The Role of Age and Sex in Symptoms, Neurocognitive
Performance, and Postural Stability in Athletes After Concussion
Covassin T, Bay E. J Neurosci Nurs. 2012

There is no question that the topic of
concussions is currently at the forefront of sports medicine.  As with any injury, a structured approach
must be taken regarding recognition, recovery and return to play.  That said, our follow-up and treatment of
concussions may need to take into account not only the athlete’s age, but their
gender as well. The purpose of this study was to examine how sex and age may
affect post-concussion symptom reporting, postural stability and neurocognitive
testing (NCT).  NCT includes the
following areas: visual memory, verbal memory, visual processing speed and reaction
time.  Covassin et al. hypothesized that
concussed high school athletes would demonstrate 1) more concussion symptoms 2)
greater postural instability and 3) greater neurocognitive impairments when
compared to concussed collegiate athletes. 
The authors also expected female athletes would present with prolonged
NCT deficits, more concussion symptoms, and greater postural stability deficits
than concussed male athletes. A total of 222 subjects (157 male, 65 female; 150
HS, 72 collegiate) participated in this study all of which met the following
inclusion criteria: 14-25y/o, sustained a sports related concussion diagnosed
by a sports medicine professional during an academic 2-year span, previously
undergone baseline computer-based ImPACT (NCT) testing.  Post-injury, all subjects underwent ImPACT
testing at 2, 7 and 14-days after injury. 
Post-concussion postural stability was measure through the Balance Error
Scoring System (BESS) on days 1, 2, and 3; however, there was no baseline BESS
testing performed.  The BESS test is a
battery of 6 tests that measures an individual’s static and dynamic posture
after sustaining a concussion.  A higher
score on the BESS test indicates poorer postural stability. Concussion symptoms
were measured through self-reporting completion of a Post-Concussion Symptom
Scale obtained during ImPACT testing. 
After data analysis, the following items were discovered: NCT
performance (verbal memory, visual memory and reaction time) was significantly
worse for all athletes 2 days post-injury when compared to baseline.  By day 14, there was no significant
difference between baseline scores and follow-up scores.  HS athletes in general performed worse than
collegiate athletes in regards to visual and verbal memory, though this finding
was not significant.  When regarding subject
sex, female athletes collectively performed worse on visual memory and
presented more post-concussion symptoms than males.  Concussion symptoms were significantly
greater at 7 days post injury when compared to baseline for all groups.  On average, post-concussion symptoms reverted
to baseline levels 14-days after injury. 
The BESS test illustrated that the HS male athletes exhibit worse
postural stability than male collegiate athletes and female collegiate athletes
performing worse than female HS athletes. 
However, with no baseline data available in terms of the BESS test, it
is difficult to quantify the degree to which postural stability has been

The findings of this study are
important for many reasons.  First, this
study supports what other research has begun to show, that there is an
age/developmental component that needs to be considered when managing
concussions.  High school athletes appear
to recover at a slower rate than collegiate athletes, especially in regards to
visual and verbal memory.  Another key
aspect of this study is that sex does appear to play some role in memory
recovery as well as concussion symptoms. 
While female athletes present with more symptoms, it is quite possible
that male athletes may not have been entirely forthright in relaying their
symptoms.  Items like returning to play
and societal pressures may have hindered truthful reporting in an effort to
return to the field faster.  All of these
items, from memory deficits, to postural instability and how they differ between
the sexes and at different ages are all items that clinicians should begin
considering during the concussion management and return to play.  What are your thoughts on the results of this
study?  Do they mirror what you are
seeing with your athletes?  Are you
currently including any form of postural component to your baseline concussion

Written by: Mark Rice
Reviewed by: Stephen Thomas

Related Posts:

Covassin T, & Bay E (2012). Are There Gender Differences in Cognitive Function, Chronic Stress, and Neurobehavioral Symptoms After Mild-to-Moderate Traumatic Brain Injury? The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses, 44 (3), 124-33 PMID: 22555349