Iverson Grant L, Schatz Philip
Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, MA , USA .
Brain Inj. 2015;29(2):263-75. doi: 10.3109/02699052.2014.965214. Epub 2014 Oct 14.
This study examined seven topics relating to neuropsychological assessment following sport-related concussion: (i) traditional vs. computerized tests; (ii) the value of baseline, pre-season testing; (iii) invalid baseline scores and poor effort; (iv) when to assess following injury; (v) the reliability of neuropsychological tests; (vi) reliable change methodology; and (vii) new methods for identifying cognitive impairment.
Baseline testing can be helpful for quantifying cognitive deficits following injury and for assessing recovery. At present, however, there is insufficient evidence to conclude that having baseline test results is clearly superior to not having baseline test results. Although invalid baseline test performance can be detected in some athletes, validity indicators cannot determine the extent to which the results were due to deliberately poor performance, confusion or misunderstanding regarding some aspect of the test, distractions in group testing environments or some combination of factors. When interpreting baseline and post-injury data, sophisticated psychometric methods (e.g. reliable change, multivariate base rates) are available to assist with more accurate identification of cognitive impairment and the serial monitoring of recovery.
The value of neuropsychological assessment in the management of sport-related concussion has a strong empirical foundation. Additional research is needed, however, to refine its use.
本研究探讨了与运动相关脑震荡后神经心理学评估相关的七个主题：（i）传统测试与计算机化测试；（ii）基线、季前测试的价值；（iii）无效的基线分数和不佳的努力程度；（iv）受伤后何时进行评估；（v）神经心理学测试的可靠性；（vi）可靠变化方法；以及（vii）识别认知障碍的新方法。
基线测试有助于量化受伤后的认知缺陷并评估恢复情况。然而，目前尚无足够证据得出有基线测试结果明显优于没有基线测试结果的结论。虽然在一些运动员中可以检测到无效的基线测试表现，但有效性指标无法确定结果在多大程度上是由于故意表现不佳、对测试某些方面的混淆或误解、团体测试环境中的干扰或多种因素的某种组合。在解释基线和受伤后的数据时，可以使用复杂的心理测量方法（如可靠变化、多变量基础率）来更准确地识别认知障碍并对恢复情况进行连续监测。
神经心理学评估在运动相关脑震荡管理中的价值有坚实的实证基础。然而，需要进一步研究以完善其应用。
