Neurocognitive Performance of Concussed Athletes when Symptom Free (Original Research) (Report‪)‬

Sport-related concussion is commonly evaluated with a clinical examination and the athlete's report of postconcussion symptoms. These subjective evaluations are routinely supported by an objective neurocognitive assessment. (1-5) The neurocognitive assessment is purported to provide the greatest amount of objective clinical information during the postconcussion evaluation. (6) Although pencil-and-paper batteries traditionally have been administered to assess cognitive domains, improvements in technology have resulted in a shift toward computer-based tests. (7) Among other benefits, computer platforms offer the advantage of standardized test administration and scoring and improved measurement precision. (8) Results vary, but computer-based neurocognitive assessments appear to be as sensitive to concussion's deleterious effects as their pencil-and-paper counterparts. (9-11) Test administration protocols differ among clinical settings, but serial postconcussion assessments commonly are reported. (1,12,13) Multiple postconcussion assessments allow for the accurate tracking of neurocognitive decrements and the sub sequent recovery from concussion. This protocol, however, may result in practice effects that obscure deficits related to concussive injuries. For instance, Peterson et al (12) found that healthy control subjects improved by 23% to 44% on some pencil-and-paper neurocognitive tests given on days 1, 2, 3, and 10. Practice effects also have been seen on some computerized test output scores when administered multiple times. (14,15)