1
|
Shumski EJ, Schmidt JD, Lynall RC. Cognition Uniquely Influences Dual-Task Tandem Gait Performance Among Athletes With a Concussion History. Sports Health 2024; 16:542-550. [PMID: 37377161 PMCID: PMC11195850 DOI: 10.1177/19417381231183413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND After a concussion, there are unique associations between static balance and landing with cognition. Previous research has explored these unique correlations, but the factor of time, dual-task, and different motor tasks leave gaps within the literature. The purpose of this study was to determine the associations between cognition and tandem gait performance. HYPOTHESIS We hypothesized that athletes with a concussion history would display stronger associations compared with athletes without a concussion history between cognition and tandem gait. STUDY DESIGN Cross-sectional. LEVEL OF EVIDENCE Level 3. METHODS A total of 126 athletes without (56.3% female; age, 18.8 ± 1.3 years; height, 176.7 ± 12.3 cm; mass, 74.8 ± 19.0 kg) and 42 athletes with (40.5% female; age, 18.8 ± 1.3 years; height, 179.3 ± 11.9 cm; mass, 81.0 ± 25.1 kg) concussion history participated. Cognitive performance was assessed with CNS Vital Signs. Tandem gait was performed on a 3-meter walkway. Dual-task tandem gait included a concurrent cognitive task of serial subtraction, reciting months backward, or spelling words backward. RESULTS Athletes with a concussion history exhibited a larger number of significant correlations compared with athletes without a concussion history for cognition and dual-task gait time (4 significant correlations: rho-range, -0.377 to 0.358 vs 2 significant correlations: rho, -0.233 to 0.179) and dual-task cost gait time (4 correlations: rho range, -0.344 to 0.392 vs 1 correlation: rho, -0.315). The time between concussion and testing did significantly moderate any associations (P = 0.11-0.63). Athletes with a concussion history displayed better dual-task cost response rate (P = 0.01). There were no other group differences for any cognitive (P = 0.13-0.97) or tandem gait (P = 0.20-0.92) outcomes. CONCLUSION Athletes with a concussion history display unique correlations between tandem gait and cognition. These correlations are unaffected by the time since concussion. CLINICAL RELEVANCE These unique correlations may represent shared neural resources between cognition and movement that are only present for athletes with a concussion history. Time does not influence these outcomes, indicating the moderating effect of concussion on the correlations persists long-term after the initial injury.
Collapse
Affiliation(s)
- Eric J. Shumski
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia
| | - Julianne D. Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia
| | - Robert C. Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia
| |
Collapse
|
2
|
Lempke LB, Shumski EJ, Prato TA, Lynall RC. Reliability and Minimal Detectable Change of the Standardized Assessment of Reaction Time. J Athl Train 2023; 58:579-587. [PMID: 36252207 PMCID: PMC10496444 DOI: 10.4085/1062-6050-0391.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Postconcussion reaction time deficits are common, but existing assessments lack sport-related applicability. We developed the Standardized Assessment of Reaction Time (StART) tool to emulate the simultaneous cognitive and motor function demands in sport, but its reliability is unestablished. OBJECTIVES To determine the intrarater, interrater, and test-retest reliability of StART and to examine the dual-task effect, time effect, and relationships between StART and computerized and laboratory-based functional reaction time assessments. DESIGN Prospective cohort study. SETTING Clinical laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty healthy, physically active individuals (age = 20.3 ± 1.8 years, females = 12, no concussion history = 75%). MAIN OUTCOME MEASURE(S) Participants completed the StART, computerized reaction time (Stroop task via CNS Vital Signs), and laboratory-based jump landing and cutting reaction time under single-task and dual-task (subtracting by 6s or 7s) cognitive conditions at 2 testing sessions a median of 7 days apart. We used intraclass correlation coefficients (ICCs), repeated-measure analysis of variance, and Pearson r correlations to address our aims. RESULTS Overall, good to strong interrater (ICC [2,k] range = 0.83-0.97), intrarater (ICC [3,k] range = 0.91-0.98), and test-retest (ICC [3,k] range = 0.69-0.89) reliability were observed. A significant reaction time assessment-by-cognitive condition interaction was present (P = .018, ηp2 = 0.14), with StART having the largest dual-task effect. Main time effects for dual-task conditions were seen across all reaction time assessments (mean difference = -25 milliseconds, P = .026, ηp2 = 0.08) with improved performance at the second testing session. No StART outcomes correlated with computerized reaction time (P > .05), although some correlated with single-task (r range = 0.42-0.65) and dual-task (r range = 0.19-0.50) laboratory cutting reaction time. CONCLUSIONS The StART demonstrated overall reliable performance relative to other reaction time measures. Reliability coupled with a strong dual-task effect indicates that StART is a valid measure for examining functional reaction time and may have future utility for sport-related concussion return-to-play decision-making.
Collapse
Affiliation(s)
- Landon B. Lempke
- Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor
- Division of Sports Medicine, Boston Children’s Hospital, MA
- Micheli Center for Sports Injury Prevention, Waltham, MA
| | - Eric J. Shumski
- UGA Concussion Research Laboratory and
- UGA Biomechanics Laboratory, Department of Kinesiology, University of Georgia, Athens
| | - Thomas A. Prato
- UGA Concussion Research Laboratory and
- UGA Biomechanics Laboratory, Department of Kinesiology, University of Georgia, Athens
| | - Robert C. Lynall
- UGA Concussion Research Laboratory and
- UGA Biomechanics Laboratory, Department of Kinesiology, University of Georgia, Athens
| |
Collapse
|
3
|
Shumski EJ, Anderson MN, Oh J, Schmidt JD, Lynall RC. Computerized and functional reaction time in varsity-level female collegiate athletes with and without a concussion history. J Sci Med Sport 2023; 26:189-194. [PMID: 36906428 DOI: 10.1016/j.jsams.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES To 1) determine the association between computerized and functional reaction time, and 2) compare functional reaction times between female athletes with and without a concussion history. DESIGN Cross-sectional study. METHODS Twenty female college athletes with concussion history (age = 19.1 ± 1.5 years, height = 166.9 ± 6.7 cm, mass = 62.8 ± 6.9 kg, median total concussion = 1.0 [interquartile range = 1.0, 2.0]), and 28 female college athletes without concussion history (age = 19.1 ± 1.0 years, height = 172.7 ± 8.3 cm, mass = 65.4 ± 8.4 kg). Functional reaction time was assessed during jump landing and dominant and non-dominant limb cutting. Computerized assessments included simple, complex, Stroop, and composite reaction times. Partial correlations investigated the associations between functional and computerized reaction time assessments while covarying for time between computerized and functional reaction time assessments. Analysis of covariance compared functional and computerized reaction time, covarying for time since concussion. RESULTS There were no significant correlations between functional and computerized reaction time assessments (p-range = 0.318 to 0.999, partial correlation range = -0.149 to 0.072). Reaction time did not differ between groups during any functional (p-range = 0.057 to 0.920) or computerized (p-range = 0.605 to 0.860) reaction time assessments. CONCLUSIONS Post-concussion reaction time is commonly assessed via computerized measures, but our data suggest computerized reaction time assessments are not characterizing reaction time during sport-like movements in varsity-level female athletes. Future research should investigate confounding factors of functional reaction time.
Collapse
Affiliation(s)
- Eric J Shumski
- Department of Kinesiology, UGA Concussion and Biomechanics Research Laboratory and Biomechanics Laboratory, University of Georgia, United States of America.
| | - Melissa N Anderson
- Department of Kinesiology and Applied Physiology, University of Delaware, United States of America
| | - Jeonghoon Oh
- Department of Neurosurgery, Center of Neuroregeneration, Houston Methodist Research Institute, United States of America
| | - Julianne D Schmidt
- Department of Kinesiology, UGA Concussion and Biomechanics Research Laboratory and Biomechanics Laboratory, University of Georgia, United States of America
| | - Robert C Lynall
- Department of Kinesiology, UGA Concussion and Biomechanics Research Laboratory and Biomechanics Laboratory, University of Georgia, United States of America
| |
Collapse
|
4
|
Sensitivity and Specificity of the ImPACT Neurocognitive Test in Collegiate Athletes and US Military Service Academy Cadets with ADHD and/or LD: Findings from the NCAA-DoD CARE Consortium. Sports Med 2023; 53:747-759. [PMID: 36239903 DOI: 10.1007/s40279-022-01768-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Computer-based neurocognitive tests are widely used in sport-related concussion management, but the performance of these tests is not well understood in the participant population with attention-deficit/hyperactivity disorder (ADHD) and/or learning disorder (LD). This research estimates the sensitivity and specificity performance of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computer-based neurocognitive test in identifying concussion in this population. METHODS Study participants consisted of collegiate university athletes and military service academy cadets from the National Collegiate Athletic Association-Department of Defense CARE Consortium who completed the ImPACT test between 2014 and 2021. Participants who self-identified as belonging to one of the subgroups of interest (ADHD with or without LD [ADHD:LD+/-], LD with or without ADHD [LD:ADHD+/-], ADHD and/or LD [ADHD a/o LD]) and completed a baseline (1874 ADHD:LD+/-, 779 LD:ADHD+/-, 2338 ADHD a/o LD) or 24-48 h post-concussion (175 ADHD:LD+/-, 77 LD:ADHD+/-, 216 ADHD a/o LD) ImPACT assessment were included. Sensitivity and specificity were calculated using a normative data method and three machine learning classification methods: logistic regression, classification and regression tree, and random forest. RESULTS Using the four methods, participants with ADHD:LD+/- had sensitivities that ranged from 0.474 to 0.697, and specificities that ranged from 0.538 to 0.686. Participants with LD:ADHD+/- had sensitivities that ranged from 0.455 to 0.688, and specificities that ranged from 0.456 to 0.588. For participants with ADHD a/o LD, sensitivities ranged from 0.542 to 0.755, and specificities ranged from 0.451 to 0.724. CONCLUSIONS For all subgroups and analytical methods, the results illustrate sensitivity and specificity values below typically accepted levels indicative of clinical utility. These findings support that using ImPACT alone may be insufficient to inform concussion diagnoses and encourages the use of a multi-dimensional concussion assessment.
Collapse
|
5
|
Lempke LB, Oldham JR, Passalugo S, Willwerth SB, Berkstresser B, Wang F, Howell DR, Meehan WP. Influential Factors and Preliminary Reference Data for a Clinically Feasible, Functional Reaction Time Assessment: The Standardized Assessment of Reaction Time. J Athl Train 2023; 58:112-119. [PMID: 35476022 PMCID: PMC10072093 DOI: 10.4085/1062-6050-0073.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Clinical reaction-time (RT) measures are frequently used when examining patients with concussion but do not correlate with functional movement RT. We developed the Standardized Assessment of RT (StART) to emulate the rapid cognitive demands and whole-body movement needed in sport. OBJECTIVE To assess StART differences across 6 cognitive-motor combinations, examine potential demographic and health history confounders, and provide preliminary reference data for healthy collegiate student-athletes. DESIGN Prospective, cross-sectional study. SETTING Clinical medicine facilities. PATIENTS OR OTHER PARTICIPANTS A total of 89 student-athletes (56 [62.9%] men, 33 [37.1%] women; age = 19.5 ± 0.9 years, height = 178.2 ± 21.7 cm, mass = 80.4 ± 24 kg; no concussion history = 64 [71.9%]). MAIN OUTCOME MEASURE(S) Student-athletes completed health history questionnaires and StART during preseason testing. The StART consisted of 3 movements (standing, single-legged balance, and cutting) under 2 cognitive states (single task and dual task [subtracting by 6's or 7's]) for 3 trials under each condition. The StART trials were calculated as milliseconds between penlight illumination and initial movement. We used a 3 × 2 repeated-measures analysis of variance with post hoc t tests and 95% CIs to assess StART cognitive and movement differences, conducted univariable linear regressions to examine StART performance associations, and reported StART performance as percentiles. RESULTS All StART conditions differed (P ≤ .03), except single-task standing versus single-task single-legged balance (P = .36). Every 1-year age increase was associated with an 18-millisecond (95% CI = 8, 27 milliseconds) slower single-task cutting RT (P < .001). Female athletes had slower single-task (15 milliseconds; 95% CI = 2, 28 milliseconds; P = .02) and dual-task (28 milliseconds; 95% CI = 2, 55 milliseconds; P = .03) standing RT than male athletes. No other demographic or health history factors were associated with any StART condition (P ≥ .056). CONCLUSIONS The StART outcomes were unique across each cognitive-motor combination, suggesting minimal subtest redundancy. Only age and sex were associated with select outcomes. The StART composite scores may minimize confounding factors, but future researchers should consider age and sex when providing normative data.
Collapse
Affiliation(s)
- Landon B. Lempke
- Division of Sports Medicine, Boston Children's Hospital, MA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
| | - Jessie R. Oldham
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond
| | - Scott Passalugo
- Division of Sports Medicine, Boston Children's Hospital, MA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
| | - Sarah B. Willwerth
- Division of Sports Medicine, Boston Children's Hospital, MA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
| | | | - Francis Wang
- Harvard University Health Service, Cambridge, MA
| | | | - William P. Meehan
- Division of Sports Medicine, Boston Children's Hospital, MA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
| |
Collapse
|
6
|
Computerized Cognitive Function Does Not Correlate With Choice Reaction Time During a Hopping Task. J Sport Rehabil 2023; 32:462-466. [PMID: 36791727 DOI: 10.1123/jsr.2022-0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 02/16/2023]
Abstract
CONTEXT Cognitive performance has been shown to be associated with musculoskeletal injury risk. Cognitive assessments are often administered in controlled environments despite sport settings challenging cognition in uncontrolled, less predictable environments. Cognitive assessments should be representative of sport demands; thus, integrating motor with cognitive assessments may be more clinically relevant. Accordingly, the purpose of this research was to investigate the relationship between tablet-based cognitive tests and choice reaction time during a hopping task. DESIGN Cross-sectional. METHODS A total of 20 healthy participants volunteered to participate. Participants completed 3 tablet-based cognitive assessments. Average raw response time and fully corrected scores were used for analysis. In addition, participants completed a choice reaction hopping task to capture neuromuscular-cognitive reaction time. Participants completed a forward hop over a hurdle, landing on a single limb. Light sensors were utilized for the choice reaction component to capture reaction time in seconds, cue them when to hop, and indicate the landing limb. The relationship between the tablet-based cognitive assessments and reaction time during a hopping task was examined with Pearson correlations (α = .05). RESULTS The choice reaction time from the hop task had a negligible correlation (r = -.20-.07) to the fully corrected tablet-based cognitive tests. The choice reaction time from the hop task had a negligible correlation (r = .02) to the average response time of the Pattern Comparison Processing Speed Test and a low correlation (r = .34-.36) to the Dimensional Change Card Sort Test and Flanker Inhibitory Control and Attention Test. CONCLUSIONS This study determined that tablet-based cognitive assessments had trivial relationships to choice reaction time during a hopping task. This research has implications as clinicians aim to evaluate and analyze cognitive performance. Although reaction time was a critical component of all the assessments in this study, an individual's performance on a tablet-based assessment does not indicate performance during a functional reaction time assessment.
Collapse
|
7
|
Lempke LB, Lynall RC, Hoffman NL, Devos H, Schmidt JD. Slowed driving-reaction time following concussion-symptom resolution. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:145-153. [PMID: 32961301 PMCID: PMC7987557 DOI: 10.1016/j.jshs.2020.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/09/2020] [Accepted: 08/21/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND Concussed patients have impaired reaction time (RT) and cognition following injury that may linger and impair driving performance. Limited research has used direct methods to assess driving-RT post-concussion. Our study compared driving RT during simulated scenarios between concussed and control individuals and examined driving-RT's relationship with traditional computerized neurocognitive testing (CNT) domains. METHODS We employed a cross-sectional study among 14 concussed (15.9 ± 9.8 days post-concussion, mean ± SD) individuals and 14 healthy controls matched for age, sex, and driving experience. Participants completed a driving simulator and CNT (CNS Vital Signs) assessment within 48 h of symptom resolution. A driving-RT composite (ms) was derived from 3 simulated driving scenarios: stoplight (green to yellow), evasion (avoiding approaching vehicle), and pedestrian (person running in front of vehicle). The CNT domains included verbal and visual memory; CNT-RT (simple-, complex-, Stroop-RT individually); simple and complex attention; motor, psychomotor, and processing speed; executive function; and cognitive flexibility. Independent t tests and Hedge d effect sizes assessed driving-RT differences between groups, Pearson correlations (r) examined driving RT and CNT domain relationships among cohorts separately, and p values were controlled for false discovery rate via Benjamini-Hochberg procedures (α = 0.05). RESULTS Concussed participants demonstrated slower driving-RT composite scores than controls (mean difference = 292.86 ms; 95% confidence interval (95%CI): 70.18-515.54; p = 0.023; d = 0.992). Evasion-RT (p = 0.054; d = 0.806), pedestrian-RT (p = 0.258; d = 0.312), and stoplight-RT (p = 0.292; d = 0.585) outcomes were not statistically significant after false-discovery rate corrections but demonstrated medium to large effect sizes for concussed deficits. Among concussed individuals, driving-RT outcomes did not significantly correlate with CNT domains (r-range: -0.51 to 0.55; p > 0.05). No correlations existed between driving-RT outcomes and CNT domains among control participants either (r-range: -0.52 to 0.72; p > 0.05). CONCLUSION Slowed driving-RT composite scores and large effect sizes among concussed individuals when asymptomatic signify lingering impairment and raise driving-safety concerns. Driving-RT and CNT-RT measures correlated moderately but not statistically, which indicates that CNT-RT is not an optimal surrogate for driving RT.
Collapse
Affiliation(s)
- Landon B Lempke
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA 30602, USA
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA 30602, USA
| | - Nicole L Hoffman
- School of Kinesiology and Recreation, Illinois State University, Normal, IL 61790, USA
| | - Hannes Devos
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA 30602, USA.
| |
Collapse
|
8
|
Brown WD, Baird J, Kriz PK. A Battery of Easily Accessible, Simple Tools for the Assessment of Concussion in Children. J Pediatr 2021; 229:232-239.e1. [PMID: 33068568 DOI: 10.1016/j.jpeds.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether a non-proprietary, novel testing battery can identify recently concussed children within 8 weeks of injury. STUDY DESIGN In total, 568 clinic outpatients aged 10-18 years were sorted into 3 groups: 316 had never been concussed, 162 had ever been concussed before 8 weeks earlier, and 90 had been recently concussed within 8 weeks. At initial and any subsequent visits, a neurologic examination and 4 procedures were performed: Stick Drop, Wall Ball, Sharpened Modified Romberg (SMR), and Animal Naming. Analysis included inter-group and intra-person performance differences using a series of t tests on the Stick Drop, Wall Ball, SMR, and Animal Naming. RESULTS The recently concussed group performed worse (P < .01 for all) on Stick Drop, total Wall Ball bounces and drops, and SMR compared with never-concussed and ever-concussed groups. This effect for Stick Drop, SMR, and Wall Ball but not Animal Naming persisted beyond the 4 weeks commonly stated to define recovery. Of 59 recently concussed subjects who returned for ≥1 visit, there were improvements in Stick Drop average (P = .004) and maxima (P = .02) as well as SMR (P = .01) but not Animal Naming between initial and subsequent visits. CONCLUSIONS This novel, rapid testing battery distinguished groups of children ages 10-18 years who had and had not experienced a recent concussion. A view that physical concussion symptoms resolve within a month of injury may be incomplete. Deployment of this readily available, inexpensive and non-proprietary battery should be compared with other tools and studied further in serial assessments.
Collapse
Affiliation(s)
- William D Brown
- Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, RI; Department of Neurology, Hasbro Children's Hospital/Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, RI.
| | - Janette Baird
- Department of Emergency Medicine, Hasbro Children's Hospital/Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, RI
| | - Peter K Kriz
- Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, RI; Department of Orthopedics, Hasbro Children's Hospital/Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, RI
| |
Collapse
|
9
|
Sensitivity and Specificity of Computer-Based Neurocognitive Tests in Sport-Related Concussion: Findings from the NCAA-DoD CARE Consortium. Sports Med 2020; 51:351-365. [PMID: 33315231 DOI: 10.1007/s40279-020-01393-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND To optimally care for concussed individuals, a multi-dimensional approach is critical and a key component of this assessment in the athletic environment is computer-based neurocognitive testing. However, there continues to be concerns about the reliability and validity of these testing tools. The purpose of this study was to determine the sensitivity and specificity of three common computer-based neurocognitive tests (Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT], CNS Vital Signs, and CogState Computerized Assessment Tool [CCAT]), to provide guidance on their clinical utility. METHODS This study analyzed assessments from a cohort of collegiate athletes and non-varsity cadets from the NCAA-DoD CARE Consortium. The data were collected from 2014-2018. Study participants were divided into two testing groups [concussed, n = 1414 (baseline/24-48 h) and healthy, n = 8305 (baseline/baseline)]. For each test type, change scores were calculated for the components of interest. Then, the Normative Change method, which used normative data published in a similar cohort, and the Reliable Change Index (RCI) method were used to determine if the change scores were significant. RESULTS Using the Normative Change method, ImPACT performed best with an 87.5%-confidence interval and 1 number of components failed (NCF; sensitivity = 0.583, specificity = 0.625, F1 = 0.308). CNS Vital Signs performed best with a 90%-confidence interval and 1 NCF (sensitivity = 0.587, specificity = 0.532, F1 = 0.314). CCAT performed best when using a 75%-confidence interval and 2 NCF (sensitivity = 0.513, specificity = 0.715, F1 = 0.290). When using the RCI method, ImPACT performed best with an 87.5%-confidence interval and 1 NCF (sensitivity = 0.626, specificity = 0.559, F1 = 0.297). CONCLUSION When considering all three computer-based neurocognitive tests, the overall low sensitivity and specificity results provide additional evidence for the use of a multi-dimensional assessment for concussion diagnosis, including symptom evaluation, postural control assessment, neuropsychological status, and other functional assessments.
Collapse
|
10
|
Goh SC, Saw AE, Kountouris A, Orchard JW, Saw R. Neurocognitive changes associated with concussion in elite cricket players are distinct from changes due to post-match with no head impact. J Sci Med Sport 2020; 24:420-424. [PMID: 33160856 DOI: 10.1016/j.jsams.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Determine intra-individual changes in CogSport performance in elite cricket players diagnosed with concussion, and differentiate this from changes which may be attributed to post-match with no head impact. DESIGN Retrospective observational study of elite Australian male and female cricket players with diagnosed concussion and prospective cohort study of cricket players with no head impact post-match. METHODS CogSport performance relative to an individual's baseline was compared between 46 cricket players diagnosed with concussion following a head impact sustained during a match, and 84 cricket players who played a match during which they had no head impact. RESULTS CogSport performance post-match for players diagnosed with concussion was slower for detection speed (p < 0.001), identification speed (p = 0.007), and one back speed (p = 0.011). No changes in one card learning speed or any accuracy measures were observed. CogSport performance post-match with no head impact was faster but less accurate for one card learning (both p < 0.001). No changes in the other three test components were observed. CONCLUSIONS Slower performance in three of four CogSport tasks (detection, identification, one back) may be indicative of concussion, as these intra-individual changes were not observed in players post-match with no head impact. The fourth task, one card learning, may not be a useful indicator of concussion as it was not observed to change with concussion yet was susceptible to change post-match with no head impact. CogSport may have clinical utility in assisting the clinical diagnosis of concussion in elite male and female cricket players.
Collapse
Affiliation(s)
- Sherwin C Goh
- Brisbane Sports and Exercise Medicine Specialists, Australia.
| | | | | | | | | |
Collapse
|
11
|
Lempke LB, Johnson RS, Schmidt JD, Lynall RC. Clinical versus Functional Reaction Time: Implications for Postconcussion Management. Med Sci Sports Exerc 2020; 52:1650-1657. [PMID: 32053547 DOI: 10.1249/mss.0000000000002300] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE This study aimed to examine the association between clinical and functional reaction time (RT) assessments with and without simultaneous cognitive tasks among healthy individuals. METHODS Participants (n = 41, 49% female; 22.5 ± 2.1 yr; 172.5 ± 11.9 cm; 71.0 ± 13.7 kg) completed clinical (drop stick, Stroop) and functional (gait, jump landing, single-leg hop, anticipated cut, unanticipated cut) RT assessments in random order. All RT assessments, except Stroop and unanticipated cut, were completed under single- (movement only) and dual-task conditions (movement and subtracting by 6s or 7s). Drop stick involved catching a randomly dropped rod embedded in a weighted disk. Stroop assessed RT via computerized neurocognitive testing. An instrumented walkway measured gait RT when center-of-pressure moved after random stimulus. All other functional RT assessments involved participants jumping forward and performing a vertical jump (jump landing), balancing on one leg (single-leg hop), or a 45° cut in a known (anticipated cut) or unknown (unanticipated cut) direction. RT was determined when the sacrum moved following random visual stimulus. Pearson correlation coefficients and a 5 × 2 repeated-measures ANOVA compared RT assessments and cognitive conditions. RESULTS Stroop RT outcomes did not significantly correlate with functional RT assessments (r range = -0.10 to 0.24). A significant assessment by cognitive task interaction (F4,160 = 14.01; P < 0.001) revealed faster single-task RT among all assessments compared with dual-task (mean differences, -0.11 to -0.09 s; P < 0.001), except drop stick (P = 0.195). Single-leg hop (0.58 ± 0.11 s) was significantly slower compared with jump landing (0.53 ± 0.10 s), anticipated cut (0.49 ± 0.09 s), gait (0.29 ± 0.07 s), and drop stick (0.21 ± 0.03 s; P values ≤ 0.001). Dual-task assessments were significantly slower than single-task assessments (mean difference, 0.08 s; P < 0.001). CONCLUSIONS Clinical and functional RT assessments were not correlated with each other, suggesting that sport-like RT is not being assessed after concussion. Functional and dual-task RT assessments may add clinical value and warrant further exploration after concussion.
Collapse
Affiliation(s)
- Landon B Lempke
- UGA Biomechanics Laboratory and UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA
| | | | | | | |
Collapse
|
12
|
WALTON SAMUELR, BROSHEK DONNAK, FREEMAN JASONR, CULLUM CMUNRO, RESCH JACOBE. Valid but Invalid: Suboptimal ImPACT Baseline Performance in University Athletes. Med Sci Sports Exerc 2018; 50:1377-1384. [PMID: 29485429 DOI: 10.1249/mss.0000000000001592] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to investigate the frequency of valid yet suboptimal Immediate Postconcussion Assessment and Cognitive Test (ImPACT) performance in university athletes and to explore the benefit of subsequent ImPACT administrations. METHODS This descriptive laboratory study involved baseline administration of ImPACT to 769 university athletes per the institution's concussion management protocol. Testing was proctored in groups of ≤2 participants. Participants who scored below the 16th percentile according to ImPACT normative data were readministered the ImPACT test up to two additional times because these scores were thought to be potentially indicative of suboptimal effort or poor understanding of instructions. Descriptive analyses were used to examine validity indicators and individual Verbal and Visual Memory, Visual Motor Speed, and Reaction Time ImPACT composite scores in initial and subsequent administrations. RESULTS On the basis of ImPACT's validity criteria, 1% (9/769) of administrations were invalid and 14.6% (112/769) had one or more composite score of <16th percentile but were considered valid. After one readministration, 71.4% (80/112) achieved scores of ≥16th percentile and an additional 18 of 32 scored ≥16th percentile after a third administration. Verbal Memory was most commonly <16th percentile on the first administration (43%), Verbal Memory and Visual Motor Speed on the second administration (44% each), and Visual Motor Speed alone on the third administration (50%). CONCLUSIONS Approximately 16% of ImPACT records were flagged as invalid or had one or more composite scores of <16th percentile, potentially indicative of suboptimal performance. Upon readministration, 88% of those participants scored >16th percentile. Clinicians must be aware of suboptimal ImPACT performance as it limits the clinical utility of the baseline assessment. Further research is needed to address factors leading to "valid" but invalid baseline performance.
Collapse
|
13
|
Abstract
Sport concussion (SC) has emerged as a major health concern in the medical community and general public owing to increased research and media attention, which has primarily focused on male athletes. Female athletes have an equal, if not increased, susceptibility to SC. An ever-growing body of research continues to compare male and female athletes in terms of SC before and after an injury. Clinicians must be cognizant of this literature to make evidence-based clinical decision when providing care to female athletes and discern between dated and/or unsupported claims in terms of SC.
Collapse
Affiliation(s)
- Jacob E Resch
- Department of Kinesiology, University of Virginia, 210 Emmet Street South, Charlottesville, VA 22904, USA.
| | - Amanda Rach
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, 1300 Jefferson Park Avenue, Charlottesville, VA 22908, USA
| | - Samuel Walton
- Department of Kinesiology, University of Virginia, 210 Emmet Street South, Charlottesville, VA 22904, USA
| | - Donna K Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, 1300 Jefferson Park Avenue, Charlottesville, VA 22908, USA
| |
Collapse
|
14
|
Resch JE, Schneider MW, Munro Cullum C. The test-retest reliability of three computerized neurocognitive tests used in the assessment of sport concussion. Int J Psychophysiol 2017; 132:31-38. [PMID: 28935224 DOI: 10.1016/j.ijpsycho.2017.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 09/06/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
Computerized neurocognitive tests (CNTs) are widely used at all competitive levels of sport to assess sport concussion (SC). Whereas there are multiple CNTs available, little is known about how some of the most popular platforms compare. The purpose of this study was to investigate the test-retest reliability of the Automated Neuropsychological Assessment Metrics (ANAM), Concussion Vital Signs (CVS) and the Immediate Postconcussion and Cognitive Testing battery (ImPACT) using clinically relevant time points in healthy college-age participants. Participants were healthy college-age students (N=128) randomly assigned into one of three groups which were administered ANAM, CVS, or ImPACT at Days 1, 45 and 50. Intraclass correlation coefficients (ICCs) and Pearson correlations were used to assess reliability of the various CNT scores and subtest scores between time points. Participants were tested approximately 47.1±2.75days after time point 1 and approximately 7.0±2.45days after time point 2. ICC values ranged from 0.18 (Procedural Reaction Time) to 0.53 (Mathematical Processing and Simple Reaction Time 1) for ANAM, 0.14 (Continuous Performance Test) to 0.85 (Reaction Time) for CVS, and 0.19 (Verbal Memory) to 0.89 (Visual Motor Speed) for ImPACT. Significant improvements (p<0.05) across time were observed for (7/10) CNS Vital Signs composite scores, but no additional significant changes in performance were observed for the remaining CNTs. Overall, weak to strong reliability coefficients for ANAM, CVS, and ImPACT were observed when using clinically relevant time points of repeated administration.
Collapse
Affiliation(s)
- Jacob E Resch
- The University of Virginia, 210 Emmet St. S, Memorial Gymnasium, Charlottesville, VA 22932, United States.
| | - Mathew W Schneider
- The University of Texas at Arlington, 500 S. Nedderman Dr., Arlington, TX 7601, United States
| | - C Munro Cullum
- The University of Texas Southwestern Medical Center, 6333 Forest Park Rd, 1st Floor, BLA100, Dallas, TX 75235, United States.
| |
Collapse
|
15
|
Abstract
Neuropsychological assessment is a key component of the multidimensional approach recommended by international consensus guidelines for evaluation of athletes affected by sport-related concussion (SRC). Over the past 2 decades, a number of conventional and computerized neuropsychological test batteries have been developed for the assessment of SRC. Standardized neurocognitive assessment tools are now commonly used across the continuum of concussion care, ranging from the sports sideline to critical care setting and the outpatient concussion clinic. We provide a brief, high-level overview of current approaches to best practice in neuropsychological assessment of SRC.
Collapse
Affiliation(s)
- Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Breton Asken
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Room 3151, Gainesville, FL 32611, USA
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| |
Collapse
|
16
|
Provance AJ, Engelman GH, Terhune EB, Coel RA. Management of Sport-Related Concussion in the Pediatric and Adolescent Population. Orthopedics 2016; 39:24-30. [PMID: 26709563 DOI: 10.3928/01477447-20151218-13] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 11/25/2014] [Indexed: 02/03/2023]
Abstract
Concussions make up nearly 10% of all high school athletic injuries. Recent changes in concussion management guidelines and legislation aim to make concussion care more standardized and safe but simultaneously pose a challenge for the primary care and sports medicine physician. Pediatric and adolescent concussions may cause anxiety for the treating physician due to concerns over return-to-play decisions, academic issues, and the potential for second impact syndrome. Determining when to refer a patient to an emergency department acutely, to an outpatient concussion clinic, or to other subspecialists may be a difficult decision for the primary care physician. The aim of this article is to review current evidence regarding concussion treatment and return-to-school and return-to-play recommendations to provide the primary care and sports medicine physician with practical guidelines for managing concussions.
Collapse
|
17
|
Haran FJ, Dretsch MN, Bleiberg J. Performance on the Defense Automated Neurobehavioral Assessment across controlled environmental conditions. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 23:411-7. [PMID: 27182844 DOI: 10.1080/23279095.2016.1166111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Neurocognitive assessment tools (NCAT) are commonly used to screen for changes in cognitive functioning following a mild traumatic brain injury and to assist with a return to duty decision. As such, it is critical to determine if performance on the Defense Automated Neurobehavioral Assessment (DANA) is adversely affected by operationally-relevant field environments. Differences in DANA performance between a thermoneutral environment and three simulated operationally-relevant field environments across the thermal stress continuum were calculated for 16 healthy U.S. Navy service members. Practice effects associated with brief test-retest intervals were calculated within each environmental condition. There were no significant differences between the simulated environmental conditions suggesting that performance on the DANA Brief is not impacted by thermal stress. Additionally, there were no significant differences in performance within each simulated environmental condition associated with repeated administrations.
Collapse
Affiliation(s)
- F Jay Haran
- a Naval Submarine Medical Research Laboratory (NSMRL) , Groton , CT , USA
| | - Michael N Dretsch
- b Warfighter Health Division, U.S. Army Aeromedical Research Laboratory , Fort Rucker , AL , USA
| | - Joseph Bleiberg
- c Walter Reed National Military Medical Center (WRNMMC) , Bethesda , MD , USA
| |
Collapse
|
18
|
Sullivan EV, Brumback T, Tapert SF, Fama R, Prouty D, Brown SA, Cummins K, Thompson WK, Colrain IM, Baker FC, De Bellis MD, Hooper SR, Clark DB, Chung T, Nagel BJ, Nichols BN, Rohlfing T, Chu W, Pohl KM, Pfefferbaum A. Cognitive, emotion control, and motor performance of adolescents in the NCANDA study: Contributions from alcohol consumption, age, sex, ethnicity, and family history of addiction. Neuropsychology 2016; 30:449-73. [PMID: 26752122 DOI: 10.1037/neu0000259] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate development of cognitive and motor functions in healthy adolescents and to explore whether hazardous drinking affects the normal developmental course of those functions. METHOD Participants were 831 adolescents recruited across 5 United States sites of the National Consortium on Alcohol and NeuroDevelopment in Adolescence 692 met criteria for no/low alcohol exposure, and 139 exceeded drinking thresholds. Cross-sectional, baseline data were collected with computerized and traditional neuropsychological tests assessing 8 functional domains expressed as composite scores. General additive modeling evaluated factors potentially modulating performance (age, sex, ethnicity, socioeconomic status, and pubertal developmental stage). RESULTS Older no/low-drinking participants achieved better scores than younger ones on 5 accuracy composites (general ability, abstraction, attention, emotion, and balance). Speeded responses for attention, motor speed, and general ability were sensitive to age and pubertal development. The exceeds-threshold group (accounting for age, sex, and other demographic factors) performed significantly below the no/low-drinking group on balance accuracy and on general ability, attention, episodic memory, emotion, and motor speed scores and showed evidence for faster speed at the expense of accuracy. Delay Discounting performance was consistent with poor impulse control in the younger no/low drinkers and in exceeds-threshold drinkers regardless of age. CONCLUSIONS Higher achievement with older age and pubertal stage in general ability, abstraction, attention, emotion, and balance suggests continued functional development through adolescence, possibly supported by concurrently maturing frontal, limbic, and cerebellar brain systems. Determination of whether low scores by the exceeds-threshold group resulted from drinking or from other preexisting factors requires longitudinal study. (PsycINFO Database Record
Collapse
Affiliation(s)
- Edith V Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Ty Brumback
- Department of Psychiatry, University of California, San Diego
| | - Susan F Tapert
- Psychology Service, Veterans Affairs San Diego Healthcare System
| | - Rosemary Fama
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | | | - Sandra A Brown
- Department of Psychiatry, University of California, San Diego
| | - Kevin Cummins
- Department of Psychiatry, University of California, San Diego
| | | | | | | | - Michael D De Bellis
- Healthy Childhood Brain Development Research Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Stephen R Hooper
- Department of Allied Health Sciences, University of North Carolina School of Medicine
| | | | - Tammy Chung
- Department of Psychiatry, University of Pittsburgh
| | - Bonnie J Nagel
- Departments of Psychiatry and Behavioral Neuroscience, Oregon Health and Sciences University
| | - B Nolan Nichols
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | | | | | - Kilian M Pohl
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Adolf Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| |
Collapse
|
19
|
Prospective, Head-to-Head Study of Three Computerized Neurocognitive Assessment Tools (CNTs): Reliability and Validity for the Assessment of Sport-Related Concussion. J Int Neuropsychol Soc 2016; 22:24-37. [PMID: 26714883 PMCID: PMC4882608 DOI: 10.1017/s1355617715001101] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Limited data exist comparing the performance of computerized neurocognitive tests (CNTs) for assessing sport-related concussion. We evaluated the reliability and validity of three CNTs-ANAM, Axon Sports/Cogstate Sport, and ImPACT-in a common sample. High school and collegiate athletes completed two CNTs each at baseline. Concussed (n=165) and matched non-injured control (n=166) subjects repeated testing within 24 hr and at 8, 15, and 45 days post-injury. Roughly a quarter of each CNT's indices had stability coefficients (M=198 day interval) over .70. Group differences in performance were mostly moderate to large at 24 hr and small by day 8. The sensitivity of reliable change indices (RCIs) was best at 24 hr (67.8%, 60.3%, and 47.6% with one or more significant RCIs for ImPACT, Axon, and ANAM, respectively) but diminished to near the false positive rates thereafter. Across time, the CNTs' sensitivities were highest in those athletes who became asymptomatic within 1 day before neurocognitive testing but was similar to the tests' false positive rates when including athletes who became asymptomatic several days earlier. Test-retest reliability was similar among these three CNTs and below optimal standards for clinical use on many subtests. Analyses of group effect sizes, discrimination, and sensitivity and specificity suggested that the CNTs may add incrementally (beyond symptom scores) to the identification of clinical impairment within 24 hr of injury or within a short time period after symptom resolution but do not add significant value over symptom assessment later. The rapid clinical recovery course from concussion and modest stability probably jointly contribute to limited signal detection capabilities of neurocognitive tests outside a brief post-injury window. (JINS, 2016, 22, 24-37).
Collapse
|
20
|
Nelson LD, Pfaller AY, Rein LE, McCrea MA. Rates and Predictors of Invalid Baseline Test Performance in High School and Collegiate Athletes for 3 Computerized Neurocognitive Tests: ANAM, Axon Sports, and ImPACT. Am J Sports Med 2015; 43:2018-26. [PMID: 26059178 PMCID: PMC4747101 DOI: 10.1177/0363546515587714] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Preseason baseline testing using computerized neurocognitive tests (CNTs) is increasingly performed on athletes. Adequate effort is critical to establish valid estimates of ability, but many users do not evaluate performance validity, and the conditions that affect validity are not well understood across the available CNTs. PURPOSE To examine the rates and predictors of invalid baseline performance for 3 popular CNTs: Automated Neuropsychological Assessment Metrics (ANAM), Axon Sports, and Immediate Post-Concussion and Cognitive Testing (ImPACT). STUDY DESIGN Controlled laboratory study. METHODS High school and collegiate athletes (N = 2063) completed 2 of 3 CNTs each during preseason evaluations. All possible pairings were present across the sample, and the order of administration was randomized. Examiners provided 1-on-1, scripted pretest instructions, emphasizing the importance of good effort. Profile validity was determined by the manufacturers' standard criteria. RESULTS The overall percentage of tests flagged as of questionable validity was lowest for ImPACT (2.7%) and higher for ANAM and Axon (10.7% and 11.3%, respectively). The majority of invalid baseline profiles were flagged as such because of failure on only 1 validity criterion. Several athlete and testing factors (eg, attention deficit hyperactivity disorder [ADHD], estimated general intellectual ability, administration order) predicted validity status for 1 or more CNTs. Considering only first CNT administrations and participants without ADHD and/or a learning disability (n = 1835) brought the rates of invalid baseline performances to 2.1%, 8.8%, and 7.0% for ImPACT, ANAM, and Axon, respectively. Invalid profiles on the Medical Symptom Validity Test (MSVT) were rare (1.8% of participants) and demonstrated poor correspondence to CNT validity outcomes. CONCLUSION The validity criteria for these CNTs may not identify the same causes of invalidity or be equally sensitive to effort. The validity indicators may not be equally appropriate for some athletes (eg, those with neurodevelopmental disorders). CLINICAL RELEVANCE The data suggest that athletes do not put forth widespread low effort or that some validity criteria are more sensitive to invalid performance than others. It is important for examiners to be aware of the conditions that maximize the quality of baseline assessments and to understand what sources of invalid performance are captured by the validity criteria that they obtain.
Collapse
Affiliation(s)
- Lindsay D. Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Adam Y. Pfaller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Lisa E. Rein
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|