Concussion history is not a predictor of computerised neurocognitive performance

Correspondence to:
 Dr Ferrara
 Department of Kinesiology, 330 River Road, Athens, GA 30602, USA; [email protected]

Concussion evaluation has undergone considerable changes in the previous decade with the addition of objective tests to complement the physical assessment. Experts now recommend that the concussion assessment protocol include a battery of tests that evaluate self reported concussion related symptoms, postural control, and neurocognitive functioning.¹ Advances in technology allow the postural control and neurocognitive assessments to be completed using computer driven tests. Computer assessments show improvement over traditional testing by meliorating measurement precision of postural sway and cognitive features such as reaction time.^2–5 Although the neurocognitive evaluation is suggested to be the cornerstone of the evaluation, each facet of the assessment battery provides critical information to the clinician making a diagnosis and return to play decision.⁶

Concussion assessment in sport is unique in that there is access to the subject before injury. Athletes at high risk of concussion often perform a baseline test to establish “normal” functioning in a pre-concussed state. If an athlete subsequently sustains an injury, the same assessment battery is re-administered. This protocol allows the clinician to establish the level of decrement after injury, track improvements, and make a return to play decision. Some post-concussion assessment protocols are performed serially,^2,7 although it is now advocated that no testing is performed until the athlete is symptom-free to decrease the potential for practice or learning effects.⁸ Regardless of the assessment methodology, cognitive deficits associated with sport concussion commonly resolve spontaneously within a matter of days of the injury.^2,9,10

However, the long term consequences of concussion have yet to be clearly established. There is some evidence that chronic deficits in cognitive functioning may result from multiple sport related concussions. Using a pencil and paper assessment battery, Collins et al¹¹ reported that athletes with two or more concussions performed worse on tests that evaluated executive functioning and information processing. Differences on a similar assessment were also found between jockeys who reported no concussion history and those who reported up to two previous injuries.¹² Pencil and paper assessment batteries have also shown no difference between those suffering multiple sport related concussions and those reporting no history of injury.¹³