scholarly journals Age of First Exposure to Contact Sports and Neurocognitive Performance in U.S. Service Academy Athletes

2019 ◽  
Vol 34 (5) ◽  
pp. 753-753
Author(s):  
J B Caccese ◽  
G L Iverson ◽  
K L Cameron ◽  
M N Houston ◽  
G T McGinty ◽  
...  
Keyword(s):  
Reaction Time ◽  
Symptom Severity ◽  
Sports Participation ◽  
Ice Hockey ◽  
Motor Speed ◽  
Neurocognitive Performance ◽  
Contact Sports ◽  
Visual Motor ◽  
Service Academy ◽  
The Impact

Abstract Purpose To examine the association between estimated age of first exposure (eAFE) to contact sports and neurocognitive performance and symptom ratings in collegiate U.S. Military Service Academy athletes. We hypothesized that contact-sports participation before the age of 12 would not be associated with worse neuropsychological test performance or greater symptom reporting. Methods Male cadets (N=891) who participated in contact sports [i.e., in lacrosse (n=211), wrestling (n=170), ice hockey (n=81), soccer (n=119), rugby (n=10)], or non-contact sports (n=298), completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test before the season. Generalized linear modeling was used to predict each cognitive domain score and the symptom severity score. Predictor variables were entered in the following order: group (contact vs. non-contact), eAFE (eAFE<12 vs. eAFE≥12), group-by-eAFE, and covariates for learning accommodation status, concussion history, and age. Results The group-by-eAFE interaction was not significant for any of the ImPACT composite scores (Verbal Memory, Wald Χ2=.073, p=.788; Visual Memory, Wald Χ2=2.71, p=.100; Visual Motor Speed, Wald Χ2=.078, p=.780; Reaction Time, Wald Χ2=.003, p=.955; Symptom Severity, Wald Χ2=2.87, p=.090). Learning accommodation history was associated with lower scores on Visual Motor Speed (Χ2=6.19, p=.013, B=-2.97). Older age was associated with faster reaction time (Χ2=4.40, p=.036, B=-.006) and lesser symptom severity (Χ2=5.55, p=.019, B=-.068). No other parameters were significant. Conclusion We observed no association between eAFE, contact-sport participation, cognitive functioning, or subjectively-experienced symptoms in this cohort. Earlier eAFE to RHI is not related to worse neurocognitive performance or greater subjectively-experienced symptoms in collegiate student-athletes enrolled in military academies.

scholarly journals THE RELATIONSHIP BETWEEN ACUTE MOOD, SLEEP, AND SEX ON NEUROCOGNITIVE PERFORMANCE POST-CONCUSSION IN ADOLESCENTS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0019
Author(s):  
Sara Stremlau ◽  
Richard Cameron Allred ◽  
Richard Gerkin ◽  
Steven Erickson ◽  
Jamie Pardini
Keyword(s):  
Reaction Time ◽  
Verbal Memory ◽  
Visual Memory ◽  
Cognitive Testing ◽  
Motor Speed ◽  
Neurocognitive Performance ◽  
Symptom Report ◽  
Mood Symptoms ◽  
Visual Motor ◽  
And Performance

Background: Both sleep disturbance and mood changes are common symptoms post-concussion (Sell & Rubeor, 2017). Studies have found these symptoms are correlated with poorer performance on neurocognitive testing (Kontos et al., 2012 and Kostyun et al., 2015). In addition, Brown et al., (2015) showed that females report more symptoms at both baseline and post-concussion compared to males on the Post-Concussion Scale and the Sport Concussion Assessment Tool 2. Hypothesis/Purpose: The purpose of this study is to investigate how a patient’s sex, as well as self-reported acute mood and sleep symptoms are related to neurocognitive performance in individuals with concussion. Methods: Data were acquired through IRB-approved retrospective chart review. Composite scores from the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computerized evaluation and self-reported symptom scores on the Post-Concussion Symptom Scale were gathered for 1619 adolescents age 12-18 (49.3% female) who presented to a large metropolitan outpatient clinic for treatment of concussion. Results: Females endorsed higher overall symptoms (x=19.52, SD 19.37, median 13.0 for females; x=12.88, SD 15.89, median 7.0 for males; Mann-Whitney U Test p<0.001). This same pattern emerged for the mood and sleep symptom clusters (female mood mean=2.92, SD 4.51; male mood mean=1.64, SD 3.34; female sleep mean=1.59, SD 2.0; male sleep mean=1.11, SD 1.84; both Independent Samples Mann-Whitney U Tests ps<0.001). There were significant but modest negative correlations between mood symptoms and performance on verbal memory (r=-0.174), visual memory (r=-0.213), and visual motor speed (r=-0.146) composites (all ps<0.01). There was positive correlation between reaction time composite and mood symptoms (r=0.191). There were significant but modest negative correlations between sleep symptoms and performance on verbal memory (r=-0.171), visual memory (r=-0.184), and visual motor speed (r=-0.161) composites (all ps<0.01). There was a positive correlation between reaction time composite and sleep symptoms (r=0.196, p<0.01). Conclusion: Consistent with prior research, adolescent females reported more symptoms post-concussion, including total symptom score, mood symptoms, and sleep symptoms. Adolescents presenting with more mood and sleep symptoms demonstrated poorer performance on neurocognitive testing. However, given the modest nature of the correlation, a significant amount of variation in test performance is not explained by symptom report. Results from this study underscore the importance of a multidimensional concussion assessment that includes both symptom report and cognitive testing when working with pediatric athletes. This study also reinforces the importance of understanding potential effects of sleep, mood, and sex on concussion.

scholarly journals A Cohort Study of the Temporal Stability of ImPACT Scores Among NCAA Division I Collegiate Athletes: Clinical Implications of Test–Retest Reliability for Enhancing Student Athlete Safety

2020 ◽  
Vol 35 (7) ◽  
pp. 1131-1144
Author(s):  
Sara J Mason ◽  
Bradley S Davidson ◽  
Marybeth Lehto ◽  
Aurélie Ledreux ◽  
Ann-Charlotte Granholm ◽  
...  
Keyword(s):  
Reaction Time ◽  
Ncaa Division I ◽  
Verbal Memory ◽  
Temporal Stability ◽  
Division I ◽  
Cognitive Test ◽  
Motor Speed ◽  
Visual Motor ◽  
Composite Scores ◽  
The Impact

Abstract Objective In this study we examined the temporal stability of the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) within NCAA Division I athletes across various timepoints using an exhaustive series of statistical models. Methods Within a cohort design, 48 athletes completed repeated baseline ImPACT assessments at various timepoints. Intraclass correlation coefficients (ICC) were calculated using a two-way mixed effects model with absolute agreement. Results Four ImPACT composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, and Reaction Time) demonstrated moderate reliability (ICC = 0.51–0.66) across the span of a typical Division I athlete’s career, which is below previous reliability recommendations (0.90) for measures used in individual decision-making. No evidence of fixed bias was detected within Verbal Memory, Visual Motor Speed, or Reaction Time composite scores, and minimal detectable change values exceeded the limits of agreement. Conclusions The demonstrated temporal stability of the ImPACT falls below the published recommendations, and as such, fails to provide robust support for the NCAA’s recommendation to obtain a single preparticipation cognitive baseline for use in sports-related concussion management throughout an athlete’s career. Clinical interpretation guidelines are provided for clinicians who utilize baseline ImPACT scores for later performance comparisons.

Signs of cognitive dysfunction in adult players of club level rugby

2019 ◽  
Vol 50 (1) ◽  
pp. 128-140 ◽  
Author(s):  
Diana Zoccola ◽  
Ann B Shuttleworth-Edwards ◽  
Sarah E Radloff
Keyword(s):  
Reaction Time ◽  
Cognitive Dysfunction ◽  
Verbal Memory ◽  
Visual Memory ◽  
Rugby Union ◽  
Motor Speed ◽  
Visual Motor ◽  
The Impact ◽  
Rugby Players

The objective of this study was to investigate players of club level Rugby Union (hereafter rugby) over one rugby season, for signs of residual cognitive dysfunction due to repeated concussive events incurred during long-term participation in the sport. Adult male players of club level rugby, without a diagnosis of a concussion during the season ( n = 20), were compared with non-contact club level sports participants ( n = 22) of equivalent sex, age, education, and estimated IQ at pre-, mid-, and post-season intervals. Measures included the ImPACT Verbal Memory, Visual Memory, Visual Motor Speed and Reaction Time composites, and the Purdue Pegboard test. Statistical group comparisons revealed consistently poorer performance for rugby players compared with controls for ImPACT Visual Motor Speed and Reaction Time composites at all test intervals, and for the Purdue Pegboard tasks at the first two test intervals. Repeat measures comparisons across the three test intervals demonstrated differential learning patterns between groups on ImPACT Visual Memory, ImPACT Reaction Time, and Purdue Both tasks, suggestive of cognitive vulnerability in the rugby group. Overall, the results reveal deleterious cognitive performance in adult club level rugby players relative to equivalent non-contact sports controls. The finding serves to endorse indications from other studies that demonstrate persistent brain injury effects in association with long-term participation in a contact sport. Recommendations for further research and management of concussion in rugby players are discussed.

scholarly journals HOW DO LEARNING DISORDERS IMPACT CLINICAL MEASURES FOLLOWING CONCUSSION?

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0018
Author(s):  
Aaron J. Zynda ◽  
Mathew A. Stokes ◽  
Jane S. Chung ◽  
C. Munro Cullum ◽  
Shane M. Miller
Keyword(s):  
Symptom Score ◽  
Learning Disorders ◽  
Total Symptom Score ◽  
Adhd Group ◽  
Motor Speed ◽  
The North ◽  
History Of ◽  
Visual Motor ◽  
Clinical Measures ◽  
The Impact

Background: There is limited evidence examining the impact of learning disorders on testing and screening scores used in evaluation following concussion in adolescents. Purpose: To examine differences in clinical measures between adolescents with a history of dyslexia or ADD/ADHD and those without a history of learning disorder (LD) following concussion. Methods: Data were collected from participants enrolled in the North Texas Concussion Network Prospective Registry (ConTex). Participants ages 10-18 who had been diagnosed with a concussion sustained within 30 days of enrollment were included. Participants were separated into three groups based on self-reported prior diagnosis: dyslexia, ADD/ADHD, and no history of LD. Clinical measures from initial presentation were examined, including ImPACT®, King-Devick (KD), SCAT-5 symptom log, Patient Health Questionnaire (PHQ-8), and Generalized Anxiety Disorder (GAD-7) scale. Independent t-test analysis was performed to compare scores between groups. Results: A total of 993 participants were included; 68 with dyslexia, 141 with ADD/ADHD, and 784 with no history of LD. There was no difference in age, sex, time since injury, or history of concussion between the dyslexia group and no LD group. In the ADD/ADHD group, there were significantly more male participants (64.5% and 50.3% respectively, p=0.002). Participants with a history of dyslexia had a significant increase in KD time (63.7 sec vs 56.5 sec, p=0.019). Additionally, ImPACT® testing showed a decrease in visual motor speed (28.87 vs 32.99, p= 0.010). Total symptom score was higher in this group as well (36.22 vs 28.27, p=0.013). In those with a history of ADD/ADHD, multiple domains were found to be significantly different on ImPACT® testing including visual motor speed (30.05), reaction time (0.75), and cognitive efficiency (0.23) when compared to those with no LD (32.99, 0.71, and 0.27 respectively, p=0.004, 0.047, 0.027). KD time was also significantly higher in this group (62.1 sec vs 56.5 sec, p=0.008), as was the total symptom score (32.99 vs 28.27, p=0.043). PHQ-8 and GAD-7 were both significantly higher in the group with ADD/ADHD (5.79 and 5.06 respectively, p=0.001) than those with no LD (4.32 and 3.56, p=0.001). Conclusion: Differences were seen in participants with a history of dyslexia and ADD/ADHD on clinical concussion measures, including ImPACT® and KD testing, SCAT-5 symptom log, and screenings for depression and anxiety. A better understanding of the unique profiles seen in these patients will aid providers in their evaluation and assist as they counsel families regarding their child’s injury.

A-120 Comparison of Baseline and Post-Concussion ImPACT Performance in Spanish-English Bilingual and English Monolingual Athletes

2021 ◽  
Vol 36 (6) ◽  
pp. 1170-1170
Author(s):  
Erick Rogers ◽  
Hana Kuwabara ◽  
Grace Goodwin ◽  
Sara Moore ◽  
Nia Hopkins ◽  
...  
Keyword(s):  
Reaction Time ◽  
Visual Memory ◽  
Cognitive Testing ◽  
English Speakers ◽  
Future Research ◽  
Motor Speed ◽  
Linear Modeling ◽  
Impact Performance ◽  
Sport Type ◽  
Visual Motor

Abstract Objective Research comparing English and Spanish administrations of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) have consistently found differences in performance on various cognitive composites. Few studies have examined the effect of bilingualism on baseline and post-concussion assessments. This study examined whether monolingual English-speakers (MO) and bilingual Spanish/English speakers (BI) differed in cognitive performance at baseline (BL) and post-concussion (PC). Methods Participants were selected from a larger database of high school athletes administered ImPACT in English at BL and PC. Participants included 86 BI athletes (Mage = 14.53; 65.10% male) and 86 MO athletes matched on age, gender, sport type, and probable concussion as defined by number of PC follow-up assessments (PCF; 0 vs. ≥1). To examine group differences and changes over time in cognitive composites, a general linear modeling approach was used with language and PCF as between-subjects factors and time as a within-subjects factor. Results There was a significant Language x Time x PCF interaction for Visual Memory (VM), Visual Motor Speed (VMS), and Reaction Time (RT). On VM and RT, MO with multiple PCF performed the worst at PC, while MO with 0 PCF performed the best at PC. On VMS, BI with 0 PCF performed the worst at BL. Conclusion Visual memory and reaction time were less affected in bilingual compared to monolingual athletes with probable concussion. However, at baseline, bilingual athletes had slower visual motor speed compared to monolingual athletes. Future research should focus on how bilingualism may serve as both a protective and risk factor for cognitive functioning after probable concussion.

scholarly journals B-44 An Examination of Balance Measurements in Predicting Post-Concussion Neurocognitive Dysfunction

2019 ◽  
Vol 34 (6) ◽  
pp. 990-990
Author(s):  
A DaCosta ◽  
A Crane ◽  
M Fasciana ◽  
A LoGalbo
Keyword(s):  
Reaction Time ◽  
Verbal Memory ◽  
Visual Memory ◽  
Clinical Utility ◽  
Collegiate Athletes ◽  
Motor Speed ◽  
Balance Performance ◽  
Neurocognitive Dysfunction ◽  
Balance Deficits ◽  
Visual Motor

Abstract Objective Previous research indicates that athletes experiencing concussions demonstrate acute balance deficits (Guskiewicz, 2011). Although it is hypothesized that balance performance is related to neurocognitive function in athletes experiencing a concussion (Guskiewicz, Ross, & Marshall, 2001; Broglio, Sosnoff, Ferrara, 2009), limited research exists regarding the clinical utility of baseline measures. Method 68 collegiate athletes (ages 18-23; M = 19.62, SD = 1.44) were evaluated using the Balance error scoring system (BESS) and ImPACT at baseline and post-concussion. Multiple linear regressions were used to determine how BESS performance change across evaluations predicted post-concussion neurocognitive dysfunction compared to post-concussion performance alone. Results BESS performance changes from baseline to post-concussion significantly predicted post-concussion Verbal Memory (R² = .06, p = .05), Visual Memory (R² = .135, p = .002), Visual-Motor Speed (R² = .146, p = .001), Reaction Time (R² = .156, p = .001), and Total Symptom Scores (R² = .112, p = .005); while post-concussion BESS scores predicted Visual Memory (R² = .138, p = .002), Visual-Motor Speed (R² = .137, p = .002), and Reaction Time (R² = .145, p = .001). Therefore, assessing change in BESS performance is a more comprehensive predictor of neurocognitive dysfunction than solely post-concussion BESS performance. Conclusions Changes in BESS performance from baseline to post-concussion was found to be a more comprehensive predictor of neurocognitive dysfunction than post-concussion BESS scores alone. Therefore, our results support the clinical utility of evaluating balance at pre-participation to better understand neurocognitive risk factors.

scholarly journals Sports Participation, Demographic Factors and Knee Symptom Severity in Riyadh, Saudi Arabia

2021 ◽  
pp. 154-167
Author(s):  
Moaath A. Alamir ◽  
Abdulaziz F. Altammami ◽  
Faris H. Binyousef ◽  
Ahmed A. Alharbi ◽  
Feras A. Alrakaf
Keyword(s):  
Saudi Arabia ◽  
Symptom Severity ◽  
Online Survey ◽  
Sport Participation ◽  
Sports Participation ◽  
Exercise Duration ◽  
Severe Form ◽  
Cross Sectional ◽  
Lequesne Index ◽  
The Impact

Aims: to explore the prevalence of knee symptoms in the general population of Riyadh, Saudi Arabia, and evaluate the impact of sports participation and other demographic variables on the progression of knee symptoms in Riyadh, Saudi Arabia. Study design:  Cross-sectional study Place and duration of study: A self-administered online survey was conducted in Riyadh, Saudi Arabia between September 2020 to March 2021. Methodology: A total of 589 participants age 18 or older who reported concerns of knee symptoms and provided written informed consent were enrolled in the study. We excluded respondents who had undergone knee surgery (n = 16) and those diagnosed with rheumatoid arthritis or other types of arthritis (n = 25). We collected demographic information (eg, age, gender, types of engaged sports, sports participation hours, and frequency of participation per week) and knee symptoms and severity using the Lequesne index tool. Results: Advanced age was significantly associated with a higher severity score (P < .001). We found a statistically significant association between body mass index and knee symptom severity. We noted no severe knee symptoms in participants engaging in weightlifting. Most participants (64.7%) reported that walking was their most frequent exercise, and knee symptoms were common. Of respondents who walk as their primary sport, 10.6% of them are considered disabled with a severe form of knee pain according to the Lequesne index (which uses the term “handicapped” rather than disabled). Conclusion: Older and overweight respondents had a high prevalence of knee symptoms. Interestingly, the prevalence rates of individuals without knee symptoms did not differ regarding sport participation. Sports participation frequency did not change the prevalence or severity of knee symptoms, while longer exercise duration was associated with lower knee symptom severity rates.

scholarly journals Preseason Baseline Neurocognitive Performances and Symptom Reporting on ImPACT®: A Comparison of Adolescent Student-Athletes Tested in Spanish and English

2020 ◽  
Author(s):  
Justin E. Karr ◽  
Mauricio A. Garcia-Barrera ◽  
Jacqueline M. Marsh ◽  
Bruce Maxwell ◽  
Paul D. Berkner ◽  
...  
Keyword(s):  
Symptom Severity ◽  
Student Athletes ◽  
Symptom Reporting ◽  
Group Differences ◽  
Language Group ◽  
Motor Speed ◽  
Language Groups ◽  
Baseline Testing ◽  
Composite Scores ◽  
The Impact

Abstract Context: Student-athletes are commonly administered the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®) battery at preseason baseline and post concussion. The ImPACT® is available in many different languages, but few studies have examined differences in cognitive performances and symptom ratings based on language of administration. Objective: This study examined differences on ImPACT® neurocognitive composites and symptom reporting at preseason baseline testing between student-athletes completing ImPACT® in Spanish versus English. Design: Cross-sectional study. Setting: Preseason baseline testing for a high school concussion management program in STATE-XXX. Patients of Other Participants: Adolescent student-athletes completing testing in Spanish (n=169) and English (n=169) were matched on age, gender, and health/academic history. Language groups were compared on each outcome for the full sample and for gender-stratified subsamples. Main Outcome Measure(s): Neurocognitive composite scores and individual and total symptom severity ratings from the ImPACT® battery. Results: Athletes tested in Spanish had lower neurocognitive performances on two of five composite scores (i.e., Visual Motor Speed, p&lt;.001, d=.51; Reaction Time: p=.004, d=.33) and reported greater symptom severity (p&lt;.001, r=.21). When analyses were stratified by gender, similar Visual Motor Speed differences were observed between language groups among boys (p=.001, d=.49) and girls (p=.001, d=0.49), whereas Reaction Time showed a larger group difference for boys (p=.012, d=.42) than girls (p=.128, d=.21). Language group differences in symptom reporting were similar for boys (p=.003, r=.22) and girls (p=.008, r=.21), with more frequent endorsement of physical and affective symptoms by athletes tested in Spanish. Conclusions: Language group differences in total symptom severity were small (r=.21), and language group differences in neurocognitive performances were small-to-medium (d=.05–.51). Compared to previous studies comparing athletes tested in Spanish and English on ImPACT®, smaller effects were observed in the current study, which may be attributable to close matching on variables related to neurocognitive performances and symptom reporting. Key points:

scholarly journals Exposure to Serial Post-Concussion Neurocognitive Testing Does not Affect Future “Updated” Baseline Neurocognitive Performance in Adolescent Athletes

2019 ◽  
Vol 34 (5) ◽  
pp. 757-757
Author(s):  
S O'Connor ◽  
T Dean ◽  
R J Elbin ◽  
P Schatz
Keyword(s):  
Dose Response ◽  
Visual Memory ◽  
Impact Testing ◽  
Motor Speed ◽  
Neurocognitive Testing ◽  
Symptom Scores ◽  
Baseline Testing ◽  
Visual Motor ◽  
Response Groups ◽  
The Impact

Abstract Purpose We investigated a dose response for serial post-concussion neurocognitive testing exposure on updated post-concussion baseline testing performance. Methods Athletes (13-18 yrs) that completed two, valid baseline neurocognitive testing (ImPACT) sessions approximately 1-3 years apart participated in this study. A sub-sample of athletes that sustained a SRC between baseline sessions were categorized into dose-response groups based on the number of serial, post-concussion neurocognitive tests completed following SRC: ONE (n=76), TWO (n=99), and THREE OR MORE (n=111). Athletes that did not sustain a SRC comprised the ZERO group (n=289). Change scores between the first to the second baseline were calculated for the ImPACT Composite and Symptom Scores and compared between the dose-response groups and controls with 5 ANOVAs, with a Bonferroni-corrected p-value of (p<.01). Baseline testing was administered using ImPACT stimuli within the “Baseline” administration, and all post-concussion ImPACT testing was administered using alternate-form associated with that specific post-injury assessment (Post-Injury1, Post-Injury2, etc). Results ANOVAs revealed no effect of number of post-concussion assessments (0, 1, 2, or 3+) on magnitude of the change between first and final baselines, for Verbal Memory (p=.08), Visual Memory (p=.96), Visual Motor Speed (p=.47), Reaction Time (p=.91), or Total Symptom Scores (p=.86). Conclusion Repeated exposure to neurocognitive testing has revealed improvements in Visual Motor Speed among normal controls, across test-retest intervals of 1-month, 1-year, and 2-years. However, in this study, exposure to post-concussion, serial neurocognitive testing had no effect on future performance on post-concussion baseline neurocognitive testing.

A - 08 Within Subjects Comparison of Clinical Outcomes After First, Second, and Third Concussions in Adolescents*

2021 ◽  
Vol 36 (4) ◽  
pp. 648-648
Author(s):  
Feder AH ◽  
French J ◽  
Blaney N ◽  
Eagle SR ◽  
Kontos AP
Keyword(s):  
Clinical Outcomes ◽  
Verbal Memory ◽  
Visual Memory ◽  
Recovery Time ◽  
Cognitive Test ◽  
Motor Speed ◽  
Neurocognitive Performance ◽  
Symptom Scale ◽  
Visual Motor ◽  
Improved Performance

Abstract Objective The objective of the current study was to examine differences in clinical outcomes between adolescents’ first, second, and third concussions. Methods We conducted a retrospective medical chart review of adolescents (n = 40) aged 10–19 years-old (M = 13.0;SD = 1.9;56% male) who presented for evaluation of concussion at a specialty clinic for their first (Concussion 1 = C1), second (C2), and third (C3) concussions. Clinical outcomes included Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Post-Concussion Symptom Scale (PCSS), Vestibular/Ocular-Motor Screening (VOMS) scores from the first clinic visit for each injury, recovery time, and days between injuries. Paired samples t-tests were conducted to compare outcomes between concussions. Results When comparing initial presentation between C1 and C2, participants demonstrated no significant differences in ImPACT, PCSS (t[38] = 0.85, p = 0.402) or VOMS (t[34] = −0.75, p = 0.461), with the exception of faster Visual Motor Speed for C2 (t[38] = −3.45, p = 0.001). Participants demonstrated improved performance from C1 to C3 on ImPACT composites of Verbal Memory (t[38] = −4.22, p &lt; 0.001), Visual Memory (t[38] = −2.99, p = 0.005), Visual Motor Speed (t[38] = −5.14, p &lt; 0.001) and Reaction Time (t[38] = 0.11, p = 0.001). Symptom report was consistent on PCSS (t[38] = 1.80, p = 0.081) and VOMS (t[30] = −0.12, p = 0.903) between C1 and C3. Recovery time was similar comparing C1 to C2 (t[36] = −0.35,p = 0.725) and C1 to C3 (t[34] = 1.74,p = 0.090). Conclusions The results suggest adolescents demonstrate similar levels of symptoms, VOMS, and recovery time after first, second, and third concussions. Neurocognitive performance improved across C1 to C3, suggesting possible learning effect or improved performance with cognitive development. These results provide additional support for similarity between an athlete’s first and second concussion with further initial evidence that a third concussion does not result in worse outcomes.

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