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Variety of strategies needed to evaluate concussion recovery

Aug. 8, 2013, 9:11 AM

According to a Vanderbilt study of cheerleaders recovering from concussion, neurocognitive testing was more accurate than an athlete’s self-report of symptoms. (iStock image)

A new study of concussion in cheerleaders found neurocognitive testing was more accurate than an athlete’s symptom self-report when assessing recovery.

The results indicate health care providers should use a variety of assessment strategies to evaluate an athlete’s concussion recovery, and not rely solely on an athlete’s report of symptoms.

Gary Solomon, Ph.D.

“Cheerleaders are like any other athletes in that they will minimize their symptoms in order not to be withheld from play,” said Gary Solomon, Ph.D., associate professor of Neurological Surgery, Psychiatry, and Orthopaedic Surgery & Rehabilitation at Vanderbilt University Medical Center, who conducted the study with Mark Lovell, Ph.D., from ImPACT Applications in Pittsburgh.

“It is not a wise practice to focus on symptoms alone. Symptoms are an important piece of the puzzle, but you also need to factor in results from neurocognitive testing and balance assessment and listen to what parents are saying.”

The study, published in The Journal of Pediatrics, followed 138 middle and high school cheerleaders who underwent pre-season baseline neurocognitive testing and had a retest following concussion.

The computerized test, Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), is a standardized measurement of neurocognitive factors including reaction time, memory and attention span.

Of the 38 percent of participants who denied an increase in symptoms after concussion, one-third had at least one ImPACT score that fell below their baseline.

This confirmed that neurocognitive testing was in many cases more accurate than self-report alone to evaluate recovery, and that athletes may report their symptoms inaccurately, overestimate their recovery or be unaware of their decreased performance.

“ImPACT is another piece of valuable information when deciding whether it is safe to return an athlete to play. They always say they are fine but then the test results come back and don’t compare favorably to their baseline, which is proof that maybe they aren’t completely fine,” Solomon said.

Solomon, who is a co-director of the Vanderbilt Sports Concussion Center, said this study shows cheerleaders are like any other athlete in their competitive spirit.

“In clinic the cheerleaders I’ve seen get just as emotional as any football player when I say they can’t return to activity yet,” he said.

“But cheerleading is the highest risk for catastrophic injury for females participating in sports. Catastrophic injury means death or permanent disability, so it is important to know when it is safe for them to go back to competing.”

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