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Who should conduct and interpret the neuropsychological assessment in sports-related concussion?

R J Echemendia¹, S Herring², J Bailes³

¹ Psychological and Neurobehavioral Associates, Inc, State College, Pennsylvania, USA
² Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery, University of Washington, Seattle, Washington, USA
³ Department of Neurological Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA

Correspondence to:
Ruben J Echemendia, Psychological and Neurobehavioral Associates, Inc, 204 East Calder Way, St 205, State College, Pennsylvania 16801, USA; rechemendia{at}comcast.net

Objective: This paper seeks to (i) describe the education and training of clinical neuropsychologists, (ii) discuss the significant differences between test administration and clinical assessment, (iii) outline the complex factors involved in psychometric test theory and test interpretation, and (iv) provide a framework for the role of clinical neuropsychologists in the interpretation and administration of neuropsychological instruments within the sports context.

Design: Review of pertinent professional practice, empirical and theoretical literature.

Intervention: Pubmed, Medline and Psych Info databases were reviewed. In total, 35 articles and 2 books were reviewed.

Results: The decision to return an athlete to play following sports-related brain injury is complex and requires the analysis of several sources of data. The decision is determined by a team physician; ideally within the context of a multidisciplinary team that employs comprehensive concussion surveillance and management, including baseline and post-injury neuropsychological assessment. Neuropsychologists possess the training and skill sets necessary to provide unique expertise in the assessment of cognitive functioning and post-injury neurocognitive and psychological assessment.

Conclusions: Baseline neuropsychological testing is a technical procedure that can be conducted by technicians under the supervision/guidance of a neuropsychologist. Post-injury assessment requires advanced neuropsychological expertise that is best provided by a clinical neuropsychologist. Significant international differences exist with respect to the training and availability of clinical neuropsychologists, which require modification of these views on a country by country basis.

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