Disclosures: Jenny Cheng-Chuan Chiang: No financial relationships or conflicts of interest

Background and/or Objectives: Although there are well-established return-to-play guidelines for collegiate athletes after a concussion, there is little standardized return-to-learn guidance. Athletes may be resuming schoolwork without a gradual step-wise reintroduction, contributing to symptom exacerbation, slower recovery, and adverse academic performance. This study investigates collegiate athletes’ performance on neuropsychological tests with graded demands within the weeks post-concussion to help inform considerations regarding return-to-learn decision-making. All subjects completed two tests, the Sternberg and the Paced Auditory Serial Addition Test (PASAT). Both tests examined attention under conditions of increasing cognitive demands.

Design: Case-control pilot study

Setting: Academic research laboratory

Participants: 56 male and female collegiate contact and non-contact sports athletes were separated into the following groups: 1) Non-concussed (n=23); 2) Chronic (n=21), at least one year from their last concussion; 3) Acute (n=12), within 2 weeks from their last concussion.

Interventions: not applicable

Main Outcome Measures: The Sternberg test examined working memory, accuracy, reaction time, and reaction time variability. The PASAT assessed auditory processing speed and working memory. As each task progresses, cognitive difficulty increases. Repeated measures ANOVA and subsequent pairwise comparison were used to investigate the mean outcome differences between the three groups.

Results: On the Sternberg, the acute group had a slower reaction time on the medium difficulty task, with higher reaction time variability compared to the chronic group (mean difference 201ms, p=0.02, and 170 ms, p=0.01, respectively; Bonferroni corrected). The acute group omitted more responses on the PASAT than the other two groups on medium and hard difficulty tasks (mean difference 8 omissions, p=0.02; LSD corrected).

Conclusions: Neuropsychologic testing sensitive to increasing cognitive demands should be considered for utilization in post-concussion evaluation in sports medicine clinics as part of a return-to-learn protocol. Further studies are needed to evaluate whether commonly used computerized tests, such as ImPACT, would also identify high-level cognitive impairments in collegiate athletes.

Level of Evidence: Level III

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/graded-neuropsychological-testing-to-inform-return-to-learn-after-concussion-in-collegiate-athletes/