Tracking neuropsychological recovery following concussion

British Journal of Sports Medicine. 2004 Oct;


Iverson, G. L., M. W. Collins, M. Gaetz and M. R. Lovell.



Introduction: The purpose of this study was to illustrate the serial use of computerized neuropsychological screening with ImPACT to monitor recovery in individual athletes. Method: Amateur athletes with concussions (n = 30, average age = 16.1, SD = 2.1 years) underwent preseason testing and three post- concussion evaluations within the following intervals: 1–2 days, 3–7 days (M = 5.2 days), and 1–3 weeks (M = 10.3 days). Results: Repeated Measures ANOVAs revealed significant main effects for all five composite scores. Compared to preseason, verbal memory scores were significantly lower at 1 day (Cohen’s d = 1.0 large effect size) and 5 days (d = 0.60, medium effect), but not at 10 days post injury. Visual memory and processing speed scores were significantly lower at 1 day (d = 0.53 and 1.1, respectively) but not at 5 or 10 days. Reaction time scores were significantly slower at 1 day (d = 1.2) and 5 days (d = 0.61), but not 10 days. Total postconcussion symptom scores were significantly greater at 1 day (d = 1.5), but not at 5 or 10 days. Athletes’ scores were examined individually using the reliable change methodology. At 1 day post injury, 90% had two or more reliable declines in performance or increases in symptom reporting. At 10 days 37% were still showing two or more reliable changes from preseason levels. Discussion: In group analyses, problems relating to concussion appeared to largely resolve by 5 days post injury and fully resolve by 10 days. Analysis of individual athletes, however, revealed that 37% continued to suffer adverse effects at 10 days post injury. Notably, the study selection criteria increased the probability of including athletes with more severe concussions. This study clearly illustrates how group analyses can obscure slowed recovery in a substantial minority of athletes.

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