Ethically we can no longer sit on the fence - a neuropsychological perspective on the cerebrally hazardous contact sports

Background and objective. The number of male and female contact sport participants is increasing worldwide. The aim of the review is to discuss the potential for deleterious sequelae of sports concussion (mild traumatic brain injury (MTBI)), and management thereof. Discussion. Incidence of concussion in the field contact sports is high, not only for boxing, but also for soccer, football and especially rugby. An overview of studies investigating persistent deleterious cognitive and symptomatic outcome following cumulative sports MTBI suggests that individuals may be at risk for permanent neurological damage following participation in a contact sport. Established sequelae of traumatic brain injury (TBI) typically involving frontal systems include cognitive decline, behavioural changes such as diminished self-regulation and aggression, and increased risk for Alzheimer's disease. The presence of such consequences hidden within the context of the widely popularised contact sports, has societal implications that should be acknowledged. Compromised scholastic abilities and enhanced aggressive tendencies in association with sports MTBI are in need of further longitudinal research. Conclusion. A comprehensive preventive approach to the management of MTBI in sport is advocated that includes professionally applied neuropsychological assessment as a crucial component. Future policy considerations are the introduction of mandatory informed consent for participation in a high-risk contact sport such as rugby, particularly at youth level, and financial provision for concussion management amongst economically disadvantaged populations. South African Journal of Sports Medicine Vol. 19 (2) 2007: pp. 32-3

Ethically we can no longer sit on the fence - a neuropsychological perspective on the cerebrally hazardous contact sports

Background and objective. The number of male and female contact sport participants is increasing worldwide. The aim of the review is to discuss the potential for deleterious sequelae of sports concussion (mild traumatic brain injury (MTBI)), and management thereof. Discussion. Incidence of concussion in the field contact sports is high, not only for boxing, but also for soccer, football and especially rugby. An overview of studies investigating persistent deleterious cognitive and symptomatic outcome following cumulative sports MTBI suggests that individuals may be at risk for permanent neurological damage following participation in a contact sport. Established sequelae of traumatic brain injury (TBI) typically involving frontal systems include cognitive decline, behavioural changes such as diminished self-regulation and aggression, and increased risk for Alzheimer's disease. The presence of such consequences hidden within the context of the widely popularised contact sports, has societal implications that should be acknowledged. Compromised scholastic abilities and enhanced aggressive tendencies in association with sports MTBI are in need of further longitudinal research. Conclusion. A comprehensive preventive approach to the management of MTBI in sport is advocated that includes professionally applied neuropsychological assessment as a crucial component. Future policy considerations are the introduction of mandatory informed consent for participation in a high-risk contact sport such as rugby, particularly at youth level, and financial provision for concussion management amongst economically disadvantaged populations. South African Journal of Sports Medicine Vol. 19 (2) 2007: pp. 32-3

Cerebral damage in diving: Taking the cue from sports concussion medicine

Within the compressed gas diving arena there is a risk of cerebral damage with deleterious neuropsychological sequelae in association with decompression illness (DCI), hypoxia, gas toxicity, as well as the cumulative subclinical effect of ‘silent’ paradoxical gas embolisms, the last being an area of growing concern. However, within diving medicine there is little evidence of the regular use of neuropsychological evaluation to monitor brain-related sequelae of frequent diving activity. In contrast, in recent years there has been an explosion of interest in the management of sports concussive injury, including emphasis on the pivotal role ofneuropsychological evaluation within that context. Taking the cue from sports concussion medicine, it is proposed that there is an urgent need to incorporate neurocognitive baseline and follow-up screening as a core component in the medical management of those involved in intensive commercial and recreational compressed air diving activities. The objective would be to facilitate (i) accurate neurodiagnostic follow-up of frank DCI or an identifiable hypoxic or toxic incident; (ii) timeous identification of cumulative deleterious effects of repetitive subclinical hypoxic/toxic incidents and/or ‘silent’ paradoxical gas embolisms that might affect them in later life; and (iii) disability assessment following any such eventsor the combination thereof for rehabilitation and compensation purposes

Dual-tasking and gait in people with Mild Cognitive Impairment. The effect of working memory

<p>Abstract</p> <p>Background</p> <p>Cognition and mobility in older adults are closely associated and they decline together with aging. Studies evaluating associations between cognitive factors and gait performance in people with Mild Cognitive Impairment (MCI) are scarce. In this study, our aim was to determine whether specific cognitive factors have a more identifiable effect on gait velocity during dual-tasking in people with MCI.</p> <p>Methods</p> <p>Fifty-five participants, mean age 77.7 (SD = 5.9), 45% women, with MCI were evaluated for global cognition, working memory, executive function, and attention. Gait Velocity (GV) was measured under a single-task condition (single GV) and under two dual-task conditions: 1) while counting backwards (counting GV), 2) while naming animals (verbal GV). Multivariable linear regression analysis was used to examine associations with an alpha-level of 0.05.</p> <p>Results</p> <p>Participants experienced a reduction in GV while engaging in dual-task challenges (p < 0.005). Low executive function and working memory performances were associated with slow single GV (p = 0.038), slow counting GV (p = 0.017), and slow verbal GV (p = 0.031). After adjustments, working memory was the only cognitive factor which remained significantly associated with a slow GV.</p> <p>Conclusion</p> <p>In older adults with MCI, low working memory performance was associated with slow GV. Dual-task conditions showed the strongest associations with gait slowing. Our findings suggest that cortical control of gait is associated with decline in working memory in people with MCI.</p

The cross-cultural utility of foreign- and locally-derived normative data for three WHO-endorsed neuropsychological tests for South African adolescents

Interpretation of neuropsychological tests may be hampered by confounding sociodemographic factors and by using inappropriate normative data. We investigated these factors in three tests endorsed by the World Health Organization: the Grooved Pegboard Test (GPT), the Children's Color Trails Test (CCTT), and the WHO/UCLA version of the Auditory Verbal Learning Test (AVLT). In a sample of 12-15-year-old, Afrikaans- and English-speaking adolescents from the Cape Town region of South Africa, analyses of covariance (ANCOVAs) demonstrated that quality of education was the sociodemographic factor with the biggest influence on test performance, and that age also significantly influenced GPT and CCTT performance. Based on those findings, we provide appropriately stratified normative data for the age group in question. Comparisons between diagnostic interpretations made using foreign normative data versus those using the current local data demonstrate that it is imperative to use appropriately stratified normative data to guard against misinterpreting performance