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Acute and Subacute Changes in Neural Activation during the Recovery from Sport-Related Concussion

Published online by Cambridge University Press:  08 July 2013

Thomas A. Hammeke*
Clement J. Zablocki VA Medical Center & Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Michael McCrea
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
Sarah M. Coats
Rehabilitation Institute at St. Mary's Hospital, Enid, Oklahoma
Matthew D. Verber
Department of Chemistry, University of North Carolina, Chapel Hill, North Carolina
Sally Durgerian
Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
Kristin Flora
Department of Psychology, Franklin College, Franklin, Indiana
Gary S. Olsen
Department of Neuropsychology, Marshfield Clinic, Marshfield, Wisconsin
Peter D. Leo
Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
Thomas A. Gennarelli
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
Stephen M. Rao
Schey Center for Cognitive Neuroimaging, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
Correspondence and reprint requests to: Thomas A. Hammeke, Clement J. Zablocki VA Medical Center, Acute Mental Health—Neuropsychology, Bldg 111, Room 3301, 5000 W. National Avenue, Milwaukee, WI 53295. E-mail:


To study the natural recovery from sports concussion, 12 concussed high school football athletes and 12 matched uninjured teammates were evaluated with symptom rating scales, tests of postural balance and cognition, and an event-related fMRI study during performance of a load-dependent working memory task at 13 h and 7 weeks following injury. Injured athletes showed the expected postconcussive symptoms and cognitive decline with decreased reaction time (RT) and increased RT variability on a working memory task during the acute period and an apparent full recovery 7 weeks later. Brain activation patterns showed decreased activation of right hemisphere attentional networks in injured athletes relative to controls during the acute period with a reversed pattern of activation (injured > controls) in the same networks at 7 weeks following injury. These changes coincided with a decrease in self-reported postconcussive symptoms and improved cognitive test performance in the injured athletes. Results from this exploratory study suggest that decreased activation of right hemisphere attentional networks mediate the cognitive changes and postconcussion symptoms observed during the acute period following concussion. Conversely, improvement in cognitive functioning and postconcussive symptoms during the subacute period may be mediated by compensatory increases in activation of this same attentional network. (JINS, 2013, 19, 1–10)

Research Articles
Copyright © The International Neuropsychological Society 2013 

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