Preliminary Evidence for Differential Trajectories of Recovery for Cognitive Flexibility Following Sports-Related Concussion

Objective: A critical barrier to the understanding of disruptions to cognitive flexibility following sports-related concussion is the use of assessments that conflate shifts of visuospatial attention and contextual rules. Because these dissociable forms of cognitive flexibility are subserved by distinct neural networks, the utility of a cognitive flexibility assessment following concussion may be reduced, depending upon the extent to which the task requires shifting visuospatial attention relative to shifting contextual rules. Accordingly, the current investigation examined the extent to which these aspects of cognitive flexibility exhibit differential trajectories of recovery following a sports-related concussion. Method: Twenty-two athletes with sports-related concussions were assessed on a cognitive flexibility task with 2 switch conditions (i.e., perceptual-based and contextual rule-based) within 72 hr of injury, after return to play, and within 1 month following return to play. Thirty-three healthy control athletes were tested at the same intervals. Results: Findings revealed that concussed athletes demonstrated protracted disruptions in task performance on a visuospatial attention-based cognitive flexibility task relative to healthy controls, whereas disruptions in task performance on a contextual rule-based cognitive flexibility task resolved after the acute phase of injury. These findings suggest that dissociable forms of cognitive flexibility exhibit differential trajectories of recovery. Conclusions: Therefore, evaluations detecting sports-related concussion disruptions in cognitive flexibility may be reduced depending on the extent to which they rely on contextual rule-based decisions. Test batteries focusing on visuospatial attention-based demands may be useful additions to aid in the objective assessment and follow-up management of athletes following the acute phase of injury. General Scientific Summary Disruptions to cognitive flexibility are common following sports-related concussion, yet present test batteries conflate dissociable forms of cognitive flexibility, thereby limiting the ability to detect distinct recovery patterns. This study provides evidence that disruptions to visuospatial attention exhibit protracted recovery up to one month following the return to full sport participation, whereas disruptions to rule-response mappings recover by the return to play period. Given the growing interest in enhancing the clinical management of concussed athletes, such findings may be particularly important for guiding interpretations of performance on neuropsychological batteries.