Neuropsychological Testing For Concussions

Several recent studies have demonstrated the value of neuropsychological testing in evaluating the cognitive effects of and recovery from sport-related concussions. Such testing has become increasingly popular in recent years, so much so that it is now, according to the 2004 Prague consensus statement, a "cornerstone" of concussion evaluation, at least for "complex" concussions (e.g. those where athletes suffer persistent post-concussion symptoms, experience concussive convulsions or prolonged loss of consciousness or have suffered repeated concussions over time or with progressively less impact force).

Baseline pre-injury and post-injury testing is now commonplace at the professional and collegiate level and has become more and more common at the high school level as well (although the cost, either conventional or computerized, is a factor in how widely such testing can be implemented at the high school level).

Pen-and-paper tests

Standard pencil and paper neuropsychological tests (see box) have proven useful for identifying cognitive deficits resulting from concussions, and have been available to sports medicine clinicians for several years. These tests are designed to assess various domains of cognitive functioning such as short-term memory, working memory, attention, concentration, visual spatial capacity, information processing speed, and reaction time. The tests assist clinicians in quantifying the severity of the injury and eliminating some of the guesswork. The key to a successful testing program is having results from pre-season baseline testing for comparison to post-injury results.

Because most states require advance training and licensing to purchase and use neuropsychological tests, and they are copyright protected, the NATA's 2004 Position Statement recommends that a licensed psychologist, preferably board-certified in clinical neuropsychology or with clinical experience in evaluating sport-related concussions, oversee and supervise the testing. These requirements are, unfortunately, likely to restrict how widely testing can be implemented at the high school level and in rural areas where access to neuropsychologists for consultation is likely to be limited.