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Importance of obtaining a psychiatric history in managing sports concussions among adolescents: case study

Archives of Clinical Neuropsychology. 2005 Oct;

20(6):933.

Kirk, J. W., M. Zacharewicz, C. Pierce and S. Schmitz.

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Abstract:

Objective: To examine the utility of obtaining a thorough psychiatric/medical history when interpreting ImPACT data for determining Return to Play (RTP). Method: Sixteen years old football player, who sustained a concussion, with no LOC, retrograde or anterograde amnesia, but confused/disoriented for up to 30 min and symptoms resolved within 4 days. Premorbid history indicated OCD, motor tic disorder, and one previous concussion. Athlete completed baseline testing, post-concussive testing (1, 9, and 14 days post-injury), and neuropsychological evaluation when neurocognitive symptoms resolved (to determine special education programming for previous academic/psychiatric difficulties). Results: Baseline ImPACT indicated significant post-concussive symptoms with an elevation and eventual decrease over post-concussion testing. Baseline ImPACT revealed deficient Visual Memory (1st percentile) and Visual–Motor Speed (1st percentile) with average Reaction Time (33rd percentile) and low average Verbal Memory (21st percentile). Serial post-concussive testing revealed a “traditional” recovery curve for reaction time, while verbal memory, visual memory, and visual motor speed only improved to the borderline-low average range by day 14. Neuropsychological data revealed average verbal intellectual skills and borderline non-verbal intellectual skills (WAIS-III, VIQ = 96, PIQ = 75), in the context of inattention and executive dysfunction (TOVA Omission, SS < 40, Variability, SS = 84; D-KEFS, TMT-4, ScS = 3; Tower Test Achievement, ScS = 4). Conclusion: Findings indicate a psychiatric history complicates baseline performance with elevated symptoms and deficient performance among certain ImPACT composites, compromising the utility of change in scores. A thorough clinical interview provides relevant historical information essential for determining RTP status.

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