An Investigation of
Sport Concussion in
UNM Athletes
Richard Campbell, Ph.D.
Professor, Dept. of Psychiatry
UNM School of Medicine
Sport Concussion: Potential Pediatric
Health Problem
Estimated 1.6-3.8 million SR-related TBIs/year
7.5 million student-athletes/recreational athletes in
high school; 30+ million younger children
participating in sports
Physical
Emotional
Chronic Traumatic
Encephalopathy (CTE)
Cognitive Effects of
mTBI/Concussion
Cognitive
Only 1025% have
LOC
Sleep
? Long term effects of
repeated concussion
?vulnerability to repeat
concussion
? Younger
children/Females more
vulnerable or worse
outcome?
Management of Sport-Related Concussion:
When is it safe to return to play?
 20 management guidelines of SR
concussion published
 Consensus that athletes should not
RTP until symptom free
 Athletes should rest until they are
asymptomatic (no vigorous physical
activity or heavy mental exertion
 When asymptomatic, return to light
aerobic exercise (International
Concussion in Sport Conferences in
• Reasons Concussions are not
Reported (McCrea et al., 2004)
–
–
–
–
Did not think it was serious (66%)
Did not want to leave game (41%)
Did not know it was a concussion (36%)
Did not want to let down teammates
(22%)
Sports Concussion/mTBI and Boxing
Vienna (Aubry et al., 2002) and Prague
(McCrory et al., 2005, and Zurich)
•
 Little consensus on how to
measure concussion-related
symptoms or impairments (ie
symptom free)
•
•
– Concussion symptom checklists
(Rely on athlete self- report)
– Brief sideline cognitive testing
– Postural stability measurements
– Neuropsychological testing
Warden et al. Neurology 2001
West Point
boxers
Felt ready to be
back in class
Impaired
reaction time
An Investigation of Sports Concussion in
University of New Mexico Athletes
• Participants:
Aims
• Determine sensitivity of cognitive assessment
tools to sequelae of sport concussion (severity,
time to recovery)
– Sideline mental status exam
– Traditional paper/pencil neuropsychological
measures
– Computerized neuropsychological testing (i.e.,
ImPACT)
•
Determine content validity of ImPACT with
traditional neuropsychological measures
•
To identify brain abnormalities associated with
sport concussion and its recovery via
neuroimaging (sMRI, DTI, MRS, MEG,fMRI) and
their relation to neurocognitive measures
– N= 103 UNM athletes (n= 76
football, n=7 womens’ soccer, n= 20
mens soccer)
– Hx. of prior concussions: 0 = 72, 1 =
28, 2 = 12, 3 = 2, 6 = 1.
– 8 subjects had concussion 2009
• Procedures
– Baseline (preseason)
neuropsychological testing
• UNM Neuropsychological Test
Battery and ImPACT
– Within 72 hours of concussion
• UNM Neuropsychological Test
Battery and ImPACT
• MRI, DTI, MRS, fMRI, MEG
– Three weeks or > after concussion
and symptom-free
• UNM Neuropsychological Test
Battery and ImPACT
• MRI, DTI, MRS, fMRI, MEG
Results: ImPACT and Traditional Neuropsych Tests
•
ImPACT Verbal Memory Composite Score correlates with:
–
–
–
–
–
•
•
HVLT Total Recall Score (r = .19, p = .05)
HVLT Delayed Recall Score (r = .36, p < .001)
HVLT Percent Retention Score (r = .33, p < .001)
BVMT Total Recall Score (r = .35, p < .001)
BVMT Delayed Recall Total Score (r = .22, p = .03).
ImPACT Visual Memory Score correlates only with BVMT Total
Recall Score (r = .29, p < .001).
ImPACT Visual Motor Composite Score correlates with:
– WAIS-IV Symbol Search (r = .42, p < .001)
– WAIS-IV Coding r = .41, p< .001)
– Trails B (r = .43, p<.001).
•
ImPACT Reaction Time Composite Score correlates with:
– WAIS-IV Coding (r = -.25, p = .01)
– Trails A (r = .29, p < .001)
– Trails B, r = .31, p < .001)
•
ImPACT Impulse Control Score correlates with Animal Naming (r
= .19, p = .05).
ImPACT
composite
scores weak to
modest
correlations
with traditional
neuropsych
measures
Results: Relation of Traditional
Neuropsych Tests and Concussion Hx
HVLT Percent Retention T-score (F(3,96) – 2.96, p = .03)
The more concussions one has the more
difficult it is to retain information based on
traditional verbal memory test
Results: Relation between Traditional
Neuropsych Tests and Concussion
Severity
The more severe the concussion the
more difficulty with processing speed
and cognitive flexibility
Neurocognitive function as measured by ImPACT does
not seem to be sensitive to number of concussions
An Investigation of Sports Concussion in University of New
Mexico Athletes
Collaborators:
Chris McGrew, MD
Robert Thoma, Ph.D.
John King, Ph.D.
John Phillips, MD
David Binder, ATC
David Smith, ATC
Andy Mayer, Ph.D.
Arvind Caprihan, Ph.D.
Charles Gasparovic, Ph.D.
Ron Yeo, Ph.D.
Per Lysne
Maggie Mannell
Susan Muraida
Jonathan Kurtyka, Ph.D.
Laura Lundy, MS
Dina Hill, Ph.D.
Krista Wild, Ph.D.
Jessica Pommy
David Ruhl
Mollie Monnig
Dalin Pulsipher, MS
Jovan Hernandez
Terri Teshiba
Flannery Merideth
Maggie Mannell
Christina Tedeschi