Smarter, Safer Concussion Management
for the Student Athlete

Sports Concussion New England
Are Some Athletes Returning to Contact Sports Too
Soon after a Concussion?
SCNE/UPMC Study Provides New Data, Raises Concerns

The study, published in the journal Brain Injury in January 2013 by lead author Dr. Neal McGrath of Sports Concussion New England and colleagues from the University of Pittsburgh Medical Center, found that over 27% of student-athletes who seemed fully recovered from a concussion still showed significant drops in memory functioning on neurocognitive testing after only moderate exercise while in training to return to sports. Clinical records of hundreds of high school-aged athletes who had undergone baseline neurocognitive testing, and later sustained sports-related concussions, were analyzed. These student-athletes were monitored carefully by their school athletic trainers and SCNE neuropsychologists during recovery. Fifty-four (54) cases were found to meet exacting study criteria:

  • All student-athletes with a history of learning disabilities or ADHD were excluded from the analysis.
  • All cases had a valid pre-injury ImPACT® baseline test and were monitored at their schools during recovery until they were symptom-free and able to achieve neurocognitive scores back to their own baseline levels.
  • All cases then took an additional ImPACT® test at school shortly after a moderate exercise session supervised by their athletic trainer.

In standard practice, once recovering student athletes become symptom-free and are able to achieve ImPACT® scores back to baseline levels, they begin to exercise under athletic trainer supervision. As long as they appear to have normal balance and agility and report no return of post-concussion symptoms during exercise, they are then usually cleared to resume play in hockey, football, soccer, and other contact sports after a few more days of progressively more intense exercise.

It is very well known, however, that during concussion recovery some student-athletes will deny and hide persisting symptoms in order to be able to return to play sooner. Some other student-athletes who truly feel symptom-free may actually still show persisting deficits on neurocognitive testing. Furthermore, the exercise physiology literature tells us that moderate levels of exercise, such as we do at the gym or that student-athletes do in reconditioning to return to play, should only enhance cognitive efficiency - not cause any decline in cognitive scores.

These student-athletes, who otherwise would normally be considered recovered, underwent an additional “post-exertion” procedure by taking another ImPACT® test shortly after a moderate exercise session. It would not be expected that such exercise should negatively affect cognitive functioning, but over 27% of those student-athletes, who would normally be considered fully recovered by common standards, had significant declines in memory scores (and not in speed scores). All of these student-athletes were followed by their athletic trainers until they were able to complete another post-exertion ImPACT® test without significant cognitive decline. It took about nine days on average for them to do so, after which they were cleared to return to contact sports. Interestingly, none of these student-athletes who “failed” post-exertion testing reported any symptom recurrence at the time. Furthermore, post-exertion test “failure” was not found to correlate with a student athlete’s number of prior concussions, age, time since injury, initial symptom severity, or other variables routinely tracked during concussion evaluation.

Further studies are now underway to explore this issue. In the meantime, we at SCNE recommend using post-exertion neurocognitive testing to augment the regular clinical evaluation and help provide further assurance that a student athlete who has sustained a concussion is fully ready to return to contact sports.

(McGrath, N., Dinn, W.M., Collins, M.W., Lovell, M.R., Elbin, R.J., and Kontos, A.P. (2013). Post-exertion neurocognitive test failure among student-athletes following concussion. Brain Injury, 27(1), 103-113.)