Neurophysiological monitoring of sport related concussion: From diagnosis to return to play
- 1University of Sydney
Abstract
The validation of objective neurophysiological monitoring of concussion from diagnosis to return to play has the potential to improve the clinical care of athletes. Extracted from event-related potentials (ERP), brain vital signs offer a non-invasive objective neurophysiological measure of three well established ERP responses that complement existing clinical assessments: 1) the N100 response related to auditory sensation; 2) the P300 response related to basic attention; and 3) the N400 response related to cognitive processing. The N400, in particular, has increasingly been demonstrated to be sensitive to head impact related cognitive impairment.
Accordingly, brain vital sign measures were collected in n =165 rugby league players from two Australian professional National Rugby League clubs (NRL), with concussed players (n=26) being subsequently assessed over a total of five separate time points (Baseline, Day 2, Day 5, Day 10, and Day 42). This timeline aligned with acute (Day 2), NRL mandatory minimum return-to-play (RTP) guidelines (Day 10), and an extended post RTP period.
Relative to baseline, the results revealed significant N400 cognitive processing latency delays at Day 2 post-concussion (p=0.002). The N400 latency delays persisted past day 5, significantly returning to baseline values at Day 10, consistent with the RTP mandatory minimum requirement. The findings indicated that neurophysiological recovery occurred in this cohort within an approximate 10-day time frame. Future studies monitoring brain vital sign changes across the trajectory of injury to recovery are needed in sports related concussion management.
Related
- Intraoperative Neurophysiological Monitoring During Continuous Radiofrequency Treatment of Morton’s Neuroma: Complete Ablation
- Endocannabinoid-mediated rescue of somatosensory cortex activity, plasticity and related behaviors following an early-life concussion in male mice
- Neurophysiological dynamics related to perception, action, and language in schizophrenia
- What evidence supports primary prevention strategies for sport-related concussion? An umbrella review
- Cognitive function and return to work: protocol for a longitudinal study investigating cognitive endurance in patients with stress-related disorders in primary health care in Sweden
BibTeX
@misc{lee2026neurophysiological,
title = {{Neurophysiological monitoring of sport related concussion: From diagnosis to return to play}},
author = {J. Lee and E. Kirby and C. R. Levi and L. Shidiak and A. Gardner and R. D'Arcy},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.12.26365262},
url = {https://www.medrxiv.org/content/10.64898/2026.10.12.26365262v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Neurophysiological monitoring of sport related concussion: From diagnosis to return to play
AU - J. Lee
AU - E. Kirby
AU - C. R. Levi
AU - L. Shidiak
AU - A. Gardner
AU - R. D'Arcy
PY - 2026
DA - 2026/10/12
PB - medRxiv
DO - 10.64898/2026.10.12.26365262
UR - https://www.medrxiv.org/content/10.64898/2026.10.12.26365262v1
AB - The validation of objective neurophysiological monitoring of concussion from diagnosis to return to play has the potential to improve the clinical care of athletes. Extracted from event-related potentials (ERP), brain vital signs offer a non-invasive objective neurophysiological measure of three well established ERP responses that complement existing clinical assessments: 1) the N100 response related to auditory sensation; 2) the P300 response related to basic attention; and 3) the N400 response related to cognitive processing. The N400, in particular, has increasingly been demonstrated to be sensitive to head impact related cognitive impairment. Accordingly, brain vital sign measures were collected in n =165 rugby league players from two Australian professional National Rugby League clubs (NRL), with concussed players (n=26) being subsequently assessed over a total of five separate time points (Baseline, Day 2, Day 5, Day 10, and Day 42). This timeline aligned with acute (Day 2), NRL mandatory minimum return-to-play (RTP) guidelines (Day 10), and an extended post RTP period. Relative to baseline, the results revealed significant N400 cognitive processing latency delays at Day 2 post-concussion (p=0.002). The N400 latency delays persisted past day 5, significantly returning to baseline values at Day 10, consistent with the RTP mandatory minimum requirement. The findings indicated that neurophysiological recovery occurred in this cohort within an approximate 10-day time frame. Future studies monitoring brain vital sign changes across the trajectory of injury to recovery are needed in sports related concussion management.
ER -