Advanced topics in neuropsychological assessment following sport-related concussion

Abstract

Objective: This study examined seven topics relating to neuropsychological assessment following sport-related concussion: (i) traditional vs. computerized tests; (ii) the value of baseline, pre-season testing; (iii) invalid baseline scores and poor effort; (iv) when to assess following injury; (v) the reliability of neuropsychological tests; (vi) reliable change methodology; and (vii) new methods for identifying cognitive impairment.

Main results: Baseline testing can be helpful for quantifying cognitive deficits following injury and for assessing recovery. At present, however, there is insufficient evidence to conclude that having baseline test results is clearly superior to not having baseline test results. Although invalid baseline test performance can be detected in some athletes, validity indicators cannot determine the extent to which the results were due to deliberately poor performance, confusion or misunderstanding regarding some aspect of the test, distractions in group testing environments or some combination of factors. When interpreting baseline and post-injury data, sophisticated psychometric methods (e.g. reliable change, multivariate base rates) are available to assist with more accurate identification of cognitive impairment and the serial monitoring of recovery.

Conclusions: The value of neuropsychological assessment in the management of sport-related concussion has a strong empirical foundation. Additional research is needed, however, to refine its use.

• Cognitive functioning
• concussion
• mild traumatic brain injury
• neuropsychological assessment
• psychometrics
• reliable change

Declaration of interest

Grant Iverson, PhD, has been reimbursed by the government, professional scientific bodies and commercial organizations for discussing or presenting research relating to mild TBI and sport-related concussion at meetings, scientific conferences and symposiums. He has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs (including professional athletes). He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs and Psychological Assessment Resources (PAR, Inc.). He has not received research support from ImPACT Applications, Inc. in the past 3 years. He receives royalties from two books relating to neuropsychology and one test (WCST-64). Philip Schatz, PhD, has served as a consultant to the International Brain Research Foundation, the Sports Concussion Center of New Jersey and ImPACT Applications, Inc., to study the effects of concussion in high school and collegiate athletes. However, these entities had no role in the conceptualization or content of the current manuscript or the decision to submit for publication.