Sports Neuropsychology

Sports Neuropsychology

Ruben Echemendia, Ph.D., Editor
Comprehensive textbook on scientific knowledge about sports-related concussion and post concussion syndrome with practical guidelines for evaluating mild brain injury and concussion.
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This book is a comprehensive text on scientific knowledge about sports-related concussion. It provides practical guidelines for evaluating mild head injury and making crucial return-to-play decisions for athletes at all levels, from school children through high school, college and professional players.

Chapters by national and international clinicians and researchers give essential information on the nature and prevalence of mild traumatic brain injury as well as pre and post-concussion assessment. It describes the effects of age and gender on athletic activity. The complex process of return-to-play decision making is examined in depth. Contents cover the spectrum from the most sophisticated evidence-based neurocognitive techniques to guidelines for counseling athletes.

While grounded in research, this book is practical and readable.

ISBN# 1-57230-078-7
Pages 324 pages, 6 x 9, hardcover
Year 2006


Ruben J. Echemendía, Ph.D.

Obtained his doctoral degree from Bowling Green State University in Bowling Green, Ohio. Dr. Echemendía served as Director of the Psychological Clinic at The Pennsylvania State University for 15 years before pursuing a full-time independent practice. During his tenure at Penn State, he founded the clinical neuropsychology laboratory in the Department of Psychology, where he focused his research on the diagnosis and management of cerebral concussion. He was the principal investigator for the grant-supported Penn State Cerebral Concussion Program.

Dr. Echemendia has served as Director of the National Hockey League's Neuropsychological Testing Program and as neuropsychological consultant to the United States Soccer Federation and the U.S. national soccer teams, the Pittsburgh Penguins Hockey Club, and several minor league, college, and high school programs. He has edited three books, is the author of numerous book chapters, and has published extensively in psychological and medical journals.

Dr. Echemendía has presented symposia, lectures, and research papers throughout the United States and internationally. He is a Fellow of the National Academy of Neuropsychology and was recently elected a Fellow of the American Psychological Association, Division of Neuropsychology.


William B. Barr, Ph.D., Department of Neurology and Psychiatry, New York University Medical Center, New York, NY

Jeffrey T. Barth, Ph.D., Brain Injury and Sports Concussion Institute, University of Virginia School of Medicine, Charlottesville, VA

Joseph Bleiberg, Ph.D., Center for Cognitive Neuroscience, National Rehabilitation Hospital, Washington, DC

Jill Brooks, Ph.D., Head to Head Consultants, P.A., Far Hills, NJ

Donna K. Broshek, Ph.D., Brain Injury and Sports Concussion Institute, University of Virginia School of Medicine, Charlottesville, VA

Alison Cernich, Ph.D., Center for Cognitive Neuroscience, National Rehabilitation Hospital, Washington, DC

Alexander Collie, Ph.D., Senior Clinical Scientist, CogState, Ltd., London, UK

Micky Collins, Ph.D., Department of Orthopaedics, UPMC Sports Medicine Concussion Program, University of Pittsburgh Medical Center, Pittsburgh, PA

Tracey Covassin, Ph.D., Department of Kinesiology, Michigan State University, East Lansing, MI

David Darby, Ph.D., CogState, Ltd., London, UK

Ruben J. Echemendía, Ph.D., Psychological and Neurobehavioral Associates, Inc., State College, PA

David M. Erlanger, Ph.D., HeadMinder, Inc., New York, NY

Jason R. Freeman, Ph.D., Brain Injury and Sports Concussion Institute, University of Virginia School of Medicine, Charlottesville, VA

John L. Furtado, M.S., Athletic Trainer, Department of Athletics, Princeton University, Princeton, NJ

Catherine I. Kaminaris, Ph.D., Department of Psychology, Drexel University, Philadelphia, PA

Tanya Kaushik, Psy.D., HeadMinder, Inc., New York, NY

Mark R. Lovell, Ph.D., Department of Orthopaedics, UPMC Center for Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA

Stephen N. Macciocchi, Ph.D., Neuropsychology Division, Shepherd Center, Emory University, Atlanta, GA

Michael Makdissi, Ph.D., Centre for Sports Medicine Research and Education, The University of Melbourne, Melbourne, Australia

Paul Maruff, Ph.D., CogState, Ltd., London, United Kingdom

Paul McCrory, Ph.D., Centre for Sports Medicine Research and Education, The University of Melbourne, Melbourne, Australia

Michael McStephen, BSc, CogState, Ltd., Melbourne, Australia

Jamie Pardini, Ph.D., Department of Orthopaedics, UPMC Sports Medicine Concussion Program, University of Pittsburgh Medical Center, Pittsburgh, PA

Margot Putukian, M.D., Director of Athletic Medicine, McCosh Health Center, Princeton University, Princeton, NJ

Dennis Reeves, Ph.D., Clinvest Corporation, Springfield, MO

Philip Schatz, Ph.D., Department of Psychology, Saint Joseph’s University, Philadelphia, PA

Jillian Schneider, M.S., Department of Psychology, Drexel University, Philadelphia, PA

Jennifer Tinker, M.S., Department of Psychology, Drexel University, Philadelphia, PA

Frank M. Webbe, Ph.D., School of Psychology, Florida Institute of Technology, Melbourne, FL

Eric A. Zillmer, Psy..D, Department of Athletics, Drexel University, Philadelphia, PA


I. Sports Neuropsychology in Context

1. Sports: A New Frontier for Neuropsychology
by Jeffrey T. Barth, Donna K. Broshek, and Jason R. Freeman

2. A History of Sports-Related Concussions: A Neuropsychological Perspective
by Eric A. Zillmer, Jillian Schneider, Jennifer Tinker, and Catherine I. Kaminaris

3. Consulting with Athletes: Rewards and Pitfalls
by Ruben J. Echemendía

II. Concussion Assessment and Management

4. Definition, Physiology, and Severity of Cerebral Concussion
by Frank M. Webbe

5. Epidemiology of Cerebral Concussion: The Extent of the Problem
by Stephen N. Macciocchi

6. Assessing Mild Traumatic Brain Injury on the Sideline
by William B. Barr

7. Return to Play
by Ruben J. Echemendía

III. Testing Programs

8. Concussion Management Programs for School-Age Children
by Jill Brooks

9. Creating a Successful Concussion Management Program at the High School Level
by Jamie Pardini and Micky Collins

10. Neuropsychological Testing Programs for College Athletes
by Philip Schatz and Tracey Covassin

11. Neuropsychological Assessment of the Professional Athlete
by Mark R. Lovell

IV. Computerized Neuropsychological Test Batteries

12. The ImPACT Neuropsychological Test Battery
by Mark R. Lovell

13. The HeadMinder Concussion Resolution Index
by Tanya Kaushik and David M. Erlanger

14. CogSport
by Alexander Collie, Paul Maruff, David Darby, Michael Makdissi, Paul  McCrory, and Michael McStephen

15. Sports Concussion Applications of the Automated Neuropsychological Assessment Metrics Sports Medicine Battery
by Joseph Bleiberg, Alison Cernich, and Dennis Reeves

V. Views from within the Sports Medicine Team

16. The Athletic Trainer's Point of View
by John L. Furtado

17. The Team Physician's Point of View
by Margot Putukian



Interest in sports-related brain injury has increased exponentially over the past 15 years. This increase has been generated by extensive media exposure and the retirement of several prominent professional athletes due to enduring symptoms following cerebral concussions. Concerns about player safety were raised by newspapers, television specials, and sports commentators. Professional leagues like the National Hockey League and the National Football League began to take a serious interest in cerebral concussions and player safety. This interest then cascaded to college programs, high school programs, and recreational athletes. Historically, neuropsychology has not been centrally involved in sports injuries despite the fact that neuropsychology has a long track record of studying mild traumatic brain injury in the general population, with pioneering work conducted by Harvey Levin, Dorothy Gronwall, Sureyya Dikman, and others. Neuropsychology only recently became involved in sports with the seminal work of Jeff Barth and his colleagues at the University of Virginia in the mid-1980's. Within a very short time frame, neuropsychology has become the “cornerstone” for the assessment and management of sports-related concussion (Aubrey et al., 2002).

The primary objective of this book is to provide clinical neuropsychologists and psychologist with an introduction to the rapidly emerging area of sports neuropsychology. The book is designed as a resource for the clinician on the diagnosis and management of concussion, the development of concussion management programs, consultation with sports teams, and interpretation of clinical data. The authors of the chapters were chosen because they are the leading figures in the field, and each bridges the gap between science and practice in his or her daily work. Although each of the chapters integrates the scientific literature with clinical practice, the focus of this book is largely clinical and is not intended to be an exhaustive review of the scientific literature.

The book is divided into five parts. Part I presents a historical context for the development of sports neuropsychology and ends with a discussion of the issues involved in consulting with sports teams. Part II provides an understanding of the pathophysiology of mild traumatic brain injury and the epidemiology of sports-related concussion. While neuropsychologists are largely involved with the evaluation of players days after injury, this section also outlines the process for making the real-time (sideline) decision of whether or not a player has sustained a concussion and whether of not he or she should be removed from play. The last chapter in this section describes the complexities inherent in the return-to-play decision-making process. For neuropsychologists, this is a unique position, since no other practice area of neuropsychology involves the act of deciding when it is safe to return a client to a situation where the risk of sustaining another brain injury is relatively high.

Part III provides the framework for clinicians and researchers who wish to develop concussion management or research programs for a variety of populations ranging form school-age children to professional athletes. The authors of these chapters have experienced the rewards and frustrations of developing programs where none had previously existed. The reader will benefit from a discussion of their successes and challenges when developing their own programs.

One of the exciting and promising developments in sports neuropsychology has been the development of computer platforms that allow for cost effective and efficient methods for assessing athletes. Which computer program should a clinician choose when establishing a new concussion management program? Part IV describes the four major computerized assessment programs. The authors describe their programs, summarize the reliability and validity studies that have been conducted, discuss interpretative strategies and provide case examples.

Sports neuropsychologists work closely with professionals from other disciplines who are involved with athletes on a daily basis. Part V introduces the perspectives of a team physician and a certified athletic trainer, who provide the reader with information regarding the nature of their training and their role in working with injured athletes, and discuss how neuropsychology has been incorporated into their practice.

In closing, I would like to thank the authors who contributed to this book for their scholarship, hard work, and support in the development and completion of this project. I would also like to thank the teams, coaches and players who have trusted us with their care.

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