Neuropsychological impairment as a consequence of football (soccer) play and football heading: a preliminary analysis and report on school students (13-16 years).

Footballers run the risk of incurring mild head injury from a variety of sources, including the intentional use of the head to play the ball, known as heading. This paper presents a preliminary exploratory analysis of data collected to examine whether cumulative incidence of mild head injury, or cumulative heading frequency, are related to neuropsychological functioning in male adolescent footballers. In a quasi-experimental cross-sectional design, neuropsychological test scores of school team footballers were compared with those of similarly aged rugby players and noncontact sport players. Cumulative mild head injury incidence was estimated using self-reports, and cumulative heading was estimated using a combination of observation and self-reports. No participants had sustained a head injury within 3 months of testing. There was no relationship between head injury and neuropsychological performance, and there were no decrements in either the footballers or the rugby players in comparison with the noncontact sport players. Within the footballers, cumulative heading did not predict any of the neuropsychological test scores. These findings indicate the absence of neuropsychological impairment arising due to cumulative mild head injury incidence, or cumulative heading. Although these null findings may be reassuring to players, parents, and football organizers, we stress that they are preliminary. Further data is being collected from the same populations to provide more reliable effect estimates.     

Neuropsychological impairment as a consequence of football (soccer) play and football heading: A preliminary analysis and report on school students (13–16 years)

Footballers run the risk of incurring mild head injury from a variety of sources, including the intentional use of the head to play the ball, known as heading. This paper presents a preliminary exploratory analysis of data collected to examine whether cumulative incidence of mild head injury, or cumulative heading frequency, are related to neuropsychological functioning in male adolescent footballers. In a quasi-experimental cross-sectional design, neuropsychological test scores of school team footballers were compared with those of similarly aged rugby players and noncontact sport players. Cumulative mild head injury incidence was estimated using self-reports, and cumulative heading was estimated using a combination of observation and self-reports. No participants had sustained a head injury within 3 months of testing. There was no relationship between head injury and neuropsychological performance, and there were no decrements in either the footballers or the rugby players in comparison with the noncontact sport players. Within the footballers, cumulative heading did not predict any of the neuropsychological test scores. These findings indicate the absence of neuropsychological impairment arising due to cumulative mild head injury incidence, or cumulative heading. Although these null findings may be reassuring to players, parents, and football organizers, we stress that they are preliminary. Further data is being collected from the same populations to provide more reliable effect estimates.     

Alcohol,head injury,and neuropsychological function

Evidence is reviewed indicating that the extent of alcohol abuse alone cannot account for the neuropsychological deficits observed in alcoholics, and that alcohol abuse and head injury may interact in some patients to influence neuropsychological status. Alcohol abuse both increases the risk for head trauma and potentiates the resulting brain injury, which can lead to negative neuropsychological consequences. Clinicians involved in the treatment of addiction should assess patients for history of head injury, and neuropsychological deficits consequent to both head injury and ethanol. These deficits may limit patient ability to comply with addiction rehabilitation programs. Conversely, clinicians in acute care and rehabilitation of the sequelae of head trauma should routinely assess their patients for substance abuse, because such abuse can have a significant impact on recovery from brain injury.     

Cerebral perfusion and neuropsychological follow up in mild traumatic brain injury: Acute versus chronic disturbances?

In a subgroup of patients with mild traumatic brain injury (TBI) residual symptoms, interfering with outcome and return to work, are found. With neuropsychological assessment cognitive deficits can be demonstrated although the pathological underpinnings of these cognitive deficits are not fully understood. As the admission computed tomography (CT) often is normal, perfusion CT imaging may be a useful indicator of brain dysfunction in the acute phase after injury in these patients.In the present study, directly after admission perfusion CT imaging was performed in mild TBI patients with follow-up neuropsychological assessment in those with complaints and a normal non-contrast CT. Neuropsychological tests comprised the 15 Words test Immediate Recall, Trailmaking test part B, Zoo Map test and the FEEST, which were dichotomized into normal and abnormal. Perfusion CT results of patients with normal neuropsychological test scores were compared to those with abnormal test scores.In total eighteen patients were included. Those with an abnormal score on the Zoo Map test had a significant lower CBV in the right frontal and the bilateral parieto-temporal white matter. Patients with an abnormal score on the FEEST had a significant higher MTT in the bilateral frontal white matter and a significant decreased CBF in the left parieto-temporal grey matter. No significant relation between the perfusion CT parameters and the 15 Words test and the Trailmaking test part B was present.In conclusion, impairments in executive functioning and emotion perception assessed with neuropsychological tests during follow up were related to differences in cerebral perfusion at admission in mild TBI. The pathophysiological concept of these findings is discussed.     

The Neuropsychology of Heading and Head Trauma in Association Football (Soccer): A Review

Association Football (soccer) is the most popular and widespread sport in the world. A significant proportion of the injuries suffered in football are head injuries involving trauma to the brain. In normal play, head trauma frequently arises from collisions, but some researchers have claimed that it also may arise as a consequence of heading the ball. Although assessments based on biomechanical analyses are equivocal on the potential for brain injury due to football heading, a growing literature seems to support the claim that neuropsychological impairment results from general football play and football heading in particular. However, this review suggests a distinction is required between the neuropsychological effects of concussive and subconcussive head trauma and that all of the neuropsychological studies conducted so far suffer from methodological problems. At best, a few of these studies may be regarded as exploratory. The review concludes that presently, although there is exploratory evidence of subclinical neuropsychological impairment as a consequence of football-related concussions, there is no reliable and certainly no definitive evidence that such impairment occurs as a result of general football play or normal football heading. The neuropsychological consequences of football-related subconcussive effects await confirmatory investigation.     

The impact of Parkinson's disease on sequence learning: perceptual pattern learning and executive function

The current study examined the contribution of brain areas affected by Parkinson's disease (PD) to sequence learning, with a specific focus on response-related processes, spatial attentional control, and executive functioning. Patients with mild PD, patients with moderate PD, and healthy age-matched participants performed three tasks-a sequence learning task with a spatial pattern that was incidental to response selection, a spatial cuing task, and neuropsychological tests of executive function. Whereas moderate PD patients failed to show significant sequence learning, mild PD patients performed comparably with controls. Neither group of PD patients was impaired in the control of spatial attention. Sequence learning was correlated with neuropsychological measures of executive function but not with the ability to control spatial attention. These results suggest that the contribution of the brain areas affected by PD to sequence learning extends beyond motor learning to include the learning of perceptual patterns and involves executive function, including cognitive flexibility and set shifting.     

Emotional and pain-related factors in neuropsychological assessment following mild traumatic brain injury

A critical issue in the field of clinical neuropsychology is the idea that emotional or pain-related factors may compromise the validity of neuropsychological assessment. In this study, 53 individuals suffering from mild traumatic brain injury related to motor vehicle accident injury completed commonly used measures of emotional and pain-related functioning. A battery of commonly used neuropsychological tests, assessing attention, learning and memory, language, visuospatial and visuomotor functions, speeded processing, fine-motor skill, and symptom validity, was administered concurrently. Findings revealed a significant and negative correlation between anxiety and impaired delayed verbal memory, suggesting that as anxiety increased, delayed verbal memory decreased. The results otherwise provided little support for the idea that emotional or pain-related factors are detrimental to neuropsychological test performance following mild traumatic brain injury.     

Strategic sequence planning and prospective memory impairments in frontally lesioned head trauma patients performing activities of daily living

The aim of this research was to study strategic sequence planning and prospective memory in activities of daily living (ADL) in 10 patients with frontal lobe lesions after a mild to moderate closed head injury (CHI). The lesions were documented radiologically. The CHI patients were compared to 12 normal controls with a neuropsychological test battery and a realistic simulation of complex multitask ADL (planning and preparing a meal). Though the CHI patients were significantly slow on one test and subject to interference on an attention test, they manifested no basic executive or memory deficit on the paper-pencil tests. However, the CHI patients manifested marked anomalies in the organization of behavior in the meal preparation task. While small sequences of actions were easily produced, large action sets could not be correctly executed. An outstanding difficulty in strategic planning and prospective memory, particularly time-based more than event-based, appears to be an important underpinning of the impairment of ADL observed in the CHI patients with frontal lobe lesions.     

Association of Hypothalamic-Pituitary-Adrenal Axis Function with Neuropsychological Performance in Children with Mild/Moderate Asthma

The present study examines the relationship between hypothalamic-pituitary-adrenal (HPA) axis function and child psychological/neuropsychological function in a group of children with mild to moderate asthma. The goal of the study was to determine whether child neuropsychological functioning and psychological functioning were associated with cortisol production in response to adrenocorticotropic hormone(ACTH) stimulation when assessed as area under the curve. Data for this study were gathered from 63 children who participated in an ancillary study within the Childhood Asthma Management Program (CAMP) during the pre-randomization phase of the CAMP trial. At 2 of the 8 CAMP clinical centers participants completed an ACTH stimulation test after an overnight stay in the General Clinical Research Center. Gender differences on baseline cortisol and change in cortisol 30 minutes after infusion of ACTH were present. Results further indicated significant associations between cortisol production and measures of child neuropsychological function. Stepwise multiple regression analysis revealed that cortisol change could be predicted by measures of gender, working memory, and arousal maintenance, providing support for the hypothesis that cortisol plays a modest role in the neuropsychological function of children with mild and moderate asthma. In contrast, cortisol production was not associated with child reports of psychological functioning. Limitations to the methods employed in this study are discussed.     

Association of hypothalamic-pituitary-adrenal axis function with neuropsychological performance in children with mild/moderate asthma.

The present study examines the relationship between hypothalamic-pituitary-adrenal (HPA) axis function and child psychological/neuropsychological function in a group of children with mild to moderate asthma. The goal of the study was to determine whether child neuropsychological functioning and psychological functioning were associated with cortisol production in response to adrenocorticotropic hormone(ACTH) stimulation when assessed as area under the curve. Data for this study were gathered from 63 children who participated in an ancillary study within the Childhood Asthma Management Program (CAMP) during the pre-randomization phase of the CAMP trial. At 2 of the 8 CAMP clinical centers participants completed an ACTH stimulation test after an overnight stay in the General Clinical Research Center. Gender differences on baseline cortisol and change in cortisol 30 minutes after infusion of ACTH were present. Results further indicated significant associations between cortisol production and measures of child neuropsychological function. Stepwise multiple regression analysis revealed that cortisol change could be predicted by measures of gender, working memory, and arousal maintenance, providing support for the hypothesis that cortisol plays a modest role in the neuropsychological function of children with mild and moderate asthma. In contrast, cortisol production was not associated with child reports of psychological functioning. Limitations to the methods employed in this study are discussed.     

Cognitive contributions to theory of mind ability in children with a traumatic head injury

The objective of the current study is to examine the contribution of intellectual abilities, executive functions (EF), and facial emotion recognition to difficulties in Theory of Mind (ToM) abilities in children with a traumatic head injury. Israeli children with a traumatic head injury were compared with their non-injured counterparts. Each group included 18 children (12 males) ages 7–13. Measurements included reading the mind in the eyes, facial emotion recognition, reasoning the other’s characteristics based on motive and outcome, Raven’s Coloured Progressive Matrices, similarities and digit span (Wechsler Intelligence Scale for Children – Revised 95 subscales), verbal fluency, and the Behaviour Rating Inventory of Executive Functions. Non-injured children performed significantly better on ToM, abstract reasoning, and EF measures compared with children with a traumatic head injury. However, differences in ToM abilities between the groups were no longer significant after controlling for abstract reasoning, working memory, verbal fluency, or facial emotion recognition. Impaired ToM recognition and reasoning abilities after a head injury may result from other cognitive impairments. In children with mild and moderate head injury, poorer performance on ToM tasks may reflect poorer abstract reasoning, a general tendency to concretize stimuli, working memory and verbal fluency deficits, and difficulties in facial emotion recognition, rather than deficits in the ability to understand the other’s thoughts and emotions. ToM impairments may be secondary to a range of cognitive deficits in determining social outcomes in this population.     

The relationship between parental report on the BRIEF and performance-based measures of executive function in children with moderate to severe traumatic brain injury.

The Behavior Rating Inventory of Executive Function (BRIEF) is a questionnaire that assesses parental observations of behaviors associated with executive function in children in the home environment. The current investigation examines the relationship between the BRIEF and individually-administered neuropsychological tests in children with traumatic brain injury. Forty-eight children with moderate to severe traumatic brain injury were administered the WISC-III and several performance-based tests of executive function (the Wisconsin Card Sorting Test, Trail Making Test Part B, verbal fluency), and a parent completed the BRIEF. Results indicate that the Metacognition Index from the BRIEF correlates with Verbal IQ, but none of the index scores from the BRIEF correlate with any of the performance-based tests of executive function. Results are discussed with respect to the ecological validity of standardized clinical neuropsychological tests of executive function.     

The Relationship Between Parental Report on the BRIEF and Performance-Based Measures of Executive Function in Children with Moderate to Severe Traumatic Brain Injury

The Behavior Rating Inventory of Executive Function (BRIEF) is a questionnaire that assesses parental observations of behaviors associated with executive function in children in the home environment. The current investigation examines the relationship between the BRIEF and individually-administered neuropsychological tests in children with traumatic brain injury. Forty-eight children with moderate to severe traumatic brain injury were administered the WISC-III and several performance-based tests of executive function (the Wisconsin Card Sorting Test, Trail Making Test Part B, verbal fluency), and a parent completed the BRIEF. Results indicate that the Metacognition Index from the BRIEF correlates with Verbal IQ, but none of the index scores from the BRIEF correlate with any of the performance-based tests of executive function. Results are discussed with respect to the ecological validity of standardized clinical neuropsychological tests of executive function.     

Cumulative mild head injury (CMHI) among college rugby players: A replication and extension study

We investigated the prevalence of cumulative mild head injury (CMHI) symptoms among college student rugby players pre- and post-season. The players completed a number of neuropsychological tests known to be sensitive to CMHI effects: vocabulary, working memory, motor coordination, and a self-report Post Concussive Symptomology (PCS) checklist. A total of 18 rugby players registered at a South African university were participants (age range 18 to 24 years, SD?=?2.02 years). Data were analysed utilising Fishers Exact Test comparisons of pre- and post-season mean scores. There was significant variability on mean scores between the rugby forwards and backline players in terms of verbal memory and concept formation, cognitive flexibility, working memory, and visual motor-processing speed. Poorer overall scores from the rugby forwards may also be indicative of depression as they reported more insomnia and anger on the PCS than the backline players.     

Assessment of performance validity in the Stroop Color and Word Test in mild traumatic brain injury patients: A criterion‐groups validation design

The current study assessed performance validity on the Stroop Color and Word Test (Stroop) in mild traumatic brain injury (TBI) using criterion‐groups validation. The sample consisted of 77 patients with a reported history of mild TBI. Data from 42 moderate–severe TBI and 75 non‐head‐injured patients with other clinical diagnoses were also examined. TBI patients were categorized on the basis of Slick, Sherman, and Iverson (1999) criteria for malingered neurocognitive dysfunction (MND). Classification accuracy is reported for three indicators (Word, Color, and Color–Word residual raw scores) from the Stroop across a range of injury severities. With false‐positive rates set at approximately 5%, sensitivity was as high as 29%. The clinical implications of these findings are discussed.     

Inhibitory control differences following mild head injury

Complex inhibitory control, defined as the ability to inhibit a planned or ongoing action, was assessed in a sample of individuals with a history of mild head injury, case-matched with normal control subjects for age and gender. This central act of control was assessed using a modification of the stop-signal paradigm. The group with mild head injury took longer to inhibit their on going action and reported more accidents than the normal control subjects. The group that reported having had a mild head injury did not differ in terms of their go reaction time, number of correct responses, handedness, education level, or reported learning disabilities. Limitations of this design and directions for future research are discussed.     

Postconcussion Symptoms

Research pertaining to the self-report of symptoms after traumatic brain injury was reviewed. Cognitive, emotional, and motivational factors have more relevance than demographic (except for female sex) and personality factors. Specific neuropsychological deficits in attention and memory have been found in the early stages after head injury of even mild severity. This is unlikely to be the only factor affecting symptom persistence. Exaggeration of cognitive dysfunction occurs in some cases, but appears unrelated to symptom overreport. Increased emotional distress typically accompanies symptom persistence. The psychological reaction of preoccupation with symptoms and emotional distress is not unique to concussion, but also occurs after severe head injury and back injury and relates more to the personal interpretation of the effect of the trauma than to objective indicators of brain injury severity.     

Linguistic recovery after closed head injury

Recovery from acute aphasia after closed head injury was studied in 21 young adults at least 6 months after injury. Three profiles of scores were found using standardized language tests. Persistent expressive and receptive impairment was present in 6 patients who sustained severe diffuse brain injury resulting in global cognitive deficit. Residual expressive impairment, primarily of naming, was associated with mild diffuse brain injury though focal left-hemisphere injury was present in 3 of 6 cases. Patients who recovered to normal levels on all language tests generally had acute neurologic findings consistent with mild diffuse brain injury. Cranial computed tomography at the time of followup frequently disclosed ventricular enlargement.     

Discrepancies between standardized measures of cognitive level and Halstead-Reitan impairment indices as inferences of brain damage following head injuries

z scores for measures of intelligence, memory, educational achievement, and neuropsychological impairment were obtained for 193 patients who had sustained impacts of mechanical energy to their skulls. Two sets of normative data, adjusted for age and sex and not adjusted for these variables, were employed to compute indices of neurocognitive proficiency (the inverse of impairment). 80% or 76 of the 96 patients whose Halstead-Reitan Indices were greater than 0.4 displayed scores for neurocognitive proficiency that were two or more standard deviations below the averages of their scores for intelligence, memory, and educational achievement. None of the patents whose Impairment Indices were 0.4 or less displayed this discrepancy. There were no statistically significant differences between these two groups of patients with respect to the presence of unconsciousness following the injury or the duration of posttraumatic memory disruptions. The results indicate that quantitative scores for neuropsychological impairments are still the most accurate criteria to discern brain dysfunction within the mild to moderate range.     

Cognitive sequelae of repeated head injury in a population of intravenous drug users

The relationship between closed head injury and performance on neuropsychological (NP) tests was investigated in a group of intravenous drug users (IVDUs). Subjects with repeated head traumas involving loss of consciousness (LOC) performed worse than both a control group without LOC and reference group with only a single episode of LOC. There were no significant differences between the last two groups. Performance on tests of memory, attention, and motor performance was significantly worse in the group with repeated head injury. The average time since the last episode of LOC was more than 11 years. We conclude from these findings that a single episode of LOC does not result in significant cognitive impairment in this population. Two or more episodes, however, are more likely to produce chronic cognitive impairment.