Sports neuropsychology: assessment and management of traumatic brain injury.

Echemendia RJ, ed. New York, NY 10012, The Guilford Press, 2006, hardcover, 314 pp, illus, ISBN: 879-1-57230-078-7, $45.

The goal of neuropsychology is to link science with practice in order to improve the daily function of people with neurocognitive deficits. Over the past 15 years, neuropsychology has expanded into the field of sports as research findings have revealed that many athletes suffer persistent cognitive and emotional symptoms following cerebral concussion, called "post-concussive syndrome." This mild traumatic brain injury (TBI) that occurs in sports may or may not be associated with loss of consciousness but can have sequelae such as headache, dizziness, depression, irritability, impaired attention, and slowed mental processing. Although these symptoms usually resolve, in some cases they persist and impair the quality of life for the athlete. Awareness of this "silent epidemic" has grown in recent years, largely due to problems experienced by some high-profile athletes, and now neuropsychologists are becoming an integral member of many sports rehabilitation teams.

This book, though not an exhaustive review of the literature, provides a broad overview of the topic of sports-related TBI. The underlying purpose is to promote the role of neuropsychologists in sports, but much of the material will appeal to a broader audience. It is divided into 5 parts, the first of which delves into a fascinating history of TBI in sports dating back to ancient times, and culminating with the current role of neuropsychology in all levels of sports today.

Part 2 covers concussion assessment and management. This is a very practical section that ably delineates the levels of cerebral concussion, including the biomechanics and pathophysiology of injury, gender differences, and repetitive injuries. The chapter on epidemiology of TBI in sports is eye-opening. More than 300,000 sports-related brain injuries are reported to occur in the Untied States annually, but the true number is estimated to be much higher. One possible reason for under-reporting is that in contact sports (such as football) "getting your bell rung" may be passed off as insignificant or just part of the game. The chapters covering assessment of mild TBI on the sidelines and decisions to return to play are very practical. All 4 chapters in part 2 would be of interest to physical therapists, athletic trainers, physicians, and even concerned parents and athletes.

Part 3 also has broad appeal. These 5 chapters describe how to conduct pre-season cognitive testing to serve as a baseline in case of injury. More important, there are detailed strategies outlining how to establish complete concussion prevention and management programs for all levels of athletes, from school-age children through high school and college, up to professional sports. These programs beg for broad support from health care professionals, academic and sports team leaders, and the community at large. Someone with an interest in sports-related TBI and a desire to create a community service project would find ample resources here.

Neuropsychologists will find part 4 helpful in the exploration and application of currently available computerized testing programs, but this narrow focus would have limited appeal for others in the TBI team. Part 5 is the least useful of all. It compromises 2 chapters, 1 written by an athletic trainer and 1 by a team physician, explaining their role on the concussion management team. Inclusion of others involved with sport-related TBI--such as the athletes with injuries and their families, educators, counselors, and even coaches--would have completed the picture and enhanced the concept of a team approach to sports neuropsychology.

The book is well-referenced and very readable. It provides a broad perspective spanning ancient history to landmark research in the 1980s to current research. The chapters have some overlap as they are written by various authors, but this is not a serious flaw, as the redundancy allows chapters to stand alone. The book is well edited so that the writing style flows naturally. There are a few helpful figures and tables, but the book's strength is in the text and references.

In summary, anyone involved with sports on any level would find chapters 1 and 2 an interesting read. Health care professionals working on the sidelines of active sports (such as football, hockey, soccer, basketball, baseball, martial arts) or involved with the rehabilitation of people with sports-related TBI would benefit from the practical and well-referenced parts 2 and 3. Those involved with neuropsychological testing will be especially interested in parts 1 and 4. Ample ideas for research can be found throughout the text. Though not suitable as a textbook for physical therapist or physical therapist assistant education programs, it would serve well as a reference book for professionals involved with sports programs or neurological rehabilitation.

Ann M York, PT, PhD, is with the Postprofessional DPT Program, Des Moines University, Des Moines, Iowa.