Central or peripheral?: A positional stance in reaction to the Prague statement on the role of neuropsychological assessment in sports concussion management

The objective of this paper is to clarify the role of neuropsychological assessment in sports concussion management in response to the Prague summary statement of the most recent international conference on concussion (McCrory, P., Johnston, K., Meeuwisse, W., Aubry, M., Cantu, R., Dvorak, J., et al. (2005). In the Prague statement it is proposed that there should be a new categorization of concussion (‘simple’ versus ‘complex’) to inform management of the injury, including the suggestion that neuropsychological assessment is not indicated for ‘simple’ concussion. However, from a neuropsychological perspective the Prague position is conceptually problematic. The present paper proposes on theoretical and empirical grounds, that neurocognitive evaluation is warranted for any concussive injury to increase diagnostic sensitivity and provide prognostic indications. Further, three levels of neurocognitive assessment and their professionally legitimate implementation (that are poorly defined in the Prague paper) are delineated. Recommendations are provided for consideration at the next international concussion meeting, with emphasis on giving due weight to the neuropsychological position.