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Subconcussive Blows to the Head: A Formative Review of Short-term Clinical Outcomes

Belanger, Heather G. PhD, ABPP-CN; Vanderploeg, Rodney D. PhD, ABPP-CN; McAllister, Thomas MD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP

The Journal of Head Trauma Rehabilitation: May/June 2016 - Volume 31 - Issue 3 - p 159–166
doi: 10.1097/HTR.0000000000000138
Original Articles

Background: Given questions about “lower thresholds” for concussion, as well as possible effects of repetitive concussion and chronic traumatic encephalopathy (CTE), and associated controversy, there is increasing interest in “subconcussive” blows and their potential significance.

Objective: A formative review with critical examination of the developing literature on subconcussive blows in athletes with an emphasis on clinical outcomes.

Methods: Studies of biomechanical, performance and/or symptom-based, and neuroimaging data were identified via PubMed search and critically reviewed. Five studies of symptom reporting/performance and 4 studies of neuroimaging were included.

Results: The relation between biomechanical parameters and diagnosed concussion is not straightforward (ie, it is not the case that greater and more force leads to more severe injury or cognitive/behavioral sequelae). Neuropsychological studies of subconcussive blows within a single athletic season have failed to demonstrate any strong and consistent relations between number and severity of subconcussive events and cognitive change. Recent studies using neuroimaging have demonstrated a potential cumulative effect of subconcussive blows, at least in a subset of individuals.

Conclusion: Human studies of the neurological/neuropsychological impact of subconcussive blows are currently quite limited. Subconcussive blows, in the short-term, have not been shown to cause significant clinical effects. To date, findings suggest that any effect of subconcussive blows is likely to be small or nonexistent, perhaps evident in a subset of individuals on select measures, and maybe even beneficial in some cases. Longer-term prospective studies are needed to determine if there is a cumulative dose effect.

Department of Mental Health and Behavioral Sciences, James A. Haley VAMC; Defense and Veterans Brain Injury Center; Department of Psychology, University of South Florida; and Department of Psychiatry and Neurosciences, University of South Florida (Drs Belanger and Vanderploeg), Tampa, Florida; and Department of Psychiatry and Behavioral Sciences, Indiana University School of Medicine, Indianapolis, Indiana (Dr McAllister).

Corresponding Author: Heather G. Belanger, PhD, ABPP-CN, James A. Haley Veterans Hospital, Department of Psychology, University of South Florida, Defense and Veterans Brain Injury Center, 13000 Bruce B. Downs Blvd, MHBS 116B, Tampa, FL 33612 (

The views expressed herein are those of the authors and do not necessarily reflect the views or the official policy of the Department of Veterans Affairs, Department of Defense, or US Government. This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans' Hospital.

The authors declare no conflicts of interest.

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