Too little sleep skews concussion testing results

Garbage in, garbage out. 

I tell my patients that, if they are going to do computerized concussion testing, make sure the testing setting is optimal AND interpreted by a neurologist or psychology specialist. 

Why would you want to compare your POST-CONCUSSION test to a poor baseline?

JR

A new study shows getting too little sleep the night before baseline testing for concussions can skew results and make future concussions seem less serious.

Getting too little sleep the night before undergoing baseline concussion testing can skew results, a new study finds.

Baseline concussion testing depicts an athlete's basic mental abilities, such as reaction time, working memory and attention span. Athletes who suffer a concussion retake the test, and if there is a large decrease in the score, they are typically banned from play until their score improves.

The study included more than 3,600 high school- and college-aged participants who were divided into three groups based on their amounts of self-reported sleep the night before baseline testing: fewer than 7 hours, 7 to 9 hours, and more than 9 hours.

The athletes who slept fewer than 7 hours the night before testing had significantly lower scores than expected on reaction time, verbal memory and visual memory. They also had significant differences in the total number of reported symptoms, compared to those in the other two groups, the study authors noted.

The study was scheduled for presentation Saturday at the annual meeting of the American Orthopaedic Society for Sports Medicine in Chicago.

"Understanding factors which modify baseline testing, potentially including sleep, will continue to help lead to more accurate concussion testing, which ultimately equips clinicians with the best judgment to avoid returning athletes to competition earlier than necessary," one of the researchers, Jake McClure of Vanderbilt University in Nashville, Tenn., said in a society news release.

The data and conclusions of research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

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Computerized Tests For Concussions May Be Unreliable

Concussion testing is a neuropsychological test. Schools are collecting this data on children at baseline often using non-standard methods.  I have been advocating using post-concussive testing as one component of an expert medical examination. The results must be interpreted in light of the individuals neurologic examination.  Are you going to trust your child's brain to a computer program alone?  JR

Schools worried about concussions increasingly use computerized tests to tell if a student athlete has a brain injury. But new research says those tests aren't reliable enough to diagnose concussion, or to tell if it's safe to return to play.

The researchers looked at research on one computerized neuropsychologist test, called ImPACT, that is widely used by colleges and high schools. (Here's one NPR story on how high schools use ImPACT to assess concussions.)

It's also used by the National Football League and National Hockey League.

But very few studies have been done on the reliability of these tests in real-world situations.

So Lester Mayers, a sports medicine doctor at Pace University in Pleasantville, N.Y., and Tom Redick, an assistant professor of psychology at Indiana University-Purdue University in Columbus, Ind., surveyed the data. They weren't happy with what they found. They say computerized tests aren't reliable enough to serve as the sole measure of brain health.

"I'm not suggesting abandoning the whole practice," Redick told Shots. "But I do think that we want to be sure we're not using something just because it's popular." Theirwork is published in the current Journal of Clinical and Experimental Neuropsychology.

One issue with the computerized testing is the length of time that passes from when a healthy athlete takes a baseline test, and when they're tested after a suspected concussion.

After a few weeks, the test becomes increasingly unreliable, the review found. That's an issue because the manufacturers recommend testing athletes twice in high school, and once in college. "This increases the likelihood that a true cognitive impairment will be missed," the authors write.

Another issue is how reliable the tests are in determining when it's safe for an athlete to return to play without risking further brain damage. Just three studies looked at that. Those studies were very small, and the results inconsistent, the authors report. They write:

"We therefore question the rationale of using ImPACT for clinical management of sport-related concussion and specifically for determining the time of return to play."

There is no gold standard for figuring out when an athlete is safe to return to play, Redick says, which makes it hard for coaches, parents, and athletes to know what to do. But computerized testing is not the solution to that problem.

The U.S. military has invested millions into computerized testing service members for traumatic brain injury, but that program has been a debacle, according to aninvestigative report last November by NPR and ProPublica. Researchers say the computerized test used, called ANAM, isn't robust enough to screen for problems that could continue weeks or months after a brain injury.

Last August, the American Academy of Pediatrics said that parents shouldn't let children box, urging parents to recommend sports "that do not encourage intentional head injuries."

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Trends in Concussion Incidence in High School Sports: A Prospective 11-Year Study.

ABSTRACT: Trends in Concussion Incidence in High School Sports: A Prospective 11-Year Study.

Lincoln AE, Caswell SV, Almquist JL, Dunn RE, Norris JB, Hinton RY.
Sports Medicine Research Center, MedStar Health Research Institute, Baltimore, Maryland.
PURPOSE: To examine the incidence and relative risk of concussion in 12 high school boys' and girls' sports between academic years 1997-1998 and 2007-2008.

CONCLUSION: Although the collision sports of football and boys' lacrosse had the highest number of concussions and football the highest concussion rate, concussion occurred in all other sports and was observed in girls' sports at rates similar to or higher than those of boys' sports. The increase over time in all sports may reflect actual increased occurrence or greater coding sensitivity with widely disseminated guidance on concussion detection and treatment. The high-participation collision sports of football and boys' lacrosse warrant continued vigilance, but the findings suggest that focus on concussion detection, treatment, and prevention should not be limited to those sports traditionally associated with concussion risk.

Read the full abstract here.

 keywords: what a concussion, what is concussion, a concussion, symptoms concussion, symptoms for concussion, concussion symptoms, symptoms of concussion, signs concussion, size for concussion, concussion signs, it's

House butts heads over concussion bill
Associated Press - February 24, 2011 4:55 PM ET

CHEYENNE, Wyo. (AP) - Members of the state House butted heads over a bill that aims to better protect student-athletes who suffer concussions while playing school prep sports.

Senate File 38 faces two more votes in the House. The bill sets standards on when student-athletes who suffer concussions can play again. The proposed bill applies to junior- and high-school students in Wyoming's public schools. Coaches also would be required to get training about concussions.

Proponents say sports concussions need to be addressed to protect athletes from dangerous head injuries. However, opponents say lawmakers should leave such details up to the high school athletic association. The proposed bill would apply to events sanctioned by the Wyoming High School Activities Association. These activities include football and cheerleading.

Source.

Concussion Leaves 14-Year-Old Basketball Player Amnesic, Left-Handed
By KATIE MOISSE, ABC News Medical Unit
Feb. 24, 2011




The 14-year-old from Spangle, Wash., was shoved to the ground after snatching a rebound during a high school basketball game.

"She didn't black out, she didn't grab her head in obvious injury," Wilson's dad, Michael, told ABC News affiliate KXLY 4. "She just got up and noticed her head hurt a little bit on the back. But basketball these days is a very physical game, and there's lots of contact."

After a fouled Wilson shot her free throws, she played two more quarters for the Liberty High Lancers. It wasn't until the team gathered after the game when Wilson asked her mom, Lorie, "Who are those girls dressed just like I am and why are they looking at me?" that anyone noticed anything wrong.

Read the rest of the article here.

Concussions cause mild traumatic brain injury. Watch this instructional video

Knocks to the head may seem funny in cartoons, sports replays, and YouTube videos, but even minor head injuries often lead to serious concussions. A concussion may leave no trace on a conventional MRI scan yet cause permanent memory loss, attention problems, and depression. NOVA scienceNOW investigates promising new leads in understanding this puzzling condition, which affects millions of people in the U.S., including many high-school and college athletes who suffer concussions yet are encouraged to return to the playing field.

http://www.pbs.org/wgbh/nova/body/brain-trauma.html

Concussions extra dangerous to teen brains

(CNN) -- Max Conradt was used to defensive linemen hurtling their 300-pound frames at him week after week. He was a high school quarterback, the team leader who took his licks and got back up.

That is, until the wrenching hit that changed everything.

"It was a vicious hit," said Ralph Conradt, Max's father. "A really bad hit."

Afterward, the 17-year-old got up slowly, staggered for a few seconds, and continued to play. When the game ended, he limped toward the sideline.

...

"It's the group we need to worry about most," said Dr. Jeffrey Kutcher, chairman of the American Academy of Neurology Sports Neurology Section, adding that fewer than half of high schools have access to athletic trainers.

"If there is any suggestion of a concussion, we need to take kids out of the game," said Dr. Stan Herring, team physician for the Seattle Seahawks. "The consequences [of not doing so] can be devastating or even fatal."

http://www.cnn.com/2010/HEALTH/02/03/concussions.teen.brains/

1 in 30 N. Texas school athletes in study has suffered concussion

12:00 AM CST on Friday, February 5, 2010

By KAREL HOLLOWAY / The Dallas Morning News
kholloway@dallasnews.com

A limited study of 15,000 North Texas athletes has found that about one in 30 has suffered concussions since 2008, according to researchers with the Texas Health Presbyterian system.

http://www.dallasnews.com/sharedcontent/dws/news/healthscience/stories/DN-concussions_05met.ART.State.Edition1.4b95c1b.html