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Differential Rates of Recovery After Acute Sport-Related Concussion: Electrophysiologic, Symptomatic, and Neurocognitive Indices

Livingston, Scott C. PhD, PT, ATC, SCS*; Goodkin, Howard P. MD, PhD; Hertel, Jay N. PhD, ATC; Saliba, Ethan N. PhD, PT, ATC; Barth, Jeffrey T. PhD, ABCN§; Ingersoll, Christopher D. PhD, ATC

Journal of Clinical Neurophysiology: February 2012 - Volume 29 - Issue 1 - p 23–32
doi: 10.1097/WNP.0b013e318246ae46
Original Research

Purpose To determine if motor evoked potentials (MEPs), postconcussion signs and symptoms, and neurocognitive functions follow a similar recovery pattern after concussion.

Methods Nine collegiate athletes with acute concussion (>24 hours after injury) participated in this retrospective time series design. Transcranial magnetic stimulation was applied over the motor cortex, and MEPs were recorded from the contralateral upper extremity. Self-reported symptoms were evaluated using the Head Injury Scale, and the Concussion Resolution Index was used to assess neurocognitive function. All measures were repeated on days 3, 5, and 10 after injury.

Results Composite scores on the Head Injury Scale were significantly higher on day 1 after injury (F 3,51 = 15.3; P = 0.0001). Processing speed on the Concussion Resolution Index was slower on days 1, 3, and 5 compared with that on day 10 (F 3,24 = 6.75; P = 0.0002). Median MEP latencies were significantly longer on day 10 compared with day 1 after concussion (t 8 = −2.69; P = 0.03). Ulnar MEP amplitudes were significantly smaller on day 3 after concussion compared with day 5 (t 8 = −3.48; P = 0.008).

Conclusions Acutely concussed collegiate athletes demonstrate changes in MEPs, which persist for up to 10 days after injury and do not follow the same recovery pattern as symptoms and neuropsychological test performance. The apparent differential rates of recovery most likely indicate different pathophysiological processes occurring in the immediate postconcussion period.

*Concussion Assessment Research Laboratory, University of Kentucky, Lexington, Kentucky

Department of Neurology

Division of Kinesiology, Department of Human Services, Curry School of Education

§Department of Neuropsychology, University of Virginia, Charlottesville, Virginia

College of Health Professions, Central Michigan University, Mount Pleasant, Michigan.

Address correspondence and reprint requests to Scott C. Livingston, PhD, PT, ATC, SCS, Division of Physical Therapy, 900 South Limestone, Lexington, KY 40536-0200, U.S.A.; e-mail:

Supported by the National Operating Committee on the Standards of Athletic Equipment (grant 13-06) and the National Athletic Trainers' Association Research and Education Foundation (grant 305DGP002)

Copyright © 2012 American Clinical Neurophysiology Society