Enduring Effects of Previous Cerebral Concussion in College Freshman and Sophomores.

Philip Schatz Ph.D. & Kelly Ann MacNamara B.S.
Saint Joseph's University, Department of Psychology, Philadelphia PA.


Abstract
Recent literature (Echemendia, et al., 2001) suggests the effects of cerebral concussion, as well as prior history of concussion in high school athletes (Moser & Schatz, in press) may cause cognitive impairment lasting longer than the 5-10 days reported by Barth, et al. (1989) in college athletes. We administered the d2 Test of Attention, and computerized versions of the Trail Making and Digit-Symbol Tests to 56 college students aged 17-19 (M=18.4; SD=.65), 19 with self-reported history of concussion and 37 with no history of concussion. MANOVA revealed a significant effect of history of concussion on performance [F(4,51)=2.78; p=.037]; univariate analyses revealed significant effects of history of concussion on d2 Omission Errors [F(1,54)=5.77; p=.02; Effect Size=.31], d2 Total Errors [F(1,54)=6.31; p=.015; ES=.32], and Digit Symbol Errors [F(1,54)=4.97; p=.03; ES=.29]. Students with history of concussion averaged significantly more d2 Omission Errors (18.5 vs. 9.4), d2 Total Errors (20.6 vs. 10.5), and Digit Symbol Errors (3.6 vs. 1.5). A trend approaching statistical significance was observed in Trail Making Test B Total Errors [F(1,54)=2.71; p=.10; ES=.22]; students with history of concussion averaged twice as many errors (1.6 vs. .8) as those with no concussion history. Overall, these results support mild, enduring effects of concussion that can be identified in youth with a history of concussion. These moderate effect sizes from a relatively small sample warrant a larger-scale investigation involving high school and college aged students.


Introduction
Single mild head injuries in healthy college-aged athletes were found to cause some decreases in neurocognitive performance, with a relatively rapid recovery curve over 5 to 10 days (Barth, et al., 1989.)

Recovery from cerebral concussions in college athletes was found to extend beyond the 5-10 day period, with some differences noted between concussed athletes and controls up to one month post-concussion (Echemendia, et al., 2001.)

Past history of two or more previous concussions were found to have mild, enduring effects in otherwise healthy high school athletes (Moser & Schatz, 2002.)

The purpose of this study was to replicate the findings of Moser and Schatz in a sample of college freshmen.

Participants
Self-reported history of concussion were examined in a sample of 56 college student freshmen, ages 17-19. Participants were divided into two independent groups on the basis of concussion history: 19 with self-reported history of one or more previous concussion, and 39 with self-reported history of no previous concussions.

Dependent Measures
d2 Test of Attention, and computerized versions of the Trail-Making Tests A&B and Digit-Symbol Sub-test of the WAIS-R.

Results
MANOVA revealed a significant effect of history of concussion on performance [F(4,51)=2.78; p=.037]; univariate analyses revealed significant effects of history of concussion on d2 Omission Errors [F(1,54)=5.77; p=.02; Effect Size=.31], d2 Total Errors [F(1,54)=6.31; p=.015; ES=.32], and Digit Symbol Errors [F(1,54)=4.97; p=.03; ES=.29].

Students with previous concussions averaged significantly more d2 Omission Errors (18.5 vs. 9.4), d2 Total Errors (20.6 vs. 10.5), and Digit Symbol Errors (3.6 vs. 1.5). Between-group differences were observed in Trail Making Test B Total Errors [F(1,54)=2.71; p=.10; ES=.22]; students with history of concussion averaged twice as many errors (1.6 vs. .8) as those with no concussion history (Table 1.)

Summary
Mild, enduring effects of cerebral concussion can be identified in otherwise healthy college freshmen with a history of concussion.

These enduring effects of previous cerebral concussions appear to involve attentional processes, and warrant further investigation.


References
Barth J.T., Alves WA, Ryan T, Macciocchi SN, Rimel RW, Jane JA, Nelson WE: Mild head injury in sports: Neuropsychological sequelae and recovery of function, in Levin HS, Eisenberg HM, Benton AR (eds): Mild Head Injury. New York, Oxford Press, 1989, pp 257-275.

Echemendia RJ, Putukian M, Mackin RS, Julian L, Shoss N. Neuropsychological test performance prior to and following sports-related mild traumatic brain injury. Clin J Sport Med. 2001 Jan;11(1):23-31.

Moser, R.S. & Schatz, P. Enduring effects of concussion in youth athletes. Archives of Clinical Neuropsychology 2002, 17(1).