-related symptoms ( eg , headache ) have resolved . Because no current guideline for the management of sport-related concussion allows a symptomatic player to return to sport , the incremental utility of NP testing remains question able . CONCLUSIONS / RECOMMENDATIONS Despite the theoretic rationale for the use of NP testing in the management of sport-related concussion , no NP tests have met the necessary criteria to support a clinical application at this time . Additional research is necessary to establish the utility of these tests before they can be considered part of a routine st and ard of care , and concussion recovery should be monitored via the st and ard clinical examination and subjective symptom checklists until NP testing or other methods are proven effective for this purpose BACKGROUND Neurorehabilitation technologies such as robot therapy ( RT ) and transcranial Direct Current Stimulation ( tDCS ) can promote upper limb ( UL ) motor recovery after stroke . OBJECTIVE To explore the effect of anodal tDCS with uni-lateral and three-dimensional RT for the impaired UL in people with sub-acute and chronic stroke . METHODS A pilot r and omised controlled trial was conducted . Stroke participants had 18 one-hour sessions of RT ( ArmeoSpring ) over eight weeks during which they received 20 minutes of either real tDCS or sham tDCS during each session . The primary outcome measure was the Fugl-Meyer assessment ( FMA ) for UL impairments and secondary were : UL function , activities and stroke impact collected at baseline , post-intervention and three-month follow-up . RESULTS 22 participants ( 12 sub-acute and 10 chronic ) completed the trial . No significant difference was found in FMA between the real and sham tDCS groups at post-intervention and follow-up ( p = 0.123 ) . A significant ' time ' x ' stage of stroke ' was found for FMA ( p = 0.016 ) . A higher percentage improvement was noted in UL function , activities and stroke impact in people with sub-acute compared to chronic stroke . CONCLUSIONS Adding tDCS did not result in an additional effect on UL impairment in stroke . RT may be of more benefit in the sub-acute than chronic phase Radiotherapy ( RT ) for head and neck cancers causes permanent salivary gl and dysfunction ( SGD ) and xerostomia . We have previously demonstrated the effectiveness of parotid-sparing RT on salivary function . The aim of this was to characterize the relationship between radiation dosages to parotid gl and s , SGD , xerostomia , and impaired quality of life ( QOL ) .  Ninety-three patients received unilateral ( n=38 ) and bilateral ( n=44 ) neck RT with parotid-sparing techniques , or st and ard three-field technique RT  ( n=11 ) . Unstimulated and stimulated parotid saliva was collected pre-RT and 1 year post-RT . Assessment of QOL and xerostomia was conducted with three question naires . The results demonstrated that reduced radiation dosages to parotid gl and s were strongly associated with percentage of baseline parotid flow rates measured at 1 year post-RT . Unilateral and bilateral neck RT with parotid-sparing techniques were successful in preserving salivary output , compared to st and ard three beam RT techniques . Lower radiation dose to contralateral parotid gl and s was associated with greater percentage of baseline salivary flow rates at 1 year post-RT , fewer xerostomic complaints , and an enhanced QOL BACKGROUND Head trauma in adolescents has been linked with deficits in attention and executive function that can compromise the performance of everyday tasks . Although previous research has examined this issue using computerized neuropsychological testing , little work has been done using laboratory-based measurements of attention and executive function in this population . A longitudinal analysis of recovery patterns of these measures among adolescents is central to underst and ing the effects of concussions across the age spectrum . PURPOSE This study prospect ively and longitudinally examined laboratory-based measures of attention and executive function in concussed adolescents sequentially during a 2-month period after injury . METHODS Two measures of attention and executive function , the Attentional Network Test and the Task-Switching Test  , were administered to 20 concussed adolescents within 72 h postinjury as well as at 1 wk , 2 wk , 1 month , and 2 months postinjury . Twenty healthy , matched control subjects were similarly assessed at the same time intervals . Data were analyzed by two-way , mixed-effects ANOVA to determine the effect of group and time on the dependent variables . RESULTS Compared with control subjects , the concussed group exhibited a significantly greater switch cost on the Task-Switching Test ( P = 0.038 , mean difference value = 38 ms ) and a significantly greater reaction time for the Attentional Network Test conflict effect component ( P = 0.015 , mean difference value = 34 ms ) for up to 2 months after injury . CONCLUSIONS Concussed adolescents have difficulty recovering executive function after injury and may require extended recuperation time before full recovery is achieved . Evaluations focusing on attention and executive function can be useful additions in the assessment and follow-up after head injury OBJECT Pediatric sports-related concussions are a growing public health concern . The factors that determine injury severity and time to recovery following these concussions are poorly understood . Previous studies suggest that initial symptom severity and diagnosis of attention deficit hyperactivity disorder ( ADHD ) are predictors of prolonged recovery ( > 28 days ) after pediatric sports-related concussions . Further analysis of baseline patient characteristics may allow for a more accurate prediction of which patients are at risk for delayed recovery after a sports-related concussion . METHODS The authors performed a single-center retrospective case-control study involving patients cared for at the multidisciplinary Concussion Clinic at Children 's of Alabama between August 2011 and January 2013 . Patient demographic data , medical history , sport concussion assessment tool 2 ( SCAT2 ) and symptom severity scores , injury characteristics , and patient balance assessment s were analyzed for each outcome group . The control group consisted of patients whose symptoms resolved within 28 days . The case group included patients whose symptoms persisted for more than 28 days . The presence or absence of the SCAT2 assessment had a modifying effect on the risk for delayed recovery ; therefore , stratum-specific analyses were conducted for patients with recorded SCAT2 scores and for patients without SCAT2 scores . Unadjusted ORs and adjusted ORs ( aORs ) for an association of delayed recovery outcome with specific risk factors were calculated with logistic regression analysis . RESULTS A total of 294 patients met the inclusion criteria of the study . The case and control groups did not statistically significantly differ in age ( p = 0.7 ) . For the patients who had received SCAT2 assessment s , a previous history of concussion ( aOR 3.67 , 95 % CI 1.51 - 8.95 ) , presenting SCAT2 score < 80 ( aOR 5.58 , 95 % CI 2.61 - 11.93 ) , and female sex ( aOR 3.48 , 95 % CI 1.43 - 8.49 ) were all associated with a higher risk for postconcussive symptoms lasting more than 28 days . For patients without SCAT2 scores , female sex and reporting a history of ADHD significantly increased the odds of prolonged recovery ( aOR 4.41 , 95 % CI 1.93 - 10.07 and aOR 3.87 , 95 % CI 1.13 - 13.24 , respectively ) . Concussions result ing from playing a nonhelmet sport were also associated with a higher risk for prolonged symptoms in patients with and without SCAT2 scores ( OR 2.59 , 95 % CI 1.28 - 5.26 and OR 2.17 , 95 % CI 0.99 - 7.73 , respectively ) . Amnesia , balance abnormalities , and a history of migraines were not associated with symptoms lasting longer than 28 days . CONCLUSIONS This case-control study suggests c and i date risk factors for predicting prolonged recovery following sports-related concussion . Large prospect i ve cohort studies of youth athletes examined and treated with st and ardized protocol s will be needed to definitively establish these associations and confirm which children are at highest risk for delayed recovery OBJECTIVES This study of concussed adolescents sought to determine if a computer-based neurocognitive assessment ( Immediate Postconcussion Assessment and Cognitive Test [ ImPACT ] ) performed on patients who present to the emergency department ( ED ) immediately following head injury would correlate with assessment s performed 3 to 10 days postinjury and if ED neurocognitive testing would detect differences in concussion severity that clinical grading scales could not . METHODS A prospect i ve cohort sample of patients 11 to 17 years of age presenting to the ED within 12 hours of a head injury were evaluated using two traditional concussion grading scales and neurocognitive testing .  ED neurocognitive scores were compared to follow-up scores obtained at least 3 days postinjury . Postconcussive symptoms , outcomes , and complications were assessed via telephone follow-up for all subjects . RESULTS Sixty patients completed phone follow-up . Thirty-six patients ( 60 % ) completed follow-up testing a median of 6 days postinjury . Traditional concussion grading did not correlate with neurocognitive deficits detected in the ED or at follow-up . For the neurocognitive domains of verbal memory , processing speed , and reaction time , there was a significant correlation between ED and follow-up scores trending toward clinical improvement . By 2 weeks postinjury , 23 patients ( 41 % ) had not returned to normal activity . At 6 weeks , six patients ( 10 % ) still had not returned to normal activity . CONCLUSIONS Immediate assessment in the ED can predict neurocognitive deficits seen in follow-up and may be potentially useful to individualize management or test therapeutic interventions . Neurocognitive assessment in the ED detected deficits that clinical grading could not and correlated with deficits at follow-up Context With increasing knowledge and research about concussion , there have been few objective studies that have used neuropsychological domain scores and postural stability to assess concussion . Objective To evaluate the recovery curve of athletes who incur sport-related concussion from repeated serial testing of neuropsychological and posturography testing . Design A prospect i ve epidemiological model was used for the course of the study . Setting Division I intercollegiate athletics . Participants Athletes participating in football , soccer , basketball , softball , and cheerleading . Main Outcome Measures  Neuropsychological scores and posturography measures  were obtained preseason and serially at day 1 , day 2 , day 3 , and day 10 postconcussion .  Control participants  were tested at the same intervals .  Neuropsychological scores were converted to st and ards score and then into domains of attention , learning , speed of information processing , concentration , memory , and verbal fluency . Analysis of covariance with the baseline test as the covariate was used to analyze the data with univariate post hoc tests performed . Results Significant group differences were found for self reported symptoms ( P = 0.001 ) , speed of information processing ( P = 0.005 ) , mean stability ( P = 0.002 ) , and vestibular function ( P = 0.003 ) between injured and control participants . A group , by day , planned comparison found that speed of information processing and composite balance measures demonstrated significant differences through day 10 postinjury , while symptoms and the vestibular ratio remained significant only through day 3 . Conclusions The concussion recovery curve demonstrated short-term neuropsychological and posturography deficits following injury . A comprehensive approach to concussion management should be used to assess the injury and make return-to-play decisions BACKGROUND Concussion is a common neurological injury occurring during contact sport . Current guidelines recommend that no athlete should return to play while symptomatic or displaying cognitive dysfunction . This study compared post-concussion cognitive function in recently concussed athletes who were symptomatic/asymptomatic at the time of assessment with that of non-injured ( control ) athletes . METHODS Prospect i ve study of 615 male Australian Rules footballers . Before the season , all participants ( while healthy ) completed a battery of baseline computerised ( CogSport ) and paper and pencil cognitive tasks .  Sixty one injured athletes ( symptomatic = 25 and asymptomatic = 36 ) were reassessed within 11 days of being concussed ; 84 controls were also reassessed . The serial cognitive function of the three groups was compared using analysis of variance . RESULTS The performance of the symptomatic group declined at the post-concussion assessment on computerised tests of simple , choice , and complex reaction times compared with the asymptomatic and control groups . The magnitude of changes was large according to conventional statistical criteria . On paper and pencil tests , the symptomatic group displayed no change at re assessment , whereas large improvements were seen in the other two groups . CONCLUSION Injured athletes experiencing symptoms of concussion displayed impaired motor function and attention , although their learning and memory were preserved . These athletes displayed no change in performance on paper and pencil tests in contrast with the improvement observed in asymptomatic and non-injured athletes . Athletes experiencing symptoms of concussion should be withheld from training and competition until both symptoms and cognitive dysfunction have resolved STUDY DESIGN Prospect i ve cohort . OBJECTIVES To identify the prevalence of neurocognitive and balance deficits in collegiate football players 48 hours following competition . BACKGROUND Neurocognitive testing , balance assessment s , and subjective report of symptoms are a commonly used test battery in examining athletes when concussion is suspected . Previous literature suggests many concussions go unreported . Little research exists examining the prevalence of neurocognitive or balance deficits in athletes who do not report concussion-like symptoms to a health care provider . METHODS Forty-five Division IA collegiate football players participated in this study . Preseason baseline scores using the  Balance Error Scoring System , the Immediate Post-Concussion Assessment and Cognitive Testing , and the Postconcussion Symptom Scale  were compared to posttest results obtained 48 hours following a game . Prevalence of symptoms was analyzed and reported . RESULTS Thirty-two ( 71 % ) of the 45 athletes tested demonstrated at least 1 deficit in either the Postconcussion Symptom Scale , Balance Error Scoring System , or at least 1 composite score of the Immediate Post-Concussion Assessment and Cognitive Testing . Nineteen of the 32 subjects demonstrated a change in 2 or more categories of neurocognitive and balance function . CONCLUSION In a cohort of football players tested 48 hours following their last game of the season , who did not seek medical attention related to a concussion , a significant number demonstrated limitations in neurocognitive and balance performance , suggesting that further research may need to be performed to improve recognition of an athlete 's deficits and to improve the ability to assess concussion . LEVEL OF EVIDENCE Differential diagnosis/symptom prevalence , level 3b OBJECTIVE To prospect ively measure the immediate neurocognitive effects and early course of recovery from concussion and to examine the effects of loss of consciousness ( LOC ) and posttraumatic amnesia ( PTA ) on the severity of neurocognitive impairment immediately after concussion . METHODS A sports-related concussion research model was used to allow prospect i ve immediate evaluation of concussion . A total of 2385 high school and college football players were studied . Ninety-one players ( 3.8 % ) sustained concussions during the study . A brief neurocognitive and neurological screening measure , the St and ardized Assessment of Concussion  , was used to assess cognitive functioning before the football season , immediately after injury , and 15 minutes , 48 hours , and 90 days after injury . RESULTS St and ardized Assessment of Concussion scores immediately after concussion were significantly lower than the preseason baseline score and the noninjured population baseline mean , even for injured subjects without LOC or PTA . Subjects with LOC were most severely impaired immediately after injury , whereas those without LOC or PTA were least impaired . Significant impairment was also detected 15 minutes after injury , but all three groups returned to baseline levels of cognitive functioning within 48 hours . CONCLUSION These findings are the first to demonstrate not only that a gradient of increasing concussion severity is represented by PTA and LOC but also that measurable neurocognitive abnormalities are evident immediately after injury without PTA or LOC OBJECTIVES To prospect ively examine the relationship of sport-related concussion with depression and neurocognitive performance and symptoms among male and female high school and college athletes . A secondary objective was to explore age and sex differences . DESIGN Pretest , multiple posttest , repeated- measures design . SETTING Laboratory . PARTICIPANTS High school and collegiate athletes ( N=75 ) with a diagnosed concussion . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES  Beck Depression Inventory-II and computerized neurocognitive test battery ( Immediate Post-concussion Assessment and Cognitive Test )  , which includes concussion symptoms ( Post-concussion Symptom Scale ) at baseline and at 2 , 7 , and 14 days postinjury . RESULTS Concussed athletes exhibited significantly higher levels of depression from baseline at 2 days ( P≤.001 ) , 7 days ( P=.006 ) , and 14 days postconcussion ( P=.04 ) . Collegiate athletes demonstrated a significant increase in depression at 14 days postconcussion than did high school athletes ( P=.03 ) . There were no sex differences in depression levels . Neurocognitive decrements at 14 days were supported for reaction time ( P=.001 ) and visual memory ( P=.001 ) . Somatic depression at 7 days postconcussion was related to slower reaction time at 7 days postconcussion . Somatic depression at 14 days postinjury was related to lower visual memory scores at 14 days postinjury . CONCLUSIONS Although not clinical ly significant , athletes experienced increased depression scores up to 14 days after concussion that coincided with neurocognitive decrements in reaction time and visual memory . Somatic depression appears to be most salient with regard to lower neurocognitive performance . Mood assessment s after concussion are warranted to help monitor and enhance recovery
Robust RT deficits were observed acutely following concussion .
Minimal magnitude differences were noted when comparing between- and within-subject effects , suggesting that pre-injury baselines may not add clinical value in determining post-injury RT impairment .
RT deficits persisted up till the intermediate-term ( 21–59 days post-injury ) timeframe and indicate lingering deficits exist .
Mean effect size differences were observed between RT measure types and computerized neurocognitive testing platforms ; however , all categories displayed negative effects consistent with impaired RT following concussion .
Reaction time ( RT ) deficits are reported following concussion , but it is unknown when these deficits normalize to pre-injury status .
It is also unclear how factors such as RT measurement technique and participant characteristics influence post-concussion RT .
The purpose of this systematic review and meta- analysis was to ( 1 ) characterize acute post-concussion ( 0–3 days ) RT impairments , ( 2 ) examine RT recovery over time , and ( 3 ) explore moderating factors related to acute RT impairment following concussion .