Post-Concussion Acute Signs and Reliable Cognitive Decline in a Finnish Youth Ice Hockey Sample

M1 - acaa108In sports concussion research, the importance of an individualized approach incorporating neuropsychological assessment data has been emphasized. This study examined the impact of acute signs of concussion on post-injury cognitive functioning using reliable change methodology in a sample of Finnish, elite-level, youth ice hockey players.From a sample of 1,823 players (all male, 14–20 years old) who completed preseason baseline testing with the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®) battery, two subgroups were identified. First, in total, 312 uninjured athletes, who completed baseline testing twice—1 year apart. The scores were contrasted to calculate reliable change indices (RCIs). Second, from a subsample of 570 athletes participating in an intensive follow-up arm of the project, the analysis included 32 concussed athletes. The RCIs were determined for the five ImPACT composite scores and used in identifying athletes with declined performance 3 days post-injury.Test-retest reliability ranged from .39 to .71. Athletes who had experienced an acute loss of consciousness, amnesia, or postural instability had increased odds for declines in two or more areas assessed by ImPACT (odds ratio = 7.67–8.00, p < .05). In contrast, acute disorientation or vacant look did not lead to cognitive change that met the reliable change threshold.The reliability coefficients and RCIs differed from those published earlier emphasizing the importance of national reference values. The presence of acute loss of consciousness, amnesia, or postural instability may indicate a more severe injury and predict the need for more intensive cognitive follow-up.Objective In sports concussion research, the importance of an individualized approach incorporating neuropsychological assessment data has been emphasized. This study examined the impact of acute signs of concussion on post-injury cognitive functioning using reliable change methodology in a sample of Finnish, elite-level, youth ice hockey players. Methods From a sample of 1,823 players (all male, 14-20 years old) who completed preseason baseline testing with the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT (R)) battery, two subgroups were identified. First, in total, 312 uninjured athletes, who completed baseline testing twice-1 year apart. The scores were contrasted to calculate reliable change indices (RCIs). Second, from a subsample of 570 athletes participating in an intensive follow-up arm of the project, the analysis included 32 concussed athletes. The RCIs were determined for the five ImPACT composite scores and used in identifying athletes with declined performance 3 days post-injury. Results Test-retest reliability ranged from .39 to .71. Athletes who had experienced an acute loss of consciousness, amnesia, or postural instability had increased odds for declines in two or more areas assessed by ImPACT (odds ratio = 7.67-8.00, p < .05). In contrast, acute disorientation or vacant look did not lead to cognitive change that met the reliable change threshold. Conclusions The reliability coefficients and RCIs differed from those published earlier emphasizing the importance of national reference values. The presence of acute loss of consciousness, amnesia, or postural instability may indicate a more severe injury and predict the need for more intensive cognitive follow-up.Peer reviewe

Adolescent athletes with learning disability display atypical maturational trajectories on concussion baseline testing : Implications based on a Finnish sample

Previous research has reported lower cognitive test scores on baseline testing in athletes reporting multiple previous concussions or a history of learning disability (LD). Age also has an important influence on cognitive performance. While these factors have been considered individually in previous studies, the present study is the first to explore the interaction of age, self-reported LD, and history of concussion on baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT (R)) in a nationwide study of adolescent athletes. ImPACT (R) was administered to 1823 Finnish male ice hockey players (aged 12-21 years old) prior to the 2015-2016 or 2016-2017 playing seasons. Linear regressions and simple slopes analyses were used for clarifying the impact of LD and previous concussion history on maturational trajectories. In comparison to typically developing athletes, athletes with LD had lower neurocognitive scores in all composites and differing maturational trajectory in verbal memory and visual motor speed. The number of previous concussions did not impair neurocognitive performance at baseline assessment. Application of standard age-based norms to adolescent athletes with a history of LD has the potential to negatively skew clinical decision-making. Separate reference values for LD athletes are warranted due to their unique developmental cognitive trajectories. The reference values for the Finnish participants in this study are presented.Peer reviewe

On-field signs of concussion predict deficits in cognitive functioning: Loss of consciousness, amnesia, and vacant look

The usefulness of on-field signs in predicting concussion outcome is under debate. We studied the prevalence of these signs and analyzed the predictive value for post-injury cognitive recovery in Finnish elite-level youth ice hockey players. Of the 570 consecutive athletes, 52 were concussed during seasons 2015-2017. After exclusion criterion analysis included 34 hockey players (14-20 years-old). Follow-up assessment was performed seven days post-injury and compared with pre-injury baseline. Cognitive performance was assessed using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT (R)) battery. Hierarchical regression analyses were conducted to examine the relationship between on-field signs of concussion and the post-injury change in cognitive performance. The findings indicated that on-field loss of consciousness, amnesia, and vacant look were associated with larger decrements in cognition. Loss of consciousness accounted for 22% of the variance in verbal memory scores; amnesia accounted for 15% of the variance in verbal memory scores, and the presence of vacant look accounted for 9% of the variance in visual memory performance. The presence of loss of consciousness, amnesia, or vacant look is risk factors for longer recovery times and predict the need for extended cognitive follow-up

On-field signs of concussion predict deficits in cognitive functioning: Loss of consciousness, amnesia, and vacant look

https://doi.org/10.1002/tsm2.179Abstract The usefulness of on-field signs in predicting concussion outcome is under debate. We studied the prevalence of these signs and analyzed the predictive value for post-injury cognitive recovery in Finnish elite-level youth ice hockey players. Of the 570 consecutive athletes, 52 were concussed during seasons 2015-2017. After exclusion criterion analysis included 34 hockey players (14-20 years-old). Follow-up assessment was performed seven days post-injury and compared with pre-injury baseline. Cognitive performance was assessed using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT?) battery. Hierarchical regression analyses were conducted to examine the relationship between on-field signs of concussion and the post-injury change in cognitive performance. The findings indicated that on-field loss of consciousness, amnesia, and vacant look were associated with larger decrements in cognition. Loss of consciousness accounted for 22% of the variance in verbal memory scores; amnesia accounted for 15% of the variance in verbal memory scores, and the presence of vacant look accounted for 9% of the variance in visual memory performance. The presence of loss of consciousness, amnesia, or vacant look is risk factors for longer recovery times and predict the need for extended cognitive follow-up.Peer reviewe