From Reuters Health Information

Non-Head Injuries May Impact Thinking Skills: Study

By Genevra Pittman

NEW YORK (Reuters Health) Jul 28 - A blow to the head isn't the only injury that can make a football player a little slow and confused.

New research shows that a sprained ankle or strained knee might also affect how athletes perform on the Automated Neuropsychological Assessment Metrics (ANAM) test battery, a computer-based assessment of attention, memory, and reaction time generally used to manage concussions.

That means trainers and team doctors should rely on talking to athletes about concussion symptoms when they're trying to decide the seriousness of a head injury -- not just on the computer-based test, researchers said.

"With every athlete when we evaluate them on the sidelines...it's getting an idea of what's going on with that player, how they're feeling, what symptoms they may have," said Dr. Mark Halstead, an orthopedic surgeon at Washington University School of Medicine in St. Louis, who wasn't involved in the new study.

When it comes to concussions, "that's what we rely on most with these athletes," he told Reuters Health.

Doctors have become increasingly concerned in recent years about the consequences of concussions, especially in young athletes.

The head injuries can cause dizziness, memory problems, and trouble paying attention, which usually resolves in a few weeks. But when athletes try to come back from the blow too quickly, they risk developing the rare but dangerous "second impact syndrome," which happens when someone sustains a second head injury before the first is completely healed.

For the current study, researchers at the University of Toronto gave the 20-minute computerized battery of tests to 72 student-athletes, including football, hockey, and lacrosse players. Eighteen of those athletes had suffered a concussion in the past three days, and another 18 had been taken out recently by a muscle or tendon injury.

The other 36, used for comparison, were uninjured.

As expected, the head-injured athletes did worse than non-injured athletes, with slower reaction times and worse memory and attention. But those who had sustained a muscle or tendon injury also did worse than the healthy comparison group on some of the tests -- and their scores generally fell in between the scores of non-injured and head-injured athletes.

"It suggests that we need to take this testing with a grain of salt -- it isn't the end-all, be-all," Dr. Halstead said. "There may be some other factors that affect how someone performs on the test" besides how banged-up their brain is.

Those factors could include athletes' frustration with being injured, or other emotional responses to the injury, researchers led by Michael Hutchison said in a paper published online July 18 in the American Journal of Sports Medicine. Another possibility, they said, is that the pain and discomfort from tendon or muscle injuries might actually make athletes think less clearly.

"If you have someone that has had a head injury, you can't automatically assume everything you find (on the test) is head-injury related," Hutchison told Reuters Health. "It requires a little bit of interpretation."

Dr. Halstead said the results aren't a huge surprise, and that the computer test is only one tool doctors use to monitor how someone's doing after a head injury. "We can certainly manage a concussion fine without it," he said.

The findings show the importance of "using the whole picture, rather than just a test." But Dr. Halstead added that because the study was relatively small, further research will be needed to get the "big picture" of how non-head injuries may affect thinking skills -- and what that means for the tools doctors use to manage concussions.

For further information: http://www.medscape.com/viewarticle/747174?src=mp&spon=8