Do Concussions Cause Cognitive Impairments for Athletes?

Neuropsychological tests are often conducted to determine the safety of athletes returning to sports after a concussion. They are also used to rule out cognitive damage. The current study compares the cognitive functions of athletes with no injuries, athletes with injuries to muscle and bones, and athletes with concussion. In this study, 72 athletes were tested before and after the injury. The results showed that athletes with either musculoskeletal injury or concussion fared worse in cognitive testing than athletes with no injuries, suggesting a measurable damage to the brain function. “Although these findings support previous research that neuropsychological tests can effectively measure concussion-related cognitive impairment, this study provides evidence that athletic injury, in general, also may produce a degree of cognitive disruption.”

Concussion or head injury that affects brain function is commonly caused during sports and is a serious health problem in a large number of male and female athletes, spanning all age groups, across all levels of competition. The symptoms of concussion are not very easy to diagnose instantaneously. Even when a concussion is diagnosed, the symptoms of brain injury are often subtle and transient. Neuropsychological tests are used and recommended for objective diagnosis of concussion-related cognitive damage. New technology has allowed and contributed for faster and more reliable ways of testing for cognitive damage. “Domains of testing include working memory, attention, concentration, information processing, reaction time, and short-term verbal and nonverbal memory abilities.” This study investigates whether the cognitive impairment observed after trauma results only from concussion or also from an overall athletic injury.

* Baseline neuropsychological testing is mandatory in student athletes at the University of Toronto. Demographic characteristics and history of health of the student athletes are recorded.
* Three groups were studied, including 36 athletes without injuries, 18 athletes with concussion and 18 athletes with musculoskeletal injuries.
* Concussion was diagnosed based on health problems like headaches and nausea, and observable changes in behavior like coordination and alertness.
* Musculoskeletal injury was defined as any soft tissue injury that did not include the head and that resulted in an inability to play.
* The athletes took neuropsychological tests, which assessed reaction time, learning, and memory and information processing; the athletes also completed the Symptom Rating Scale test soon after reporting the injury.

* Athletes suffering from concussion suffered from more physical symptoms like headache and nausea than athletes with musculoskeletal injuries. Their cognition, mood, perception, and so on were found to be similar.
* In subtests for the learning control group, it was found that the control group scored significantly better than the concussion group, which scored the lowest. The musculoskeletal group was more similar to the concussion group.
* In subtests for matching to sample (MSP) and simple reaction time (SRT), the musculoskeletal and concussion groups performed worse than the control group.

Shortcomings/Next steps
It is necessary to examine why injuries other than those related to the head affect the cognitive functions of brain. Future studies should focus on distinguishing the symptoms of athletes with concussion from those in athletes with musculoskeletal injuries, by following them throughout the medical treatment. The increase in the sample size may reveal subtle differences in the results of subtests.

This study accounts for non-neurological damage that affects cognition, by including musculoskeletal injuries in the analysis. These injuries are unrelated to the head injury resulting in concussion. Concussion temporarily affects the following functions: the ability to respond correctly to stimuli, being attentive at a task, learning new things, and retaining memory. Although not to the same extent, athletes with musculoskeletal injuries also show impaired cognition. This effect may be the result of emotional weakness that is exposed upon physical injury of athletes, or because the pain caused by the trauma negatively influences their thinking powers. It seems reasonable to treat the musculoskeletal injuries with the same seriousness as the concussion caused by injury to the head.

For More Information:
The Influence of Musculoskeletal Injury on Cognition: Implications for Concussion Research
Publication Journal: The American Journal of Sports Medicine, July 2011
By Michael Hutchison, MSc; Paul Comper, PhD; University of Toronto, Ontario, Canada

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