Once the double vision, headache and dizziness caused by a cerebral concussion disappear, team physicians must evaluate an athlete's fitness to return to play, but according to a Penn State neuropsychologist, making that decision is not easy and should be individualized, not based on group data.

"If athletes return to play before the effects of a concussion are gone, they run the risk of incurring a more serious injury should they be hurt again," says Dr. Ruben J. Echemendia, director of Penn State's Psychological Clinic and associate professor of psychology. "On the other hand, if we prevent athletes from playing when they are well, it is detrimental to their careers and to the team's outcome."

In the past, physicians have judged readiness to play by standard clinical guidelines that a player can return to play a specified number of days after all symptoms disappear. Recently, a significant amount of attention has been focused on the use of neuropsychological tests for assisting in the return-to-play decision.

One method for assessing whether an athlete has improved enough to play is to use Reliable Change scores. Reliable Change Scores are calculated using data gathered from many individuals. They depend on a baseline, preseason test score for each athlete. The post-injury scores are then compared with the preseason scores and used to determine if the athlete is improving. The Reliable Change score creates a wide band of scores beyond which the athlete is thought to be either "reliably" better or worse.

For example, if a test has a Reliable Change score of 7 and a baseline score of 25 was obtained, a post-injury score of 32 (or 18) would be needed to be "reliably" different.

"The indiscriminate use of RC scores would lead to equal numbers of false positive and false negative decisions," Echemendia told attendees today (Aug. 20) at the annual meeting of the American Psychological Association in B
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Contact: A'ndrea Elyse Messer
aem1@psu.edu
814-865-9481
Penn State
20-Aug-1999