The role of neuropsychological (computerised) testing

Computerised neuropsychological (NP) testing is not essential in the diagnosis and management of concussion. These systems are used to measure cognitive function which is one component of a multi-modal assessment and a multi-modal assessment is recommended to support a clinical diagnosis of concussion.

These systems are often used by professional sporting teams in conjunction with or substituting for SCAT5©. Computerised NP testing use in professional teams is supported by baseline testing which is traditionally not available in the community setting.

Cognitive recovery is known to largely overlap with the time course of symptom recovery however it more commonly follows symptom resolution. It is for this reason that serial cognitive assessment using either SCAT5© or a computerised NP system is employed in concussion management.

Makdissi et al³ in 2010 confirmed this delay in cognitive recovery when they compared cognitive recovery to symptom resolution. Data from this study confirmed that impairments on computerised testing persisted for 2–3 days after symptom resolution in 35% of concussed athletes.

Despite Makdissi's study, sole reliance on NP testing to determine recovery and return to play is not recommended. Studies by both Echlin⁴ and Broglio⁵ confirmed that normal NP testing occurred in up to 38% of diagnosed concussive cases who had persistent symptoms.

In summary, sole reliance on computer NP testing to determine a return to play is NOT recommended. If available, NP testing can be used in conjunction with symptom checklists and balance evaluation as an aid to the clinical decision making process.