ImPACT Composite Scores Research Articles

The Relationship between ADHD and Concussion History on Neuropsychological Test Scores in Collegiate Athletes

INTRODUCTION: Attention Deficit Hyperactivity Disorder (ADHD) and previous history of concussion (PHC) are being reported more frequently in college athletes; the presence of these co-morbidities and their effects on concussion assessment has been somewhat limited. PURPOSE: Determine if a relationship exists between ADHD and PHC and the effect of these co-morbidities on neuropsychological test scores. METHODS: This study was a retrospective cross-sectional between groups design. D-1 college athletes (N=1840, males N=1737, females N=103) with a mean age of 19.8+1.6 years completed a computerized neuropsychological test (ImPACT) to establish baseline assessment of concussion history during pre-participation physicals. Participants were divided into groups based upon self-reported diagnosis of ADHD and PHC. Self-report symptoms and ImPACT composite scores served as dependent variables. Comparisons of groups were calculated utilizing regression models and One-Way ANOVAs. All statistical analyses were conducted utilizing STATA 9.0. RESULTS: 102 (5.5%) participants self-reported a diagnosis of ADHD. 486 (26.5%) of the participants self-reported a history of concussion. There was a difference between ADHD and controls for self-reported symptoms (F (1, 1838) = 26.226, p > 0.001, Composite Verbal Memory (F (1, 1838) = 10.02, p = 0.002), Composite Motor (F (1, 1838) = 5.96, p = 0.015), Composite reaction time (F (1, 1838) = 3.94, p = 0.047). No statistical differences were found between the PHC group and normal counterparts. There was a difference for the interaction between ADHD and PHC on Composite Verbal Memory (F (5, 1834) = 2.44, p= 0.0325). CONCLUSIONS: The increase of media and clinician awareness of PHC and ADHD diagnoses has increased reporting during baseline assessment. Significant differences existed between groups with participants with ADHD and participants with ADHD and PHC performing below their "normal" counterparts. Previous literature supports the potential additive effect of learning disabilities and PHC; however this subgroup of ADHD did not replicate previous findings. The increase of ADHD and PHC diagnoses demands that health care practitioners understand the implications and effects of these disabilities on neuropsychological tests utilized in concussion assessment.

Does Previous Concussion History Influence Balance And Neuropsychological Function After Heading In Soccer Players?

The activity most frequently associated with concussions in soccer is the act of heading the ball. Understanding the extent to which soccer heading can affect the brain and concerns over the cumulative effects of multiple concussions in sport have raised awareness among clinicians. PURPOSE: The purpose of this study was to assess the effects of an acute bout of purposeful heading in female soccer players with a history of concussion, on measures of balance and neuropsychological function. METHODS: A total of 24 college-aged soccer players with >4 years of competitive experience participated. Subjects were allocated to one of four groups: control (CON) and experimental group (EXP0) had no history of concussion, subjects with 1-2 previous concussions (EXP1), and those with 3 or more concussions (EXP2). Baseline session measurements included Concussion Symptom Checklist, ImPACT neuropsychological testing, and balance testing using the Balance Error Scoring System (BESS). For the soccer heading trials, subjects in EXP0, EXP1, and EXP2 were asked to head 20 soccer balls delivered from a JUGS soccer machine at a speed of 65 km/h at 80'. Subjects in the CON stood at the ready, but did not head the ball. Immediately upon concluding the heading session, subjects were re-tested on each of the baseline measurements. Group differences were assessed using repeated measures ANOVA techniques on each of the three dependent variables (concussion symptoms, ImPACT composite scores, and BESS scores) between sessions. RESULTS: Concussion-related symptoms were elevated in 3 of the 4 groups (exception CON) post-heading. There were no significant interactions or main effects for any of the ImPACT composite scores. There was however, a significant group by time interaction for the BESS (dual stance/firm condition), indicating that EXP2 had more errors post-heading than any of the other 3 groups. CONCLUSION: Balance deficits appeared following an acute bout of heading in a group of soccer players reporting 3 or more previous concussions. Perhaps those who have suffered multiple concussions in the past, should be carefully monitored during the course of a soccer match and use caution when heading the soccer ball. Although all groups demonstrated elevated concussion-like symptoms post-heading, the question remains as to how long these linger.