title: The influence of musculoskeletal injury on cognition: implications for concussion research.
abstract: BACKGROUND
  Safe return-to-play decisions after concussion can be challenging for sports medicine specialists. Neuropsychological testing is recommended to objectively measure concussion-related cognitive impairments.
  
  
  OBJECTIVE
  The objective of this study was to measure cognitive functioning among 3 specific athletic groups: (1) athletes with no injuries (n = 36), (2) athletes with musculoskeletal injuries (n = 18), and (3) athletes with concussion (n = 18).
  
  
  METHODS
  Case-control study; Level of evidence, 3.
  
  
  METHODS
  Seventy-two intercollegiate athletes completed preseason baseline cognitive testing and follow-up assessment using the Automated Neuropsychological Assessment Metrics (ANAM) test battery. Injured athletes were tested within 72 hours of injury. A 1-way analysis of covariance adjusted for baseline scores was performed to determine if differences existed in cognitive test scores among the 3 groups.
  
  
  RESULTS
  A group of athletes with concussion performed significantly worse than a group of athletes with no injuries on the following subtests of the ANAM at follow-up: Code Substitution Learning, Match to Sample, and Simple Reaction. Athletes with musculoskeletal injuries performed significantly worse than those with no injury on the Match to Sample subtest. No significant differences between athletes with concussion and athletes with musculoskeletal injuries were found on all ANAM subtests.
  
  
  CONCLUSIONS
  Concussion produces cognitive impairment in the acute recovery period. Interestingly, athletes with musculoskeletal injuries also display a degree of cognitive impairment as measured by computerized tests.
  
  
  CONCLUSIONS
  Although these findings support previous research that neuropsychological tests can effectively measure concussion-related cognitive impairment, this study provides evidence that athletic injury, in general, also may produce a degree of cognitive disruption. Therefore, a narrow interpretation of scores of neuropsychological tests in a sports concussion context should be avoided.
authors.affiliation: Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, Canada. michael.hutchison@utoronto.ca
authors.forename: Michael
authors.initials: M
authors.lastname: Hutchison
authors.forename: Paul
authors.initials: P
authors.lastname: Comper
authors.forename: Lynda
authors.initials: L
authors.lastname: Mainwaring
authors.forename: Doug
authors.initials: D
authors.lastname: Richards
mesh_terms: D000293:Adolescent; D056352:Athletes; D001265:Athletic Injuries / Q000175:diagnosis; D001924:Brain Concussion / Q000175:diagnosis*; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000293:injuries*; D009483:Neuropsychological Tests; D011930:Reaction Time; D055815:Young Adult