The Female Athlete: The Role of Gender in the Assessment and Management of Sport-Related Concussion

Concussions remain a serious public health concern, with approximately 1.6 million to 3 million sport and recreational traumatic and brain injuries occurring every year in the United States. Most research on concussions has been conducted on male athletes, specifically, football players. However, female sport participation has steadily increased over the past decade. Recent studies suggest that the incidence of and recovery from sport-related concussion varies between male and female athletes, with women having a higher risk of sustaining a concussion and taking a longer time to recover than men. As a result, this article addresses the role of gender in the assessment and management of sport-related concussion

The Role of Age and Sex in Symptoms, Neurocognitive Performance, and Postural Stability in Athletes After Concussion

Background: Researchers have begun to focus on age and sex differences in concussion outcomes. Results suggest that younger athletes and female athletes may take longer to recover from a concussion. However, little is known about the interactive effects of age and sex on symptoms, neurocognitive testing (NCT), and postural stability. Hypothesis/Purpose: The purpose of the study was to examine sex and age differences in symptoms, NCT, and postural stability following concussion. We hypothesized that high school and female athletes would have worse symptoms, NCT, and postural stability than college and male athletes, respectively. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 296 concussed athletes from a multistate, 2-year study were enrolled in this study. Participants completed the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) and Post-Concussion Symptom Scale (PCSS) at baseline and again at 2, 7, and 14 days after concussion. Participants completed the Balance Error Scoring System (BESS) at 1, 2, and 3 days after concussion. Results: Female athletes performed worse than male athletes on visual memory (mean, 65.1% and 70.1%, respectively; P = .049) and reported more symptoms (mean, 14.4 and 10.1, respectively) after concussion ( P = .035). High school athletes performed worse than college athletes on verbal (mean, 78.8% and 82.7%, respectively; P = .001) and visual (mean, 65.8% and 69.4%, respectively; P = .01) memory. High school athletes were still impaired on verbal memory 7 days after concussion compared with collegiate athletes ( P = .001). High school male athletes scored worse on the BESS than college male athletes (mean, 18.8 and 13.0, respectively; P = .001). College female athletes scored worse on the BESS than high school female athletes (mean, 21.1 and 16.9, respectively; P = .001). Conclusion: The results of the current study supported age differences in memory and sex differences in memory and symptoms and an interaction between age and sex on postural stability after concussion that warrant consideration from clinicians and researchers when interpreting symptoms, specific components of NCT, and postural stability tests. Future research should develop and assess interventions tailored to age and sex differences and include younger (&lt;14 years) participants. </jats:p

Tracking Neurocognitive Performance Following Concussion in High School Athletes

Objective: To extend previous research designs and examine cognitive performance up to 30 days postconcussion. Method: A prospective cohort design was used to examine 2000 athletes from 8 mid-Michigan area high schools to compare baseline neurocognitive performance with postconcussion neurocognitive performance. All concussed athletes were readministered the Immediate Post Assessment and Cognitive Test (ImPACT) at 2, 7, 14, 21, and 30 days postconcussion. Results: A total of 72 high school athletes (aged 15.8 ± 1.34 years) sustained a concussion. A significant within-subjects effect for reaction time (F = 10.01; P= 0.000), verbal memory (F = 3.05; P = 0.012), motor processing speed (F= 18.51; P = 0.000), and total symptoms following an injury (F= 16.45; P= 0.000) was found. Concussed athletes demonstrated a significant decrease in reaction time up to 14 days postconcussion (P = 0.001) compared with baseline reaction time. Reaction time returned to baseline levels at 21 days postinjury (P = 0.25). At 7 days postinjury, impairments in verbal memory (P= 0.003) and motor processing speed (P= 0.000) were documented and returned to baseline levels by 14 days postinjury. Concussed athletes self-reported significantly more symptoms at 2 days postconcussion (P = 0.000) and exhibited a resolution of symptoms by 7 days postinjury (P = 0.06). Conclusion: High school athletes could take up to 21 days to return to baseline levels for reaction time. These data support current recommendations for the conservative management of concussion in the high school athlete

One-Year Test-Retest Reliability of the Online Version of ImPACT in High School Athletes

Background: The ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) neurocognitive testing battery is a popular assessment tool used for concussion management. The stability of the baseline neurocognitive assessment is important for accurate comparisons between postconcussion and baseline neurocognitive performance. Psychometric properties of the recently released online version of ImPACT have yet to be established; therefore, research evaluating the reliability of this measure is warranted.Purpose: The authors investigated the 1-year test-retest reliability of the ImPACT online version in a sample of high school athletes.Study Design: Case series; Level of evidence, 4Methods: A total of 369 varsity high school athletes completed 2 mandatory preseason baseline cognitive assessments approximately 1 year apart as required by their respective athletics program. No diagnosed concussion occurred between assessments.Results: Intraclass correlation coefficients (ICCs) for ImPACT online indicated that motor processing speed (.85) was the most stable composite score, followed by reaction time (.76), visual memory (.70), and verbal memory (.62). Unbiased estimates of reliability were consistent with ICCs: motor processing speed (.85), reaction time (.76), visual memory (.71), and verbal memory (.62).Conclusion: The online ImPACT baseline is a stable measure of neurocognitive performance across a 1-year time period for high school athletes. These reliability data for online ImPACT are higher than the 2-year ICCs previously reported from the desktop version.Clinical Relevance: It is recommended that the ImPACT baseline assessment (both desktop and online) continue to be updated every 2 years. The online version of ImPACT appears to be a stable measure of neurocognitive performance over a 1-year period, and systematic evaluation of its stability over a 2-year period is warranted

The Female Athlete: The Role of Gender in the Assessment and Management of Sport-Related Concussion

Recent estimates from the Centers for Disease Control and Prevention indicate that sport and recreational traumatic brain injuries (TBIs) have increased from 300,000 per year 1 to approximately 1.6 million to 3 million per year in the United States. 2 This trend suggests that concussions are a growing problem that affects athletes at both the high school and collegiate level. An increase in female participation in sport shows that there are currently more than 178,000 women participating on National Collegiate Athletic Association (NCAA) teams 3 and approximately 3 million women playing organized high school sports. GENDER DIFFERENCES IN THE EPIDEMIOLOGY OF SPORT-RELATED CONCUSSIONS Several researchers have identified differences in the incidence of sport-related concussion among collegiate athletes of different genders. Covassin and colleagues 5 examined NCAA injury data from 1997 to 2000 and found collegiate female athletes to The authors have nothing to disclose

Relationship of soccer heading to computerized neurocognitive performance and symptoms among female and male youth soccer players

Primary objective: The purpose of this study was to investigate the relationship between soccer heading and computerized neurocognitive performance and symptoms in female and male youth soccer players. Research design: Cross-sectional and prospective design. Methods and procedures: A total of 63 (27 females, 36 males) youth soccer players aged 13–18 years (M?= ?15.89, SD?=?1.17) participated in the study. Participants completed the Immediate Post-concussion Assessment and Cognitive Test (ImPACT) and symptom report. Main outcomes: Computerized neurocognitive performance (e.g., verbal and visual memory, motor processing, and reaction time) and symptoms. Results: There were no differences in neurocognitive performance or symptoms among low-, moderate-, and high-exposure header groups. The current sample outperformed the 10th percentile norms for neurocognitive and symptom scores. Males headed the ball more frequently and reported lower verbal and visual memory and motor processing speed scores than females. Conclusion: The current findings did not support a relationship between soccer heading and computerized neurocognitive performance and symptoms. The researchers suggest that any purported effects of soccer heading in youth are subtle and may affect only a small number of athletes. The reported sex differences in heading exposure warrant further attention

Individual and combined effects of LD and ADHD on computerized neurocognitive concussion test performance: Evidence for separate norms

Decreased neurocognitiveperformance in individualswith self-reported attention deficit hyperactivity disorder (ADHD) and learningdisabil-ity (LD) is well documented in the neuropsychological research literature. Previous studies employing paper-and-pencil neurocognitive assess-ments report lower performance in individuals with ADHD and LD. The purpose of the current study was to examine the influence of a self-reported diagnosis of LD, ADHD, and combined LD/ADHD on baseline computerized neurocognitive testing (CNT) used for the concussion assessment. Results revealed athletes with a self-reported diagnosis of LD, ADHD, and/or combined LD/ADHD demonstrated lower perform-ance on baseline CNT and reported larger numbers of symptoms than did control athletes without these diagnoses. These findings provide evi-dence for the development of separate normative data for athleteswith LD,ADHD, and LD/ADHDdiagnoses on CNT batteries commonly used for concussion management

Sex differences in vestibular/ocular and neurocognitive outcomes after sport-related concussion

Objective: To examine sex differences in vestibular and oculomotor symptoms and impairment in athletes with sport-related concussion (SRC). The secondary purpose was to replicate previously reported sex differences in total concussion symptoms, and performance on neurocognitive and balance testing. Design: Prospective cross-sectional study of consecutively enrolled clinic patients within 21 days of a SRC. Setting: Specialty Concussion Clinic. Participants: Included male (n = 36) and female (n = 28) athletes ages 9 to 18 years. Interventions: Vestibular symptoms and impairment was measured with the Vestibular/Ocular Motor Screening (VOMS). Participants completed the Immediate Post-concussion Assessment and Cognitive Test (ImPACT), Post-concussion Symptom Scale (PCSS), and Balance Error Scoring System (BESS). Main Outcomes Measures: Sex differences on clinical measures. Results: Females had higher PCSS scores (P = 0.01) and greater VOMS vestibular ocular reflex (VOR) score (P = 0.01) compared with males. There were no sex differences on BESS or ImPACT. Total PCSS scores together with female sex accounted for 45% of the variance in VOR scores. Conclusions: Findings suggest higher VOR scores after SRC in female compared with male athletes. Findings did not extend to other components of the VOMS tool suggesting that sex differences may be specific to certain types of vestibular impairment after SRC. Additional research on the clinical significance of the current findings is needed