The study is the first to provide a direct comparison of neurocognitive recovery in professional and younger athletes, within days of concussion occurrence, by using a computerized neurocognitive testing tool, ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). The project highlights the NFL's ongoing effort to study recovery from concussion.
NFL Athletes vs. High School Athletes
NFL athletes in this study demonstrated a rapid neuropsychological recovery following concussion. As a group, NFL players returned to pre-injury baseline neurocognitive performance in one week, with the majority of athletes having normal performance two days after injury. By comparison, the high school athletes demonstrated a slower injury recovery and longer lasting neuropsychological effects from concussions than the NFL athletes, according to study principal investigator Elliott Pellman, M.D., who is chairman of the NFL MTBI committee. "The most dramatic difference was evident on tests measuring reaction time and speed: NFL athletes demonstrated rapid return to expected normal levels of functioning while the high school group lagged behind," reported Dr. Pellman.
"This project is an example of how research at the NFL level is providing valuable information to help improve injury management at all levels of competition as well as directly contributing to the care of the NFL athlete," he added.
"Results of this study support previously published findings that indicate that NFL athletes recover quickly. We evaluated the athletes by using formal tests of reaction time, concentration and memory," said Mark Lovell, Ph.D., director of neuropsychological testing for the NFL and director of the University of Pittsburgh Medical Center's (UPMC) Sports Medicine Concussion Program.
"These current findings also underscore the critical need for careful evaluation and management of concussions in younger athletes and caution in not allowing a concussed young athlete to return to play until they have recovered," Dr. Lovell stressed.
A concussion is any alteration in mental status resulting from the brain being jolted inside of the skull due to a blow to the head or upper body. Symptoms can include amnesia, dizziness, confusion, headache, nausea, disorientation, and sometimes loss of consciousness. "Generally, an athlete who sustains an initial concussion can fully recover as long as the brain has had time to heal before sustaining another hit," explained Dr. Lovell. "The tricky part is that concussion signs and symptoms are not always straightforward and the effects and severity of injury and safe return-to-play can be difficult to determine. Thus the need for careful clinical evaluation of symptoms and objective assessment of neurocognitive function with testing methods such as ImPACT."
ImPACT, developed by Dr. Lovell and colleagues at UPMC, is the most widely used computerized neurocognitive function test battery that athletes can complete on a laptop or desktop computer within about 30 minutes. In addition to the NFL, who initially pioneered the use of computer-based testing in sports, ImPACT also is used throughout numerous sports including automobile racing, ice hockey, soccer, rugby, skiing and snow boarding. It can precisely measure even the subtle effects of a concussion, such as decline in memory, information processing speed and reaction time, as well as symptom levels. Athletes can take an individual pre-season baseline test and store the data to use for comparison to post-injury test scores, if the athlete should sustain a concussion during the season.
Among the potential reasons for the difference between professional and high school athletes, the current study authors suggest, include neuro-developmental factors that may put children at greater risk and different tolerance levels between the two groups. Also, NFL players are a highly select population of elite, conditioned and skilled athletes who may be less prone to injury than less athletically conditioned and skilled amateur athletes.
NFL Advancing the Scientific Study of Concussion
This study is one in a series of 12 scientific investigations by the NFL's MTBI Committee published in Neurosurgery over the last several years. The last decade has witnessed rapid development of new innovative concussion management strategies in the NFL, including the implementation of computerized neuropsychological testing to easily and quickly provide team physicians and athletic trainers with unique objective data to aid in standard clinical assessment of concussion effects, recovery and safe return-to-play, according to Dr. Pellman.
"Neuropsychological testing can assist team physicians in their comprehensive medical evaluation of injured athletes by providing quantitative information on recovery from concussion and diagnostic information regarding subtle disruptions of cognitive processes such as attention, memory and speed that may not be detected by a cursory sideline evaluation and may not be recognized or admitted by the injured athlete himself," explained Dr. Lovell.
"Today, every NFL team is using some form of neuropsychological testing, and we anticipate that future studies will allow for even more sophisticated study of this group of elite athletes," added Dr. Pellman.
This study was funded by NFL Charities and was conducted under the auspices of the NFL Committee on Mild Traumatic Brain Injury chaired by Dr. Pellman. For more information on ImPACT, go to www.impacttest.com.