Pre- and postinjury neurocognitive functioning of adolescent Finnish athletes : acute signs of concussion and modifying factors

Kati Peltonen

Research output: ThesisDoctoral ThesisCollection of Articles


Concussion is a common injury in high velocity sports such as ice hockey. The importance of appropriate identification, evaluation and management of concussions has been emphasized to avoid more severe injuries and long-term consequences and premature retirements. Adolescent athletes are more prone to concussion than adults, and concussion may cause severe acute and long- term complications in the developing athletes. The initial recognition and evaluation of concussion occurs acutely on the scene of injury. Some observable on-field signs that are thought to indicate concussion diagnosis are loss of consciousness (LOC), amnesia, disorientation, postural instability, and vacant look. A multifaceted approach is recommended for concussion evaluation. The neuropsychological assessment is mentioned as the “cornerstone” of concussion management even if it is insufficient alone. It is important to model the typical cognitive performance and development and to provide reference values for clinicians in order for them to identify atypical brain function after injury. The general aim of the present study was to examine the cognitive performance and post-injury cognitive decline of adolescent athletes. The study’s objective was to explore the association between on-field signs of concussion and postinjury neurocognitive deficits. An additional aim was to examine the modifying factors in concussion assessment such as age, concussion history, learning disability and repeated testing. This thesis comprises three studies exploring the neurocognitive performance of adolescent athletes pre- and postinjury using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery. The first study examined the interaction effects of age, learning disability (LD), and previous concussion history on cognitive performance at a baseline in a sample of 1823 Finnish adolescent athletes. The second study explored the usefulness of on-field signs of concussion (i.e., LOC, amnesia, disorientation, postural instability, and vacant look) for predicting worse-than baseline neurocognitive performance during the acute, postinjury period in a sample of 34 concussed young athletes. The third study further examined the effects of on-field signs on the rate of acute neurocognitive decline in a sample of 32 concussed participants using reliable change indices (RCIs) derived from a healthy sample of 312 athletes. Compared to typically developing athletes, athletes with LD had lower neurocognitive scores across all domains in a preseason baseline assessment. Additionally, athletes with LD demonstrated atypical maturational trajectories in verbal memory and visual motor speed. The number of prior concussions did not affect neurocognitive performance at the baseline. Hierarchical regression analyses were utilized to examine the predictive value of on-field signs for postinjury cognitive recovery. On-field LOC, amnesia and vacant look were related to larger deficits in cognition at 7 days postinjury compared to concussed adolescent athletes without these signs. LOC accounted for 22% of the variance in verbal memory performance, and amnesia accounted for 15% of variance in verbal memory performance at group level. Vacant look sign accounted for 9% of the variance in visual memory scores. The effect of acute signs of concussion on postinjury cognitive functioning was further explored using RCI methodology. RCI methodology was applied to determine whether the change between baseline- and postinjury-cognitive functioning is meaningful at the individual level. The 1-year test-retest reliability of the Finnish version of ImPACT ranged from .39 to .71. RCIs derived from a healthy sample were calculated and applied to concussed sample. Athletes with an acute LOC, amnesia, or postural instability were approximately 8 times more likely to have impairments in two or more cognitive areas evaluated by ImPACT on day 3 postinjury. Acute on-field disorientation or a vacant look did not lead to reliable cognitive decline. In all, the findings of the present study suggest that cognitive functioning develops throughout adolescence and that athletes with LD differ from their counterparts in cognitive maturational trajectories. Separate reference values for LD athletes are needed, considering their unique cognitive development. Baseline testing might be beneficial in subpopulations such as youth athletes and athletes with LD that display large variability in cognitive performance or differing developmental trajectories over time. Based on the present study, the presence of LOC, amnesia, or vacant look are risk factors for longer recovery times. The presence of acute postural instability might also indicate a more severe injury that warrants an intensive cognitive follow-up. The present findings have direct implications for concussion recognition, evaluation, and management. Reference values and reliable change indices for Finnish language and culture are provided for youth athletes and can be directly implemented in real-life situations. Overall, this study adds valuable information about the neurocognitive performance of youth athletes.
Original languageEnglish
Awarding Institution
  • University of Helsinki
  • Hokkanen, Laura , Supervisor
  • Koskinen, Sanna, Supervisor
Award date2 Oct 2021
Place of PublicationHelsinki
Print ISBNs978-951-51-7477-2
Electronic ISBNs978-951-51-7478-9
Publication statusPublished - 2021
MoE publication typeG5 Doctoral dissertation (article)

Bibliographical note

M1 - 66 s. + liitteet

Fields of Science

  • Brain Concussion
  • +complications
  • +diagnosis
  • Post-Concussion Syndrome
  • Unconsciousness
  • Confusion
  • Amnesia
  • Cognitive Dysfunction
  • Neurocognitive Disorders
  • Learning Disabilities
  • Athletes
  • Athletic Injuries
  • Age Factors
  • Adolescent
  • Recurrence
  • 515 Psychology

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