Effects of computerized neurocognitive testing for high school athletes with concussions

Athletes given neurocognitive tests are less likely to be returned to play within 10 days of injury

December 20, 2011

Boston, Mass. – Approximately 40 percent of United States (U.S.) high schools use computerized neurocognitive tests when assessing sport-related concussions, a dramatic increase over previous years, according to researchers at Children’s Hospital Boston. These neurocognitive assessments can help ensure that an athlete has completely recovered from a concussion before going back on the field.

Reported online in Pediatrics by William Meehan, III, MD, of the Sports Concussion Clinic at Boston Children's Hospital and with colleagues at Nationwide Children's Hospital, the findings arise from a national study of injured athletes at U.S. high schools and a survey of athletic trainers employed by those highs schools.

Awareness of the problem of concussions in young athletes has grown dramatically in recent years, as medical practitioners better understand the long-term effects of sustaining multiple concussions. Computerized neurocognitive assessments offer an objective means of monitoring recovery.

In their study, Meehan and his colleagues showed that athletes whose concussions are managed using computerized neurocognitive assessments are less likely to be returned to sports within 10 days of their injury, suggesting that the computerized assessments detect persistent symptoms or problems with brain function that traditional clinical assessments do not reveal.

While most U.S. high schools are not using computerized neurocognitive assessments, Meehan notes that, “Our study shows that the proportion of concussed athletes receiving computerized neurocognitive testing has increased from 26 percent in the 2008-2009 academic year to 40 percent during the 2009-2010 academic year. I suspect this number will continue to rise,” he said.

The researchers note that there are several computerized neurocognitive assessments available, although they found that 93 percent of the schools employing these tests use ImPACT, a program developed at the University of Pittsburgh Medical Center.

There is some controversy regarding exactly who should interpret the results of these tests. The study team found that physicians and athletic trainers interpret the vast majority of these tests, while a neuropsychologist carries out the interpretation in only 17 percent of cases.

“Ideally, every concussed athlete would be assessed by an athletic trainer, a physician, and a neuropsychologist,” Meehan concluded. “But given the large number of athletes sustaining concussions, and the relative scarcity of neuropsychologists, that is simply not possible.” Thus, the study emphasizes the need to train other medical professionals to administer and interpret computerized neurocognitive tests for the limited purpose of assessing sport-related concussions. However, Meehan cautions, “no athletic trainer, physician, or neuropsychologist should attempt to interpret these assessments without first undergoing proper training.”    

The study was supported by the national Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the U.S. Center for Disease Control and Prevention (CDC), the National Federation of State High School Associations, the National Operating Committee on Standards for Athletic Equipment, EyeBlack, and Don-Joy Orthotics.

Erin Tornatore

Children’s Hospital Boston is home to the world’s largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 1,100 scientists, including nine members of the National Academy of Sciences, 11 members of the Institute of Medicine and nine members of the Howard Hughes Medical Institute comprise Children’s research community. Founded as a 20-bed hospital for children, Children’s Hospital Boston today is a 395 bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Children’s also is the primary pediatric teaching affiliate of Harvard Medical School. For more information about research and clinical innovation at Children’s, visit: http://vectorblog.org.