Isabelle Seward

Mr. Yagid
10/20/15
Journal Title: Factors Associated With Concussion-like Symptom Reporting in High School
Athletes
Iverson, G. (2015). Factors Associated With Concussion-like Symptom Reporting in High
School Athletes. JAMA Pediatrics.

Isabelle Seward
Mr. Yagid
9/29/15
Journal Article Review: Providing Sport Psychology Consulting Services in Professional
Hockey
Halliwell, W. (n.d.). Providing Sport Psychology Consulting Services in Professional Hockey. The
Sport Psychologist, 4(4), 369-377.

Journal Summary: This article relates experiences and knowledge gained in providing
sport psychology consulting services to professional hockey teams over a 6-year period. The
process of getting involved in professional hockey is described and the importance of obtaining
ample consulting experience before working with professional athletes is discussed.
Philosophical and organizational components of service delivery are presented along with the
range and type of service provided. The development of trust and confidence in the player1
consultant relationship is seen as the key to effective sport psychology consulting. Also, the
importance of being able to read situations, fit into the professional sports environment, and
adopt a low-key, behind-the-scenes approach is discussed. It may be necessary to keep this in
mind in terms of potential increase in concussion reporting. Many athletes do not report
concussions for fear of losing playing time, so therefore the utilization of a psychologist or a
psychological approach.

Isabelle Seward
Mr. Yagid
10/14/15
Gronwall, D. (1999). PACED AUDITORY SERIAL-ADDITION TASK: A MEASURE OF
RECOVERY FROM CONCUSSION. Perceptual and Motor Skills, 44, 367-373.
Journal Article Body: A study conducted by the Aukland Hospital reviews the possibility of
measuring concussion severity utilizing a paced auditory test. The test measures the information
processing of an individual and can be used as a tool to measure the recovery process. This test
was administered by Dr. Gronwall to his concussed patients at the hospital. The purpose of his
study was to identity mild concussions in his patients in order to create a recovery plan for
reduced work without using a post concussion amnesia scale, as most of his patients did not
experience significant amnesia, but rather complained of other types of symptoms (specifically
concentration, focusing and memory issues). The results of his study indicated lower test results
in his concussed patients as opposed to his patients who did not suffer from a concussion.This
indicates that there were slower information processing speeds in the mildly concussed patients
which can then be used to prove how a reduced work load is vital in terms of athlete or patient
recovery. This article proves how concussion recognition technology has vastly improved, and
can be used to develop more programs similar to this and the ImPACT test to improve accuracy
and consistency to ultimately increase recovery time.
1: How could a paced auditory test be integrated into a test in the app?
2: Is there any way to determine if a neurocognitive test is or is not more accurate than the
auditory approach?
3: Would results still be similar for patients who do not suffer from symptoms regarding
sound sensitivity?

Isabelle Seward
Mr. Yagid
10/22/14
Journal Article Review: The Spectrum of Disease in Chronic Traumatic Encephalopathy
Mckee, A. (n.d.). The Spectrum of Disease in Chronic Traumatic Encephalopathy. Brain A
Journal of Neurology, 1-22. Retrieved October 22, 2014, from
http://www.bu.edu/cte/files/2009/10/McKee-2012-Spectrum-of-CTE1.pdf
Journal Article Body: A study conducted by Boston University on 85 brain donations revealed
that 80% showed stages of Chronic Traumatic Encephalopathy over a wide variety of ages,
genders, and histories to mild traumatic brain injuries. A majority of the subjects had been
athletes (boxers, football players and hockey players) or veterans, Prior to examination of the
brains, information of health records were obtained through calling patients families. Data
collected compares brains showing signs of CTE with Alzheimers disease and explains the
differences present in symptoms.
CTE is determined by the presence of astrocytic tangles, neurofibrillary tangles and p-tau tangles
at disturbed according to the phase of disease they are in. Alzheimers is characterized by the
presence of not only p-tau, but also amyloid-B neuritic plaques.
The results of Boston Universitys findings were a mix of CTE and other degenerative diseases.
11 subjects showed signs for stages I and II of Alzheimers. Other findings show that of the brains
with a history of mTBI, 80% showed signs of CTE. 7 of these diagnosed showed a combination
of signs of both CTE and Alzheimers.7 Brains represented stage I of CTE, 14 in stage II, 15
brains in both stages III and IV. These results suggest that CTE originates focally at levels of the
sulci.
1: What are the number of impacts to the head and their magnitude that cause CTE?
2: Are there genetic susceptibilities to CTE?
3: How can CTE be diagnosed in living people?

Isabelle Seward
Mr. Yagid
11/7/14
Journal Article Review: The Neuropathology and Neurobiology of Traumatic Brain Injury
Blennow, K., Hardy, J., & Zetterburg, H. (2012, December 6). The Neuropathology and
Neurobiology of Traumatic Brain Injury. Retrieved November 7, 2014.
Journal Article Body: This article describes and scales the different levels of a concussion from
mild (conscious at time of impact) to acute (unconscious) and also goes into detail about the
neuropathology of long term concussion defects, mainly, Chronic Traumatic Encephalopathy
(CTE). Impact causing a concussion is either described as straight or rotational acceleration. The
article describes how after a patient receives one mild traumatic brain injury, they are 4 times
more likely to suffer again in the future. Due to this, it is crucial to learn more about the
pathology of CTE which occurs after numerous hits to head throughout ones lifetime and results
in Alzheimers like deterioration. The neuropathology of this long term defect involves the build
up of tangles of p-tau proteins and amyloid- distribution. It is not clear what neurochemical
disturbances induce these tau pathologies to occur. The article reviews the neurobiological
aspects of mild Traumatic Brain Injury; focal (direct effect on the actual brain, found in severe
cases)and diffusion (sub/cortical contusions or laceration) . It describes DAI (diffuse axonal
injury) which is the shearing of axons or stretching and distribution of these plasma membranes
in the brain. The author speculates other possible pathologies including TDP-43 Pathology
(currently found in other neurodegenerative diseases), Lack of -Synuclein Pathology,
regenerative phenomena, and microglial activation.
1: How would one go about studying the neurochemical disturbances that trigger tau
pathologies?
2: What is currently known about the correlation between mTBI or CTE and the other
types of possible pathogenic changes?
3: What is a biomarker and how could it be beneficial to develop one that pertains to
concussions?

Isabelle Seward
Mr. Yagid
11/20/14
Journal Article: Understanding Concussion Reporting Using a Model Based on the Theory of
Planned Behavior
Kroshus, E., Baugh, C., Daneshvar, D., & Viswanath, K. (n.d.). Understanding Concussion
Reporting Using a Model Based on the Theory of Planned Behavior. Journal of Adolescent
Health, 54(3), 269-274. Retrieved November 20, 2014

Journal Review: 256 Junior Tier III male hockey players between the ages of 18 and 21 were
included in a study led by Emily Kroshus. The purpose of this study was to apply the Theory of
Planned Behavior, a psychological explanation as to how we make deliberate and planned
decisions, to predict under reporting of concussions in athletes. This was done by assessing the
athlete's knowledge, attitudes, perceived controls and subject norms of the injury in order to
reveal the athletes intention on reporting. According to the theory of planned behavior, intention
is the key component in predicting behavior. The results of this study point to the need of not
using the results of Theory of planned behaviour individually, but as a framework of
generalization. The experiment needs to be more generalized and include different sports, etc.
New educational strategies must be designed to fit the ever changing target behavior of reporting
concussions immediately in student athletes to coaches and medical personnel.
1: How could the results of this study be implicated in further research?
2: How did the individual paths of TPB correlate to the data of reporting?
3: How does the knowledge testing relate to if an athlete will report an injury or not?

Isabelle Seward
Mr. Yagid
3/14/15
Journal Article Review: Self-Reported Concussion History: Impact of Providing a Definition
Of Concussion
Robbins, C., Daneshvar, D., & Picano, J. (2014). Self-Reported Concussion History: Impact of
Providing a Definition of Concussion. Open Access Journal of Sports Medicine, 99-103.
Retrieved November 12, 2014.
Journal Summary: Over the years as concussions have become more and more understood both
medically and scientifically, the definition of the injury itself has changed. It is unclear whether
or not that this change has impacted the athletic community's understanding of concussions as a
whole. Currently the only tool most medical professionals have access to in terms of concussion
histories are self reported, which is always not the most accurate. Researchers tested that athletes
self-reporting history of concussions will increase when they are read the medical definition of
the injury, proving that many people are unaware on what they actually are. Research was
conducted cross sectionally amongst over 400 athletes within a timeframe of 3 years using over
the phone interview methods. The results of these over the phone interviews were that after
reevaluating their answer to number of self diagnosed concussions the athlete had endured, the
number of concussions had doubled over the baseline regardless of sport (contact or noncontact).
This concludes that athletes understanding of concussions are not consistent with medical
research/updates.
1: How could a definition be determined to be effective in terms of increasing the reliability
of self-diagnosed concussions?
2: What variable of participants (by sport, age, gender, etc.) seemed to understand the most
medically recent definition of concussions in this experiment?
3: What could these results be implicated in future research designs?

Isabelle Seward
Mr. Yagid
2/5/15
Journal Article Review: Chronic Traumatic Encephalopathy In Athletes:Progressive Tauopathy
following Repetitive Head Injury
McKee, A., Cantu, R., Nowinski, C., Hedley-Whyte, E., Gavett, B., Budson, A., ... Stern, R.
(2009). Chronic Traumatic Encephalopathy In Athletes:Progressive Tauopathy following
Repetitive Head Injury. Journal of Neuropathology and Experimental Neurology, 68(7), 709-735.
Journal Article Body: Chronic Traumatic Encephalopathy was first recognized in the 1920s as a
disease associated with boxing. This study focused on the neuropathological details of 47
Chronic Traumatic Encephalopathy cases. Physical categorization of symptoms is associated
with memory problems similar to Alzheimers and, Parkinsons, and speech abnormalities. The
neuropathology aspect, is categorized by atrophies of tau proteins namely in the cerebral
hemispheres, medial temporal lobe, thalamus, mammillary bodies and brain stem. The
neurofibrillary distinctions is different from other neurodegenerative diseases for the irregular
tendencies to entangle in patchy manners in the cortical layers and at sulcal depths. Results show
that beta amyloid plaques are only present in about half of the cases, proving that Chronic
Traumatic Encephalopathy is a distinct, slow neurodegenerative disease. In order to lower the
cases of the deadly disease, it is critical that new regulations are implemented and followed by
athletes to reduce their risk and gross number of annual concussions.
1: In terms of the 40% of cases where they were found, what do the lower than expected
discovery of amyloid betas mean in terms of the neuropathological tendencies of CTE?
2: How would a biomarker be created for diagnosis of CTE?
3: What is the difference, according to this study, of neuropathology in CTE vs
Alzheimers?

Isabelle Seward
Mr. Yagid
2/5/15
Journal Article Review:
Daneshvar, D., e.t. all. (2011). The Epidemiology of Sport-Related Concussion. Clinical Sports
Medicine, 30(1), 1-17.
Journal Article Body: This article identifies the factors that affect concussion rate in the sports
of American Football, Baseball/Softball, Basketball, Cheerleading, Gymnastics, Ice/Field
Hockey, Lacrosse, Soccer, Skiing/Snowboarding, Volleyball, and Wrestling, or in other terms,
the leading sports of head injury. Of each sport, participation was compared respectively to
Injuries. The results of this study recognize that the number of concussions has doubled
nationwide over the past decade, and this is speculated due to the fact that the definition of
concussions may be refined as knowledge advances across the vast majority of athletes and
coaches. However it is also stated that as athletes grow greater in size, the number of concussive
impacts may be increasing, essentially meaning that there is a correlation between magnitude of
impact and actual concussive blows. Although the greatest number of concussions occur during
competition, this study proves that due to the higher frequency of practices it is crucial to
implement new strategies to limit head to head contact. Results of this experiment also point to
the conclusion that females are the most likely to result in cognitive impairment from mild
traumatic brain injury than males usually do. In summation concussions cannot be completely
eliminated from sports, but with a better understanding of them changes can be made nationwide
to reduce the effects.
1: What is the correlation between magnitude and concussive impacts?
2: What athletic techniques are the most necessary to change in order to reduce their
chances of injury?
3: What sport groups specifically should focus on strengthening neck muscles?

Isabelle Seward
Mr. Yagid
2/5/15
Journal Article Review: PET Scanning of Brain Tau in Retired National Football League
Players: Preliminary Findings
Small, G., e.t. all. (n.d.). PET Scanning of Brain Tau in Retired National Football League
Players: Preliminary Findings. The American Journal of Geriatric Psychiatry, 21(2), 138-144.
Retrieved January 31, 2015
Journal Article Body: Chronic Traumatic Encephalopathy may show neuropathological signs of
p-tau entanglements at the time of brain autopsy. This article deals with the purpose of
diagnosing CTE in living retired national football players using a positron emission tomography
scan after intravenous injections of FFDNP, also known as 2-(1-{6-[(2-[F-18]fluoroethyl)
(methyl)amino]-2-naphthyl}ethylidene)malononitrile. 5 retired National Football Players were
chosen based on cognitive signs of impairment such as changes in mood and memory loss. PET
scans of these players cortical (amygdala, frontal, parietal, posterior cingulate, medial and lateral
temporal) and subcortical (caudate, putamen, thalamus, subthalamus, midbrain, cerebellar white
matter) brain regions were compared to controls of the same weight, height and body index.
FDDNP signals were higher in players compared with controls in all subcortical regions and the
amygdala, areas that produce tau deposits following trauma. In terms of future studies, a larger
population in comparison to autopsy reports must be included to verify all findings.
1: How would the method of PET scanning to diagnose living people be able to differentiate
what Stage of CTE a patient is in?
2: Following these results, is it conclusive to say that Stage I of CTe is induced in the
subcortical regions of the brain?
3: If this experiment was run again in a different trial, would it be beneficial to use a
chemical marker other than FDDNP?

Isabelle Seward
Mr. Yagid
2/10/15
Journal Review: The Effects of SuperBetter on Depression
Roepke, A. (2013). A Randomized Controlled Trial: The Effects of SuperBetter on Depression.
Article Body: This article describes and scales the different levels of a concussion from mild
(conscious at time of impact) to acute (unconscious) and also goes into detail about the
neuropathology of long term concussion defects, mainly, Chronic Traumatic Encephalopathy
(CTE). Impact causing a concussion is either described as straight or rotational acceleration. The
article describes how after a patient receives one mild traumatic brain injury, they are 4 times
more likely to suffer again in the future. Due to this, it is crucial to learn more about the
pathology of CTE which occurs after numerous hits to head throughout ones lifetime and results
in Alzheimers like deterioration. The neuropathology of this long term defect involves the build
up of tangles of p-tau proteins and amyloid- distribution. It is not clear what neurochemical
disturbances induce these tau pathologies to occur. The article reviews the neurobiological
aspects of mild Traumatic Brain Injury; focal (direct effect on the actual brain, found in severe
cases)and diffusion (sub/cortical contusions or laceration) . It describes DAI (diffuse axonal
injury) which is the shearing of axons or stretching and distribution of these plasma membranes
in the brain. The author speculates other possible pathologies including TDP-43 Pathology
(currently found in other neurodegenerative diseases), Lack of -Synuclein Pathology,
regenerative phenomena, and microglial activation.
1: How would one go about studying the neurochemical disturbances that trigger tau
pathologies?
2: What is currently known about the correlation between mTBI or CTE and the other
types of possible pathogenic changes?
3: What is a biomarker and how could it be beneficial to develop one that pertains to
concussions?

Isabelle Seward
Mr. Yagid
3/11/15
Journal Review:
Iverson, G., e.t. all. (2006). Tracking neuropsychological recovery following concussion in sport.
Journal Article Body: The purpose of this study was to illustrate the serial use of computerized
neuropsychological screening with ImPACT to monitor recovery in a clinical case series of
injured athletes. Amateur athletes with concussions (N = 30, average age = 16.1, SD = 2.1 years)
underwent preseason testing and three post-concussion evaluations within the following
intervals: 1-2 days, 3-7 days (M = 5.2 days), and 1-3 weeks (M = 10.3 days). The study selection
criteria increased the probability of including athletes with slow recovery. Repeated Measures
ANOVAs revealed significant main effects for all five composite scores (verbal memory, visual
memory, reaction time, processing speed, and total symptoms). In group analyses, performance
decrements and symptoms relating to concussion appeared to largely resolve by 5 days post
injury and fully resolve by 10 days. Athletes scores were examined individually using the
reliable change methodology. At 1 day post injury, 90% had two or more reliable declines in
performance or increases in symptom reporting. At 10 days, 37% were still showing two or more
reliable changes from preseason levels. This study illustrates the importance of analyzing
individual athletes test data because group analyses can obscure slow recovery in a substantial
minority of athletes.
1: What is and how does the reliable change methodology?
2: Has the author read the works by Dr. Mahilk about individualized analysis? How do
these results compare?
3: How could I incorporate the idea of individualized analysis to my app?

Isabelle Seward
Mr. Yagid
4/11/15
Journal Review: What evidence exists for new strategies or technologies in the diagnosis of
sports concussion and assessment of recovery?
Kutcher, J. (2013). What evidence exists for new strategies or technologies in the diagnosis of
sports concussion and assessment of recovery? British Ournl of Sports Medicine, 47(5).
Journal Article Body:
The purpose of this critical review is to summarise the evidence for the following
technologies/strategies related to diagnosing or managing sports-related concussion: quantitative
EEG, functional neuroimaging, head impact sensors, telemedicine and mobile devices. Primary
search keywords were concussion, sports concussion and mild traumatic brain injury. The
keywords used for secondary, topic specific searches were quantitative electroencephalography,
qEEG, functionalMRI, magnetoencephalography, near-infrared spectroscopy, positron emission
tomography, single photon emissionCT, accelerometer, impact sensor, telemetry, remote
monitoring, robotic medicine, telemedicine, mobile device, mobile phone, smart phone and tablet
computer. The primary search produced 8567 publications. The secondary searches produced
nine publications that presented original data, included a comparison group in the study design
and involved sports-related concussion. Four studies spoke to the potential of qEEG as a
diagnostic or management tool, while five studies addressed the potential of fMRI to be used in
the same capacity. Emerging technologies and novel approaches that aid in sports concussion
diagnosis and management are being introduced at a rapid rate. While some technologies show
promise, their clinical utility remains to be established.
1: Why would a PET scan differ from a single photon emission CT scan?
2: How would the results of diagnosing differ between different ways of diagnosing?
3: How would clinical utility of emerging technologies be established? How is this
measured?

Isabelle Seward
Mr. Yagid
4/21/15
Journal Review: Sensitivity and specificity of the ImPACT Test Battery for concussion in
athletes.
Schatz, P. (2014). Sensitivity and specificity of the ImPACT Test Battery for concussion in
athletes. Archives of Clinical Neurology, 21(1), 91-99.
Journal Article Body: This study explored the diagnostic utility of the composite scores of

Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and Post

Concussion Symptom Scale scores (PCSS). Recently concussed high school athletes
(N=72) were tested within 72 h of sustaining a concussion, and data were compared to
non-concussed high school athletes with no history of concussion (N=66). Betweengroups MANOVA revealed a significant multivariate effect of concussion on test
performance (p<.001); univariate ANOVAS revealed all six measures contributed to the
between-groups differences. A discriminant function analyses was conducted to measure
the ability of the five ImPACT composite scores, as well as the PCSS to classify
concussion status. One discriminant function was identified that consisted of the Visual
Memory, Processing Speed, and Impulse Control composite scores PCSS, which
correctly classified 85.5% of the cases. Approximately 82% of participants in the
concussion group and 89% of participants in the control group were correctly classified.
Using these data, the sensitivity of ImPACT was 81.9%, and the specificity was 89.4%.
As part of a formal concussion management program, ImPACT is a useful tool for the
assessment of the neurocognitive and neurobehavioral sequelae of concussion, and can
also provide post-injury cognitive and symptom data that can assist a practitioner in
making safer return to play decisions.
1: How could the specificity of the test be improved?
2: How could the sensitivity of the ImpACT test be changed or improved?
3: How could these compare to my own work?

Isabelle Seward
Mr. Yagid
5/1/15
Journal Review: Sport-Related Concussion in Children and Adolescents.
Halstead, M. (2010). Sport-Related Concussion in Children and Adolescents. American
Academy of Pediatrics.
Journal Article Title: Sport-related concussion is a hot topic in the media and in

medicine. It is a common injury that is likely underreported by pediatric and adolescent

athletes. Football has the highest incidence of concussion, but girls have higher
concussion rates than boys do in similar sports. A clear understanding of the definition,
signs, and symptoms of concussion is necessary to recognize it and rule out more severe
intracranial injury. Concussion can cause symptoms that interfere with school, social and
family relationships, and participation in sports. Recognition and education are
paramount, because although proper equipment, sport technique, and adherence to rules
of the sport may decrease the incidence or severity of concussions, nothing has been
shown to prevent them. Appropriate management is essential for reducing the risk of
long-term symptoms and complications. Cognitive and physical rest is the mainstay of
management after diagnosis, and neuropsychological testing is a helpful tool in the
management of concussion. Return to sport should be accomplished by using a
progressive exercise program while evaluating for any return of signs or symptoms. This
report serves as a basis for understanding the diagnosis and management of concussion in
children and adolescent athletes.
1: How could these statistics be incorporated into the audience of my app?
2: Why are the rate of concussions in females higher than males?
3: What are different ways that concussions are managed?

Isabelle Seward
Mr. Yagid
5/11/15
Journal Review: Possible Lingering Effects of Multiple Past Concussions

Grant L. Iverson, Ruben J. Echemendia, Amanda K. LaMarre, Brian L. Brooks, and

Michael B. Gaetz, Possible Lingering Effects of Multiple Past Concussions,
Rehabilitation Research and Practice, vol. 2012, Article ID 316575, 7 pages, 2012.
Journal Article Title: The purpose of this study was to examine whether athletes with a

history of three or more concussions perform more poorly on neuropsychological testing

or report more subjective symptoms during a baseline, preseason evaluation. Athletes
reporting three or more past concussions would perform more poorly on preseason
neurocognitive testing. An archival database including 786 male athletes who underwent
preseason testing with a computerized battery (ImPACT) was used to select the
participants. Twenty-six athletes, between the ages of 17 and 22 with a history of three or
more concussions, were identified. Athletes with no history of concussion were matched,
in a case-control fashion, on age, education, self-reported ADHD, school, sport, and,
when possible, playing position and self-reported academic problems. The two groups
were compared on the four neuropsychological composite scores from ImPACT using
multivariate analysis of variance followed by univariate ANOVAs. There was a
significant effect for only the Verbal Memory composite. Although inconclusive, the
results suggest that some athletes with multiple concussions could have lingering
memory deficits.
1: What are alternate approaches other than ANOVAs?
2: Alternate approaches utilizing something other than ImPACT?
3: How could this study be revised for another trial?

Isabelle Seward
Mr. Yagid
6/15/15
Journal Review: Bodychecking Rules and Concussion in Elite Hockey
Donaldson, L. (2013). Bodychecking Rules and Concussion in Elite Hockey. PLOS One.
Journal Article Body: Athletes participating in contact sports such as ice hockey are exposed to
a high risk of suffering a concussion. We determined whether recent rule changes regulating
contact to the head introduced in 201011 and 201112 have been effective in reducing the
incidence of concussion in the National Hockey League (NHL). A league with a longstanding
ban on hits contacting the head, the Ontario Hockey League (OHL), was also studied. A
retrospective study of NHL and OHL games for the 200910 to 201112 seasons was performed
using official game records and team injury reports in addition to other media sources.
Concussion incidence over the 3 seasons analyzed was 5.23 per 100 NHL regular season games
and 5.05 per 100 OHL regular season games (IRR 1.04; 95% CI 1.01, 1.50). When injuries
described as concussion-like or suspicious of concussion were included, incidences rose to 8.8
and 7.1 per 100 games respectively (IRR 1.23; 95% CI 0.81, 1.32). The number of NHL
concussions or suspected concussions was lower in 200910 than in 201011 (IRR 0.61; 95% CI
0.45, 0.83), but did not increase from 201011 to 201112 (IRR 1.05; 95% CI 0.80, 1.38). 64.2%
of NHL concussions were caused by bodychecking, and only 28.4% of concussions and 36.8%
of suspected concussions were caused by illegal incidents. We conclude that rules regulating
bodychecking to the head did not reduce the number of players suffering concussions during
NHL regular season play and that further changes or stricter enforcement of existing rules may
be required to minimize the risk of players suffering these injuries.
1: What rules changes can be implemented to protect in sport concussions?
2: What other sports besides football is also affected in the same way?
3: Should bodychecking be eliminated entirely? What are the consequences of that?

Isabelle Seward
Mr. Yagid
6/15/15
Journal Review: ImPact Test-Retest Reliability: Reliably Unreliable?
Jacob Resch, Aoife Driscoll, Noel McCaffrey, Cathleen Brown, Michael S. Ferrara, Stephen
Macciocchi, Ted Baumgartner, and Kimberly Walpert (2013) ImPact Test-Retest Reliability:
Reliably Unreliable?. Journal of Athletic Training: Jul/Aug 2013, Vol. 48, No. 4, pp. 506-511.
Journal Article Body: Computerized neuropsychological testing is commonly used in
the assessment and management of sport-related concussion. Even though computerized
testing is widespread, psychometric evidence for test-retest reliability is somewhat
limited. Additional evidence for test-retest reliability is needed to optimize clinical
decision making after concussion.To document test-retest reliability for a commercially
available computerized neuropsychological test battery (ImPACT) using 2 different
clinically relevant time intervals. Design as a Cross-sectional study.Two research
laboratories.Group 1 (n = 46) consisted of 25 men and 21 women (age = 22.4 1.89
years). Group 2 (n = 45) consisted of 17 men and 28 women (age = 20.9 1.72
years).Both groups completed ImPACT forms 1, 2, and 3, which were delivered
sequentially either at 1-week intervals (group 1) or at baseline, day 45, and day 50 (group
2). Group 2 also completed the Green Word Memory Test (WMT) as a measure of effort.
Intraclass correlation coefficients (ICCs) were calculated for the composite scores of
ImPACT between time points. Repeated-measures analysis of variance was used to
evaluate changes in ImPACT and WMT results over time. The ICC values for group 1
ranged from 0.26 to 0.88 for the 4 ImPACT composite scores. The ICC values for group
2 ranged from 0.37 to 0.76. In group 1, ImPACT classified 37.0% and 46.0% of healthy
participants as impaired at time points 2 and 3, respectively. In group 2, ImPACT
classified 22.2% and 28.9% of healthy participants as impaired at time points 2 and 3,
respectively.We found variable test-retest reliability for ImPACT metrics. Visual motor
speed and reaction time demonstrated greater reliability than verbal and visual memory.
Our current data support a multifaceted approach to concussion assessment using clinical
examinations, symptom reports, cognitive testing, and balance assessment.
1: What alternatives are there to ImPACT in terms of testing programs?
2: How could these flaws be improved in another method of testing?
3: How are visual/verbal discrimination less reliable?

Isabelle Seward
Mr. Yagid
7/15/15
Journal Review: Sport-Related Concussion Misunderstandings Among Youth Coaches
Mcleod, T., Schwartz, C., & Bay, R. (2007). Sport-Related Concussion Misunderstandings
Among Youth Coaches. Clinical Journal of Sport Medicine, 17(2), 140-142.
Journal Summary: The objective of this study was to determine the understanding of sportrelated concussion among youth sports coaches. Designed as a cross sectional survey, it was
administered at coaches' meetings, following practices, and via mail. The participants included
156 active youth sports coaches, with 5.88 3.16 years (range 1-22) of coaching experience.
Scores on the survey instrument reflecting symptom recognition and management knowledge
constituted as the main measurements. For the 16 items comprising the symptom recognition
survey, the mean number of correct responses was 9.78 2.07. Previous coaching education was
predictive of better symptom recognition. On the true/false portion, between 49.4% and 61.5% of
coaches correctly answered the 4 statements. This investigation revealed that, among youth
sports coaches, coaching education was predictive of the ability to recognize signs and symptoms
of sport-related concussion. However, several misconceptions about concussion still exist,
highlighting that education regarding concussion is necessary. The presence of qualified health
care personnel, such as an athletic trainer, at the youth organization level may enhance early
recognition, treatment, and referral of concussions.
1: For each and any organized youth sport such as football or hockey, should it be required
to have a designated health care professional be active in the league?
2: What specific questions or aspects of specific questions did the coaches average incorrect
answers for?
3: How could generalized concussion seminars for youth coaches and parents be improved
based off of the results of this study?

Isabelle Seward
Mr. Yagid
7/15/15
Journal Review: Cumulative effects of concussion in amateur athletes
Iverson, G., Gaetz, M., & Lovell, M. (n.d.). Cumulative effects of concussion in amateur
athletes. Brain Injury, 18(5), 433-443.
Journal Summary: The objective of this study was to examine the possibility that athletes with
multiple concussions show cumulative effects of injury. Amateur athletes with a history of three
or more concussions were carefully matched (gender, age, education and sport) with athletes
with no prior concussions. All participants completed a computerized neuropsychological test
battery at preseason (ImPACT) and then within 5 days of sustaining a concussion (mean = 1.7
days). The results of this experiment show that there were differences between groups in
symptom reporting and memory performance. At baseline (i.e. preseason), athletes with multiple
concussions reported more symptoms than athletes with no history of concussion. At
approximately 2 days post-injury, athletes with multiple concussions scored significantly lower
on memory testing than athletes with a single concussion. Athletes with multiple concussions
were 7.7 times more likely to demonstrate a major drop in memory performance than athletes
with no previous concussions. In summation, this study provides preliminary evidence to suggest
that athletes with multiple concussions might have cumulative effects.
1: Do believe there would be a correlation between symptoms reported in one sport as
opposed to another?
2:Was there a correlation in recovery time for athletes with multiple concussion? (Similar
recovery time)
3:How could a decrease in memory performance be improved?

Isabelle Seward
Mr. Yagid
7/15/15
Journal Review: Cerebral Concussion in Athletes: Evaluation and Neuropsychological Testing
Maroon, J., Lovell, M., Norwig, J., Podell, K., Powell, J., & Hartl, R. (2000). Cerebral
Concussion in Athletes: Evaluation and Neuropsychological Testing. Neurosurgery, 47(3), 659672.
Journal Summary: The objective was to conduct a topic review of studies related to cerebral
concussion in athletes, as an aid to improving decision-making and outcomes. They review the
literature to provide an historical perspective on the incidence and definition of and the
management guidelines for mild traumatic brain injury in sports. In addition, metabolic changes
resulting from cerebral concussion and the second-impact syndrome are reviewed, to provide
additional principles for decision-making.The incidence of cerebral concussions has been
reduced from approximately 19 per 100 participants in football per season to approximately 4 per
100, i.e., 40,000 to 50,000 concussions per year in football alone.Each has associated
management guidelines. Concussion or loss of consciousness occurs when the extracellular
potassium concentration increases beyond the upper normal limit of approximately 4 to 5
mmol/L, to levels of 20 to 50 mmol/L, inhibiting the action potential and leading to loss of
consciousness. This phenomenon helps to explain the delayed effects of symptoms after trauma.
Knowledge of the various definitions and management strategies, as well as the utility of
neuropsychological testing, is essential for those involved in decision-making with athletes with
mild traumatic brain injuries.
1: Chemically, could a drug be created in order to prevent a delay of symptom after
trauma?
2: Would creating a drug to do the above even be beneficial to recognizing and diagnosing
mTBIs sooner?
3: What sort of athlete related concussion management would be the most beneficial?

Isabelle Seward
Mr. Yagid
7/15/15
Journal Review: Identification of Sport and Recreational Activity Concussion History Through
the Preparticipation Screening and a Symptom Survey in Young Athletes
Mcleod, T., Bay, R., Heil, J., & Mcveigh, S. (2008). Identification of Sport and Recreational
Activity Concussion History Through the Preparticipation Screening and a Symptom Survey in
Young Athletes. Clinical Journal of Sport Medicine,18(3), 235-240.
Journal Summary: The objective was to evaluate the concussion history of
young athletes using three questions on the preparticipation screening (PPS)
and a concussion symptom survey (CSS). Five hundred twenty young
athletes participated in the study. Athletes were asked about their
concussion history using three different questions on the PPS. The CSS, a list
of concussion-related symptoms, was also given to assess the history of
concussion-related symptoms associated with a previous injury to the heads.
There was little agreement among the three PPS questions, with kappa
coefficients ranging from = 0.018 to 0.342. Analysis of the CSS revealed
that 286 athletes (55.0%) reported having at least one concussion symptom
after a head injury. Of those reporting symptoms, 86.4% did not report a
concussion history in sport, and 92.7% did not report a concussion history in
recreational activities. The identification of concussion history may depend
on the phrasing of questions on the PPS. Simply asking an athlete whether
they had a concussion may not adequately identify athletes with concussion
histories. Although recommendations have been made to avoid the
terminology of ding and bell rung, it seems these terms may be needed to ensure adequate
reporting of previous concussions in young athletes.
1: Were there any correlations between athlete symptom to the sport that they participated
in?
2: Were there any patterns in terms of terminology used to describe concussion history?
3: What were the questions on the PPS?