ALTERNATIVE APPROACHES TO THE ASSESSMENT OF MILD HEAD-INJURY IN ATHLETES

Objectives: Athletic trainers and team physicians are often faced with decisions concerning the severity and timing of an athletes return to play following mild head injury (MHI). These decisions can be the mos t difficult ones facing clinicians because of the limited amount of qu antitative information indicating injury severity. Several authors hav e published guidelines for return to play following MHI, however these guidelines are based on limited scientific data. The purpose of this paper was to examine the effects of MHI on two objective measures, pos tural stability and cognitive function, to determine their usefulness in MHI assessment. The data gathered from these two measures has the p otential to establish recovery curves based on objective data. Methods : Eleven Division I collegiate athletes who sustained a MHI and eleven matched control subjects were assessed for postural stability and cog nitive function at four intervals following injury. Postural stability was assessed using the Sensory Organization Test on the NeuroCom Smar t Balance Master. Cognitive functioning was measured through the use o f four neuropsychological tests: Stroop Test, Trail Making Test, Digit s Span and Hopkins Verbal Learning Test. Separate mixed model repeated measures ANOVAs were calculated for the composite score and three rat io (vestibular, visual and somatosensory) scores from the Sensory Orga nization Test and the scores from the neuropsychological test to revea l significant differences between groups and across days postinjury. R esults: A significant group by day interaction for overall postural st ability (composite score) revealed that MHI athletes displayed increas ed postural instability for the first few days following MHI (p<.05). Analysis of the ratio scores revealed a significant interaction for th e visual ratio. No significant group differences were revealed for any of the neuropsychological tests (p>.05), however significant day diff erences were revealed (p<.05). Conclusions: The results from this stud y indicate that athletes demonstrate decreased stability until 3 days postinjury. It appears this deficit is related to a sensory interactio n problem, whereby the injured athlete fails to use their visual syste m effectively. These findings suggest that measures of postural stabil ity may provide clinicians with a useful clinical tool for determining when an athlete may safely return to competition, although these find ings need to be confirmed in larger groups of athletes.