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Neuropsychological tests assess memory, attention, reasoning and other cognitive skills in order to determine if a person is suffering TBI. This form of testing is typically indicated in cases of complex concussions.1. Previous concussions, depression, anxiety, medication use, sleep disturbance or other factors can slow recovery or masquerade as concussion symptoms.
Detailed neuropsychological testing is employed more often at the professional level and in research in athletes with mTBI.
When evaluating an athlete's performance on the neuropsychological tests, it is best to compare results with the athlete's previous tests.
Optimally a baseline test.
The problem with this type of testing is that it is predominantly qualitative and subjective in nature, meaning progress cannot be accurately tracked. Furthermore, the tests are open to cheating or ‘sandbagging’, whereby the patient intentionally performs the baseline test (pre-injury) at an inferior level, meaning that if concussed the follow-up test will not markedly differ from the baseline.
While many concussion symptom scales and sideline assessment tools exist, there is no single agreed-upon "best" concussion symptom scale or sideline assessment tool, and their development largely has outpaced investigation into their psychometric properties.
It is vital to treat each concussion individually, using as much objective information as feasibly can be obtained and whenever possible comparing post-injury results to the athlete's own individual baseline status. It also is critical that individual factors such as gender, medications, concussion history and fatigue be taken into account when interpreting the test results. Most importantly, baseline tests should be obtained in a similar environment and under similar conditions as will be used for post-injury testing.2.
Most published tools do not meet the scientific criteria classically associated with the term "robustness," which implies that core measurement properties like reliability, validity, sensitivity, and specificity have not always been established systematically before being made available for widespread use.3.
This generally involves a neuropsychological test(s). Previous concussions, depression, anxiety, medication use, sleep disturbance or other factors can slow recovery or masquerade as concussion symptoms.
The neuropsychological test(s) will assess memory, attention, reasoning and other cognitive skills. Personality and mood tests can help the neuropsychologist understand if psychological factors are at work. Results of this evaluation will help identify ongoing cognitive impairments and specify what abilities have been most affected. Repeat testing can be useful to document improvement over time.
A neuropsychologist will provide psycho-education, teaching patients about common concussion symptoms and normal recovery patterns. For cases in which patients develop an abnormal focus on their symptoms or other problems, cognitive behavioural therapy can help.
In more serious cases, neuropsychologists may suggest a rehabilitation program. In this kind of treatment, patients practice memory, reasoning and other cognitive skills to retrain the brain, just like they might undergo rehab for a physical injury. The treatment may consist of computerised training at the neuropsychologist’s office and focused practice at home.
Detailed neuropsychologic testing is employed more often at the professional level and in research in athletes with mTBI.
When evaluating an athlete's performance on the neuropsychologic tests, it is best to compare results with the athlete's previous tests.
The National Hockey League (NHL), National Football League (NFL), Major League Baseball (MLB) as well as many college teams are utilising limited neuropsychologic testing to document the possible prolonged effects of presumed minor head injuries and to assist the clinician in determining possible retirement issues.
Neuropsychologic testing is indicated in cases of complex concussions.4.
1. McCrory P, Johnston K, Meeuwisse W, et al. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Br J Sports Med. 2005 Apr. 39(4):196-204.
2. James T. Eckner, Jeffrey S. Kutcher Concussion Symptom Scales and Sideline Assessment Tools: A Critical Literature Update. Curr, Sports Med. Rep., Vol, 9, No, 1, pp, 8-15, 2010,
3. Alia S, Sullivan SJ, Hale L, et al. Self-report scales/checklists for the measurement of concussion symptoms: a systematic review. Br. } . Sports Med. 2009a; 43(Suppl. I):i3-il2.
4. McCrory P, Johnston K, Meeuwisse W, et al. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Br J Sports Med. 2005 Apr. 39(4):196-204.